The current state of empathy research.

The literature on empathy, primarily from counseling and psychotherapy and secondarily from social and developmental psychology, is reviewed. Obstacles that may account for theoretical confusions and empirical difficulties in studying empathy are highlighted. The decrease in empathy research in recent years appears attributable to the lack of clear focus and effective research tools as well as the shift in interest from empathy to other concepts such as the working alliance. It is argued that there is a need to return to studying empathy. Researchers should distinguish between dispositional and experiential empathy and between intellectual empathy and empathic emotions and indicate whether they are examining therapist or client experience of empathy. Suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy and the working alliance: The mistranslation of Freud's Einfühlung.

Suggests that the working alliance has emerged as an important theoretical construct in both psychotherapeutic practice and research. A great deal of attention has been paid to the therapist's contributions to the working alliance, with empathy posited as a necessary condition for a strong attachment between patient and therapist. Although Freud has been recognized for laying the theoretical groundwork for what is called the working alliance, he has generally not been credited with making an association between empathy and the therapeutic relationship. It is demonstrated that in 1913, Freud did posit empathy (Einfühlung) as a necessary condition for the therapeutic relationship, and that this has been overlooked by English-speaking readers due to a translation error. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of therapist self-disclosure on patients' perceptions of empathy, competence and trust in an analogue psychotherapeutic interaction.

Psychodynamically oriented clinicians uniformly contraindicate the use of therapist self-disclosure, whereas practitioners disposed toward a humanistic-existential perspective often regard this practice as an essential condition of treatment. In the present study, 57 psychotherapy patients (aged 18–55 yrs) read 1 of 3 patient–therapist dialogs in which the degree of therapist self-disclosure was high, low, or nil. Ss completed the Relationship Inventory and Sorenson Relationship Questionnaire to measure perceived therapist empathy, competence, and trust. Findings confirm the prediction that greater therapist self-disclosure would be related to poorer evaluations of the therapist. Results question the use of self-disclosure as a psychotherapeutic technique and suggest that self-disclosure may adversely affect the perceptions on which the therapeutic alliance is based. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Alliance-Building Behavior Within a Cognitive-Behavioral Treatment for Anxiety in Youth.

Explored the specific behavior of therapists contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive-behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. "Collaboration" positively predicted early child ratings of alliance, and "finding common ground" and "pushing the child to talk" negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, "collaboration" and "not being overly formal" positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated. Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child-therapist alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance: Its place as a process and outcome variable in dynamic psychotherapy research.

Argues that conceptual unclarity has surrounded psychotherapy research efforts to define and measure the therapeutic alliance. A precisely defined conception of the therapeutic alliance is offered that focuses on the patient's active collaboration in the tasks appropriate to the treatment process. The therapeutic alliance is thus distinguished from patient characteristics and attitudes as well as from therapist contributions to the formation of the alliance. The importance of the therapeutic alliance as a change measure in process research is underscored, and its place as a primary indicator of outcome is described. Empirical studies are reviewed, with particular reference to the Menninger Treatment Interventions Project, and the use of single-case methodology is considered. The special relevance of the therapeutic alliance to the investigation of the therapeutic change process with borderline patients is outlined. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist multicultural competency: A study of therapy dyads.

[Correction Notice: An erratum for this article was reported in Vol 44(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-04278-014). The fifth author's name should be spelled as follows: Alexa Mislowack.] This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A sociological perspective on the therapeutic alliance: Ethnomethodology and conversation analysis.

Traditional perspectives consider the therapeutic alliance as tied to specific goals of positive patient change. Psychometric studies suggest that the therapeutic alliance is better conceptualized as linked to aspects of the patient–therapist dyad independent from therapeutic goals. A framework to capture the relational identity of the alliance, proposed by E. Bordin (see record 94-105022-001), centers on patient–therapist collaboration. Ethnomethodology, a sociological research paradigm, suggests that "collaboration" in psychotherapy consists of methods that establish an impression of common sense between patient and therapist. These methods involve verbal and para-verbal cues, often subtle and implicit, that compose a subtext to the more explicit dialogue about therapeutic goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder.

This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SFT or TFP. Scores of both therapists and patients for the therapeutic alliance were higher in SFT than in TFP. Negative ratings of therapists and patients at early treatment were predictive of dropout, whereas increasingly positive ratings of patients in the 1st half of treatment predicted subsequent clinical improvement. Dissimilarity between therapist and patients in pathological personality characteristics had a direct effect on growth of the therapeutic alliance but showed no relationship with clinical improvement. The authors conclude that the therapeutic alliance and specific techniques interact with and influence one another and may serve to facilitate change processes underlying clinical improvement in patients with borderline personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of the development of the working alliance using hierarchical linear modeling.

The relation between the working alliance and therapeutic outcome was examined in 21 therapist–client dyads. This relation was analyzed in terms of the level of alliance at the 3rd counseling session, midpoint of treatment, and last session with linear and curvilinear models of the temporal development of the working alliance. Analyses were conducted with hierarchical linear modeling. Results revealed a significant association between the linear growth function on therapist ratings of the working alliance and therapeutic outcome. The use of hierarchical linear modeling in counseling psychology research and the need for conceptualizing the working alliance as a temporally variant as opposed to a static process are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression.

This study attempted to replicate an earlier study (R. J. DeRubeis & M. Feeley, 1990) of the prediction of symptom change from process variables in cognitive therapy for depressed outpatients. Measures of in-session therapist behavior and therapist–patient interactions were correlated with prior and subsequent symptom change. One of the positive findings was confirmed, but the other received only marginal support. A "concrete" subset of theory-specified therapist actions, measured early in treatment, predicted subsequent change in depression. The therapeutic alliance was predicted by prior symptom change in 1 of the 2 later assessments, but only at a trend level. Several negative findings were similar to those obtained in the earlier study. Specifically, the alliance, an "abstract" subset of theory-specified therapist actions, and facilitative conditions did not predict subsequent change. Implications for causal inferences in psychotherapy process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Person-centred counselling: An experiential approach.

Reviews the book, Person-centered counselling: An experiential approach by David Rennie (1998). In this book, David Rennie gives priority to the working alliance between counsellor and client, and he outlines various ways in which that alliance can be enhanced. This work began as a training guide, which was eventually expanded to include reflections on the way others have approached central issues in the counselling experience. Rennie draws on a range of theorists such as Carl Rogers and Eugene Gendlen, and makes clear his agreements and disagreements with their positions. In some preliminary chapters, Rennie addresses general issues in counselling before embarking on ideas about counselling itself. He emphasizes, in the Rogerian tradition, the importance of empathy for what clients are feeling as they enter the somewhat unusual context of counselling. The remaining chapters are devoted to the therapeutic craft, including such topics as how to listen to clients, the counsellor's reactions to the client's account of his or her experience, openness and transparency in the relationship with the client, identifying process issues, metacommunication, and the working alliance. This book is a refreshing alternative for practitioners and for students students learning the art of therapeutic intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Therapist Multicultural Competency: A Study of Therapy Dyads": Correction.

Reports an error in "Therapist Multicultural Competency: A Study of Therapy Dyads" by Jairo N. Fuertes, Thomas I. Stracuzzi, Jennifer Bennett, Jennifer Scheinholtz, A. Mislowack, Mindy Hersh and David Cheng (Psychotherapy: Theory, Research, Practice, Training, 2006[Win], Vol 43[4], 480-490). The fifth author's name should be spelled as follows: Alexa Mislowack. (The following abstract of the original article appeared in record 2006-23019-010.) This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrative cognitive therapy for depression: A randomized pilot comparison.

This pilot study examined the efficacy of an integrative form of cognitive therapy (ICT) for depression that incorporates specific strategies for addressing alliance ruptures. Although a previous study on depression found that ICT was superior to a wait-list condition (L. G. Castonguay et al., 2004), the current study provides the 1st direct comparison between ICT and traditional cognitive therapy (CT). Twenty-two depressed adults were randomly assigned to ICT or CT (11 patients per condition), which were delivered by clinicians in training. Outcome was assessed with a specific depression measure and a global symptomatology measure. The groups were also compared on patient-perceived alliance quality and therapist empathy. Effect size estimates revealed that ICT patients evidenced greater posttreatment improvement on both outcome measures (with small to medium effects) and more clinically significant change than did CT patients. ICT patients also had higher alliance and empathy scores across treatment (with medium to large effects). The findings, albeit very preliminary, support the potential viability of ICT and the potential causal influence of the rupture-repair interventions on treatment process and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy and imagery in avoidance behavior reduction.

This therapy analog study was designed to assess the relative effects of therapist empathy and instructed imagination of hierarchy scenes on avoidance behavior reduction. Ss were 30 undergraduate females who indicated "much fear," "very much fear," or "terror" on Item 39 (snakes) during a classroom-administered Fear Survey Schedule II, and who were unable to touch a live snake. After a 45-min treatment session involving (a) mechanical imagery, (b) empathetic imagery, or (c) empathetic conversation, each S completed ratings that included the 16 empathetic understanding items from the Barrett-Lennard Relationship Inventory. Although the communication of differential therapist empathy was validated, behavior change attributable to therapist empathy was minor in comparison to the effects of imagery instructions. Imagery instructions delivered in a relatively unempathetic fashion produced as much avoidance reduction as imagery instructions delivered in an empathetic manner. Unempathetic imagery instructions also produced significantly greater avoidance reduction than the establishment of an empathetic relationship without instructed imagery exercises. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome.

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist × Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in adolescent substance abuse treatment: A one-with-many analysis.

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolescents treated for substance abuse by 14 therapists. Both the client and therapist alliance ratings yielded large relationship variances, with limited consensus among clients treated by the same therapist about the quality of the alliance. If a client reported an especially strong alliance with his or her therapist, the therapist was likely to also report an especially strong alliance with that client (dyadic reciprocity). The association between the components of the alliance and treatment outcome was complicated, with different levels of measurement and different components of the alliance (perceiver, partner, or relationship) derived from different informants (therapist or client) relating to different outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

How clients perceive therapist empathy: A content analysis of "received" empathy.

Examined the structure and phenomenology of 52 undergraduates' perceptions of empathy. Ss, 27 of which were in therapy, completed self-reports on situations in which a therapist (if they had received counseling) or someone else had demonstrated empathy toward them. Analysis of Ss' self-reports revealed 4 types of client-perceived empathy: therapist (facilitative), therapist affective, therapist sharing, and therapist nurturant empathy. Findings suggest that empathy is not a global, unidimensional concept. Results are discussed in terms of previous studies, which have concentrated mainly on the therapist's and not the client's experience of therapy. The therapeutic efficacy and measurement of received empathy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Providing outpatient services to criminal procedure law patients: the clinician's perspective

This presentation identifies a number of the elements involved in implementing an effective program for the care and treatment of the Conditionally Released CPL Patient. The component parts to be explored include: societal and agency issues, the identified patient and, issues relating to the clinician and the clinical treatment team. The outpatient clinician fulfills numerous role/task functions. The roles of therapist, educator, teacher, advocate, casemanager, and "parole officer" will be discussed. Techniques for identifying and working through the worker's own "blocks" will be discussed as a prelude to establishing a therapeutic alliance. Principles of utilizing authority and contracts as basic therapeutic techniques will also be noted. Recognizing that the patients who comprise the conditionally released CPL 330 category are heterogeneous and multiply disabled, techniques for active focused rehabilitation treatment will be explored.