Expressing Empathy

The following is an excerpt from an assignment that examined empathy, the therapeutic relationship, and mirror neurons, the neural networks in our brains that are activated in response to observing human behavior. Research suggests that these networks are the building blocks of empathy and observational learning.

             Beginner therapists should also practice validation, a verbal intervention that demonstrates the therapist’s empathic understanding of the client’s thoughts or emotions (Linehan et al., 2002). In dialectical behavior therapy, validation is a central intervention that models acceptance of a client’s behavior within a specific context (Linehan et al., 2002). When this intervention is practiced, clients become attuned to their therapist’s comforting messages of acceptance (Linehan et al., 2002). Repeated exposure to these “small doses” of empathy can lead to improved connectedness, self-validation, and an expansion of the client’s identity (Bruce, Manber, Shapiro, & Constantino, 2010; Gallese, Eagle, & Migone, 2005). With this in mind, beginner clinicians should consider an important guiding phrase: When in doubt, validate.

            Reflection, or “[mirroring] a client’s words with one or two subtle changes” (Gallese, Eagle, & Migone, 2005), is a central therapeutic intervention developed by humanistic psychologist Carl Rogers. In an essay from 1986, Rogers describes how reflection is far more complicated and significant than the simple “reflection of feelings.” Instead, Rogers (1986) describes a deeply empathic process of “understanding… the client’s internal world” and accurately communicating “[how they are] experiencing it at this moment.” The subtle changes in Rogers’ reflections allowed him to check his perceptions and interpretations while remaining accepting and curious. One client described her work with Rogers as “sending rays toward [a] mirror” and having them “reflected and clarified” (Rogers, 1986). The client’s experience with Rogers lead to an “inner knowledge that was … more suited to the person [living within her]” (Rogers, 1986).

            Carl Rogers’ use of reflection accurately captures the connection between verbal validation and internal change. By allowing his clients to feel heard and understood, Rogers was sending a deep message of acceptance and curiosity across the social synapse. In her research, Fishbane (2007) describes the neurological effects of these types of messages. Within the context of an empathic therapeutic relationship, automatic, “low road” emotional reactions and conscious, “high road” emotional appraisals are integrated in a process of “limbic revision” (Fishbane, 2007). Through validation and reflection, neural pathways are built, strengthened, and changed (Fishbane, 2007). Fishbane (2007) also describes how verbal empathy builds emotional intelligence and teaches clients to “[become] a connoisseur of [their] internal experiences.”

 

            Beginner therapists should consider the importance of reflection and verbal empathy while working with clients. As a new clinician, it is easy to become overwhelmed by theories, interventions, and techniques. However, Rogers’ (1986) writings suggest that simple reflection is the greatest display of therapeutic empathy and curiosity. In many cases, it may be enough for a beginner therapist to sit comfortably, listen, and embrace the human curiosity that brought them into the field in the first place.

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References:

 

 

 

 

Bruce, N., Manber, R., Shapiro, S., & Constantino, M. (2010). Psychotherapist mindfulness and the psychotherapy process. Psychotherapy Research, Theory, Practice, Training 47, 83-97.

Fishbane, M. (2007). Wired to connect: Neuroscience, relationships, and therapy. Family Process 46(3), 395-412.

 

Gallese, V., Eagle, M., & Migone, P. (2005). Intentional attunement: mirror neurons and the neural underpinnings of interpersonal relationships. Journal of the American Psychoanalytic Association 55, 131-176.

Linehan, M., Dimeff, L., Reynolds, S., Comtois, K., Welch, S., Heagerty, P., & Kivlahan, D. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence 67, 13-26.

Rogers, C. (1986). Reflections of feelings. Person-Centered Review 1(4), 375-377.

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