Why I Need a Sexual Assault Reality Check

Last week I accidentally discovered a disturbing online video that sarcastically demeans the sexual assault awareness training we use at the University of Montana. It features a very creepy man. In my experience, it’s rare to see and hear someone who is CLEARLY misogynistic. I may be going out on a limb here, but it appears that a very creepy misogynistic man made this video.

Despite his creep factor (did I mention he was creepy?), he makes a point in the video that I’ve heard before. It goes something like this: During sexual encounters it’s the woman’s responsibility to say “No” in a way that is clear and explicit and unequivocal. If this message isn’t delivered and received, then the sexual encounter can or should continue.

Now, I’m all for women speaking up. That’s a good thing. But for me, the problem of this message is the assumption that because males are built to want and need sex, they’re basically unconcerned with how their partner is feeling and in the absence of a clear and unequivocal message, should simply proceed toward intercourse.

This assumption—that men don’t care how their partner is feeling—seems wrong to me. In my limited experience (myself, my friends, my clients), I’d conclude this: Although most men want sex, they also want their partner to want sex. Maybe I’m going out on another limb, but I think most men prefer their sexual partner to clearly and unequivocally say “Yes!” about having sex.

What I’m getting at is this: In the absence of a clear and unequivocal “Yes!” maybe men (and women) who want to have intercourse also have an obligation to COMMUNICATE. This communication could involve a verbal check in (e.g., “Are you okay?”) or some other creative means of determining whether consent is happening.

I know this idea is probably unrealistic. Some media messages imply that communication during sex is a turn off. Other media messages suggest that men could suffer from blue balls or that they’re not able to turn off their sexual drive once aroused. These are counter-arguments to a communication solution.  And if you throw a little alcohol or other drugs into the mix, the issue of clear consent becomes substantially less clear.

But I wonder if we might agree on one thing: Consent is a bigger turn-on than a verbal or nonverbal “maybe.”

And so to both my male readers, I’d love your answers to the following multiple-choice questions (and I’d love your feedback too, if you feel so inclined):

1.   Which of the following do you find to be the biggest turn-on?

a. When my sexual partner says no.

b, When my sexual partner says nothing,

c. When my sexual partner says maybe,

d. When my sexual partner clearly and repeatedly says “Yes!”

2.   Which sexual situation would you most prefer?

a. A woman who is drunk and only partially conscious says she wants to have sex with me.

b. A woman who is stoned out of her mind says she wants to have sex with me.

c. A woman who is clean and sober and wide awake says she wants to have sex with me.

Thanks for reading and you can let me know your thoughts via private email (johnsf44@gmail.com) or by posting on this blog.

 

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Mental Status Examination Video Clip

Historically, the mental status examination (MSE) has held a revered place in psychiatry and medicine. In recent years, professional competence in conducting MSEs has expanded to include all mental health professionals, especially those who work within medical settings.As an example of how MSE skills have become more cross-disciplinary, the latest accreditation standards for professional counselors require coverage of MSE concepts and skills within master’s level counseling programs (Council for Accreditation of Counseling and Related Educational Programs, 2009). Overall, the MSE offers physicians, psychologists, counselors, and social workers a unique method for evaluating the internal mental condition of patients or clients.

Very recently, our publisher, John Wiley and Sons, posted a clip from a training DVD we filmed on MSE skills. Check it out at: http://www.youtube.com/watch?v=1lu50uciF5Y

 

Guidelines for Violence Risk Assessment

Predicting violence is notoriously very difficult. Nevertheless, sometimes counselors, social workers, psychologists and psychiatrists are faced with situations where they need to make estimates or predictions of violence potential. The material below is a short preview from Clinical Interviewing, 5th edition. http://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1118270045/ref=dp_ob_title_bk

Research findings imply that therapists who hope to conduct accurate violence assessments should know actuarial violence prediction risk factors. However, as is often the case, scientific research doesn’t always parallel real-life situations faced by therapists. For example, while much of the actuarial violence research has been conducted on forensic or prison populations—with the designated outcome measure being violent recidivism—therapists typically face situations in schools, residential treatment centers, and private practice (Juhnke, Granello, & Granello, 2011). Consequently, although actuarial violence prediction risk factors may be helpful, they probably don’t generalize well to situations where a counselor is making a judgment about whether there’s duty to protect (and therefore warn) a shop teacher about a boy (who has never been incarcerated) who reports vivid images of slitting his shop teacher’s throat.

Given these limits, it’s best for us to call clinical interview-based assessments in school and agency settings violence assessment, rather than violence prediction. This distinction helps clarify the fact that what most clinicians do in general practice settings, including public and private schools, falls far short of scientific, actuarial-based violence prediction.

A Reasonable Approach to Violence Risk Assessment

Predicting violence is a challenging proposition. Despite the many shifting variables that change based on the specifics of any given situation and despite the low base rate, and therefore inherent unpredictability of violent behavior, this section provides general guidelines that may be helpful should you find yourself in a situation where violence assessment is necessary. Of course, in addition to this guide you should always pursue consultation and supervision support when working with potentially violent clients.

Table 12.2 includes a general guide to violence assessment. It doesn’t include common actuarial risk factors from two common instruments, the Violent Rate Appraisal Guide (Harris, Rice, & Quinsey, 1993) or the Psychopathy Checklist-Revised (Hare et al., 1990; Harpur, Hakstian, & Hare, 1988). If you find yourself intrigued with violence risk assessment you may want to explore a career in forensic psychology.

Table 12.2. A General Guide to Violence Assessment
The following checklist is offered as a general guide to conducting violence assessment. It should not be used as a substitute for actuarial prediction.
____1.  Ask direct and indirect questions about violent behavior history. Be especially alert to physical aggression and cruelty. If the violent behavior that’s being threatened is similar to a past violent behavior the risk of violence may be higher.

_____2. Because potentially violent individuals aren’t always honest about their violence history, you may need to ask collateral informants—someone other than the client—about the client’s history of violent behavior (assuming you have a release of information signed or have determined you have an ethical-legal responsibility to protect someone from harm).

____3.  You should listen for details that might help you identify potential victims. If the details are not forthcoming, you may need to ask specific questions in an effort to obtain those details. Identification of a specific victim increases violence risk (and provides you with information about whom you should warn).

____4. As clients talk about violent urges, you should listen for specifics about the plan. As needed, you may, through curious and indirect questioning, make efforts to further assess the specificity of the client’s violence plan. More specific plans are associated with increased violence risk.

____5. If clients don’t tell you about his or her access to a weapon or means for committing his or her planned violent act, you should ask. Similar to suicidal situations, access to lethal means increases violence risk.

____6. Historical information is doubly important. Generally speaking, the sooner violent behavior patterns began, the more likely they are to continue and clients raised in chaotic and violent environments (including gang involvement) are at higher risk for violence.

____7. Diagnostic information may be helpful. When looking at DSM diagnoses, the best violence predictors include items from list B** of the **DSM’s Antisocial Personality diagnostic criteria (see DSM-IV-TR**).

____8. Evaluate current cognitions. If clients have low expectations of being caught or of having consequences, risk may be higher.

____9. Consider substance use. Positive attitudes towards substance use and substance use when carrying weapons confer greater risk.

____10. Notice your intuition. Intuition isn’t a great predictor of anything, but if you have images of violence linked to a particular client, it’s reasonable to err on the conservative side and begin the process of warning potential victims.

**This information may change in the DSM-5

Musings About Online Counseling

As Rita and I updated the Clinical Interviewing text, we did a little web-searching for online counseling resources and the excerpt below includes our musings on this very interesting topic.

From Clinical Interviewing, 4th ed, updated, SF & SF, 2012

http://www.amazon.com/John-Sommers-Flanagan/e/B0030LK6NM/ref=ntt_dp_epwbk_1

Online Counseling: Ethics and Reality

As a part of reviewing information for this chapter, we perused Internet therapy options available to potential consumers. Previous publications suggested a possible plethora of Internet counseling and psychotherapy providers with questionable professional credentials (Heinlen, Welfel, Richmond, & O’Donnell, 2003; Shaw & Shaw, 2006). Although we hoped that Internet service provision standards had improved, we weren’t overly impressed with our results. Generally, we found that most providers may have more expertise in business and marketing than they do in professional clinical work. Affixed on this foundation of business and marketing, we found two distinct approaches: the more ethical and the less ethical.

The Less Ethical Approach

Many providers offer online services but don’t acknowledge having specific credentials (e.g., a license) typically associated with clinical expertise. For example, practitioners with bachelor’s degrees (or less) made statements like the following:

“I am a counselor, life coach, and spiritual teacher with over 20 years of experience. I have studied the fields of counseling, psychology, personal growth, relationships, communications, business, computer programming and technology, languages, spirituality, metaphysics and energetic bodywork! In addition to my training, a [sic] 18-year relationship with my second husband has deepened my capacity to help others with relationship issues.”

This sort of enthusiastic introduction was typically followed by an equally enthusiastic statement about the breadth of services offered:

“My online counseling services specialties include, but are not limited to: anxiety/panic, self-esteem, highly sensitive people, couples counseling, relationship advice, life and career coaching, emotional intelligence, personal growth, affairs, guilt issues, work and career, trust issues, abuse/boundary issues, communication skills, conflict resolution, grief and loss, emotional numbness, spiritual development, stress management, blame, court-ordered counseling, codependency, problem resolution, jealousy, codependency and attachment, anger and depression, food and body, and developing peace of mind.”

Curiously, we found that the broad range of claims on websites such as these did not move us toward developing or experiencing peace of mind.

The More Ethical Approach

There were also websites that included professional, licensed providers. For example, one website listed and described eight licensed practitioners with backgrounds in professional counseling, social work, and psychology. These professionals offered webcam therapy, text therapy, e-mail therapy, and telephone therapy.

Prices included:

  • E-mail therapy: $25 per online counselor reply
  • Unlimited e-mail therapy: $200 per month
  • Chat therapy: $45 per 50-minute session
  • Telephone therapy: $80 per 50-minute session
  • Webcam therapy: $80 per 50-minute session

The more ethical professional Internet services also tended to include information related to theoretical orientation. For example, a “postmodern” approach was described as involving: “Staying positive . . . focused on the here and now . . . offering solutions that meet your needs . . . a collaborative and respectful environment . . . quick results . . .”

How to Choose an Internet Services Provider

The National Directory of Online Counselors now exists to help consumers choose an online provider. They state:

“We have personally verified the credentials and the websites of each therapist listed in the National Directory of Online Counselors. Feel assured that the therapists listed are state board licensed, have a Master’s Degree or Doctoral Degree in a mental health discipline, and have online counseling experience.”

The listed therapists and websites are set up and ready to handle secure communication, and offer various services such as eMail Sessions, Chat Sessions, and Telephone Sessions. All work conducted by the professional licensed therapists meet[s] strict confidentiality standards overseen by their professional state board.

Both of these distinct approaches to online therapy emphasize that help is only a mouse click away.

Exploring Empathy III

This is a practice-based situation that makes for good discussion about how empathic and how leading it’s appropriate to be in a counseling or psychotherapy session.

Putting It in Practice 5.1

What and How to Validate? Empathic Responding to Trauma and Abuse

Empathy often includes validation of client emotional experiences. But sometimes clients have ambivalent feelings about their own experiences which makes empathic validation complicated. This is especially possible in cases of trauma and abuse where victims can and do experience victim guilt—feeling as though they caused their own abusive experiences. For example, take the following Therapist-client interaction:

Therapist: “Can you think of a time when you felt unfairly treated? Perhaps punished when you didn’t deserve it?”

Client: “No, not really. (15-second pause) Well, I guess there was this one time. I was supposed to clean the house for my mother while she was gone. It wasn’t done when she got back, and she broke a broom over my back.”

Therapist: “She broke a broom over your back?” (stated with a slight inflection, indicating possible disapproval or surprise with the mother’s behavior)

Client: “Yeah. I probably deserved it, though. The house wasn’t cleaned like she had asked.”

In this situation, the client seems to have mixed feelings about her mother. On the one hand, the mother treated her unfairly; on the other hand, the client felt guilty because she saw herself as a bad girl who didn’t follow her mother’s directions. The therapist was trying to convey empathy through voice tone and inflection. This technique was chosen due to concerns that focusing too strongly on the client’s guilt or indignation and anger might prematurely shut down exploration of the client’s ambivalent feelings. Despite the therapist’s minimal expression of empathy, the client defended her mother’s punitive actions. This suggests that the client had already accepted (by age 11, and still accepted at age 42) her mother’s negative evaluation of her. From a person-centered or psychoanalytic perspective, a stronger supportive statement such as “That’s just abuse, mothers should never break brooms over their daughters’ backs” may have closed off any exploration of the client’s victim guilt about the incident.

Alternatively, this is a situation where gentle, open and empathic questioning might help deepen the therapist’s understanding of the client’s unique personal experience and help her explore other feelings, like anger, that she might have in response to her mother’s abuse. For example, the therapist could have asked:

I hear you saying that maybe you feel you deserved to be hit by your mother in that situation, but I also can’t help but wonder . . . what other feelings you might have?

Or, the therapist might use a third-person or relationship question to help the client engage in empathic perspective-taking herself:

What if you had a friend who experienced something like what you experienced? What would you say to your friend?

From a nondirective perspective, sensitive nondirective responses that communicate empathy through voice tone, facial expression, and feeling reflection are usually more advantageous than open support and sympathy. There’s always time for open support later, after the client has explored both sides of the issue.

In first version of this interaction, the therapist used a nondirective model, expressing only nonverbal empathy for the client’s abuse experience. He didn’t openly criticize or judge the mother’s violence. Do you think the therapist might have been too nondirective—in some ways aligning with the part of the client that felt her mother was justified in abusing her? Is it possible that the client actually might have been more able to explore her anger toward her mother if the therapist had led her in that direction using immediacy (i.e., empathic self-disclosure):

“When I imagine myself in your situation, I can feel the guilt you feel, but also, a part of me feels angry that my mother would care so much about housecleaning and so little about me.”

This self-disclosure is both empathic and leading. Do you think it’s too leading? Or do you think it’s a better response than the neutrality often emphasized in psychoanalytic therapies? These are important issues to discuss as you intentionally develop your own therapy style. . . and so be sure to discuss the variety of ways you might respond empathically and therapeutically to this client scenario.

Exploring Empathy: Part II

Misguided Empathic Attempts

It’s surprisingly easy to try too hard to express empathy, to completely miss your client’s emotional point, or otherwise stumble in your efforts to be empathic. Classic statements that beginning therapists often use, but should avoid, include {{34 Sommers-Flanagan,John 1989;}}:

1.  “I know how you feel” or “I understand.”

In response to such a statement, clients may retort: “No. You don’t understand how I feel” and would be absolutely correct. “I understand” is a condescending response that should be avoided. However, saying “I want to understand” or “I’m trying to understand” is perfectly acceptable.

2.  “I’ve been through the same type of thing.”

Clients may respond with skepticism or ask you to elaborate on your experience. Suddenly the roles are reversed: The interviewer is being interviewed.

3.  “Oh my God, that must have been terrible.”

Clients who have experienced trauma sometimes are uncertain about how traumatic their experiences really were. Therefore, to hear a professional exclaim that what they lived through and coped with was “terrible” can be too negative. The important point here is whether you are leading or tracking the client’s emotional experience. If the client is giving you a clear indication that he or she senses the “terribleness” of his or her experiences, reflecting that the experiences “must have been terrible” is empathic. However, a better empathic response would remove the judgment of “must have” and get rid of the “Oh my God” (i.e., “Sounds like you felt terrible about what happened.”).

The Evidence Base for Empathy

There’s a substantial body of empirical research addressing the relationship between empathy and treatment process and outcomes. This research strongly supports the central role of empathy in facilitating positive treatment outcomes.

In a meta-analysis of 47 studies including over 3,000 clients, Greenberg and colleagues (2001) reported a correlation of .32 between empathy and treatment outcome. Although this is not a large correlation, they noted, “empathy . . . accounted for almost 10% of outcome variance” and “Overall, empathy accounts for as much and probably more outcome variance than does specific intervention” (p. 381).

Elliot and colleagues (2011) also conducted a more recent meta-analysis. This sample included: “224 separate tests of the empathy-outcome association” (p. 139) from 57 studies including 3,599 clients. They concluded (based on a weighted r of 0.30) that empathy accounts for about 9% of therapy outcomes variance.

Based on their 2001 meta-analysis and an analysis of various theoretical propositions, Greenberg et al., identified four ways in which empathy contributes to positive treatment outcomes.

  1. Empathy improves the therapeutic relationship. When clients feel understood, they’re more likely to stay in therapy and be satisfied with their therapist.
  2. Empathy contributes to a corrective emotional experience. A corrective emotional experience occurs when the client expects more of the same pain-causing interactions with others, but instead, experiences acceptance and understanding. Empathic understanding tends to foster deeper and more trusting interactions and disclosures.
  3. Empathy facilitates client verbal, emotional, and intellectual self-exploration and insight. Rogers (1961) emphasized this: “It is only as I see them (your feelings and thoughts) as you see them, and accept them and you, that you feel really free to explore all the hidden nooks and frightening crannies of your inner and often buried experience” (p. 34).
  4. Empathy moves clients in the direction of self-healing. This allows clients to take the lead in their own personal change—based on a deeper understanding of their own motivations.

Although it’s always difficult to prove causal relationships in psychotherapy research, it appears that empathy contributes to positive treatment outcomes {{705 Duan 2002; 4508 Elliot 2011; 1047 Greenberg 2001;}}. In fact, some authors suggest that empathy is the basis for all effective therapeutic interventions: “Because empathy is the basis for understanding, one can conclude that there is no effective intervention without empathy and all effective interventions have to be empathic” (Duan et al., 2002, p. 209).

Concluding Thoughts on Empathy

Empathy is a vastly important, powerful, and complex interpersonal phenomenon. People express themselves on multiple levels, and due to natural human ambivalence, can simultaneously express conflicting meanings and emotions. Greenberg and associates (2001) captured the challenges of being empathic with individual clients when they wrote:

Certain fragile clients may find expressions of empathy too intrusive, while highly resistant clients may find empathy too directive; still other clients may find an empathic focus on feelings too foreign. Therapists therefore need to know when—and when not—to respond empathetically. Therapists need to continually engage in process diagnoses to determine when and how to communicate empathic understanding and at what level to focus their empathic responses from one moment to the next. (p. 383)

The preceding description of how it’s necessary to constantly attune your empathic responding to your individual client probably sounds daunting . . . and it should. When we add cultural diversity to the empathic mix, the task becomes doubly daunting. Nevertheless, we encourage you to embrace the challenge with hope, optimism, and patience. It’s only by sitting with people as they struggle to express their emotional pain and suffering that we can further refine our empathic way of being. Like everything, empathic responding takes practice, something Rogers (1961) recommended over 50 years ago.

 Even though that last section was titled, Concluding Thoughts, Part III is coming soon:)

Exploring Empathy — Part I

Happy Saturday. This post is the first of a three-part preview of our discussion on Empathy from Clinical Interviewing, 5th Edition.

See: http://www.amazon.com/Clinical-Interviewing-2012-2013-John-Sommers-Flanagan/dp/1118390113/ref=ntt_at_ep_dpt_1

Empathic Understanding

Empathic understanding is a central concept in counseling and psychotherapy. Rogers (1980) defined empathy as:

. . . the therapist’s sensitive ability and willingness to understand the client’s thoughts, feelings, and struggles from the client’s point of view. [It is] this ability to see completely through the client’s eyes, to adopt his frame of reference, (p. 85) . . .  It means entering the private perceptual world of the other . . . being sensitive, moment by moment, to the changing felt meanings which flow in this other person. . . . It means sensing meanings of which he or she is scarcely aware. (p. 142)

Rogers’s definition of empathy is complex. It includes several components.

  • Therapist ability or skill
  • Therapist attitude or willingness
  • A focus on client thoughts, feelings, and struggles
  • Adopting the client’s frame of reference or perspective-taking
  • Entering the client’s private perceptual world
  • Moment-to-moment sensitivity to felt meanings
  • Sensing meanings of which the client is barely aware

A Deeper Look at Empathy

As with congruence and unconditional positive regard, the complexity of Rogers’s definition has made research on empathy challenging. Many different definitions of empathy have been articulated (Batson, 2009; Clark, 2010; Duan & Hill, 1996). According to Elliott, Bohart, Watson, & Greenberg (2011), recent advances in neuroscience have helped consolidate empathy definitions into three core subprocesses:

  1. Emotional simulation: This is a process that allows one person to experientially mirror another’s emotions. Emotional simulation likely involves mirror neurons and various brain structures within the limbic system (e.g., insula).
  2. Perspective-taking: This is a more intellectual or conceptual process that appears to involve the pre-frontal and temporal cortices.
  3. Emotion regulation: This involves a process of re-appraising or soothing of one’s own emotional reactions. It appears to be a springboard for a helping response. Emotional regulation may involve the orbitofrontal cortex and prefrontal and right inferior parietal cortices.

Empathy is an interpersonal process that requires experiencing, inference, and action. In chapter 1 we noted that playing a note on one violin will cause a string on another violin to vibrate as well, albeit at a lower level. In therapy, this has been referred to as resonance. Most people have had the experience of feeling tears well up at a movie or while someone talks about pain or trauma. This is the experiential component of empathy that Elliot et al., (2011) referred to as emotional simulation).

Beyond this physical/experiential resonance, one person cannot objectively know another person’s emotions and thoughts. Consequently, at some level, empathy always involves subjective inference. This process has been referred to as perspective-taking in the scientific literature and is considered a cognitive or intellectual requirement of empathy (Stocks, Lishner, Waits, & Downum, 2011).

Empathy—at least within the context of a clinical interview—also requires action. Therapists must cope with and process the emotions that are triggered and then provide an empathic response. Most commonly this involves reflection of feeling or feeling validation, but nearly every potential interviewing response or behavior can include verbal and nonverbal components that include empathy. The action component of empathy is likely what Elliot et al., are referring to with the term emotional regulation.

Simple guides to experiencing and expressing empathy can help you develop your empathic abilities. At the same time, we don’t believe any single strategy will help you develop the complete empathy package. For example, Carkhuff (1987) referred to the intellectual or perspective-taking part of empathy as “asking the empathy question” (p. 100). He wrote:

By answering the empathy question we try to understand the feelings expressed by our helpee. We summarize the clues to the helpee’s feelings and then answer the question, How would I feel if I were Tom and saying these things? (p. 101).

Carkhuff’s empathy question is a useful tool for tuning into client feelings, but it also oversimplifies the empathic process in at least two ways. First, it assumes therapists have a perfectly calibrated internal affective barometer. Unfortunately this is not the case as clients and therapists can have such different personal experiences that the empathy question produces completely inaccurate results; just because you would feel a particular way if you were in the client’s shoes doesn’t mean the client feels the same way. Sometimes empathic responses are a projection of the therapist’s feelings onto the client. If you rely solely on Carkhuff’s empathy question, you risk projecting your own feelings onto clients.

Consider what might happen if a therapist tends towards pessimism, while her client usually puts on a happy face. The following exchange might occur:

Client: “I don’t know why my dad wants us to come to therapy now and talk to each other. We’ve never been able to communicate. It doesn’t even bother me any more. I’ve accepted it. I wish he would accept it too.”

Therapist: “It must make you angry to have a father who can’t communicate effectively with you.”

Client: “Not at all. I’m letting go of my relationships with my parents. Really, I don’t let it bother me.”

In this case, asking the empathy question: “How would I feel if I could never communicate well with my father?” may produce angry feelings in the therapist. This process consequently results in the therapist projecting her own feelings onto the client—which turns out to be a poor fit for the client. Accurate empathic responding stays close to client word content and nonverbal messages. If this client had previously expressed anger or was looking upset or angry (e.g., angry facial expression, raised voice), the therapist might resonate with and choose to reflect anger. However, instead the therapist’s comment is inaccurate and is rejected by the client. The therapist could have stayed more closely with what her client expressed by focusing on key words. For example:

Coming into therapy now doesn’t make much sense to you. Maybe you used to have feelings about your lack of communication with your dad, but it sounds like at this point you feel pretty numb about the whole situation and just want to move on.

This second response is more accurate. It touches on how the client felt before, what she presently thinks, as well as the numbed affective response. The client may well have unresolved sadness, anger, or disappointment, but for the therapist to connect with these buried feelings requires a more interpretive intervention. Recall from Chapter 3 that interpretations and interpretive feeling reflections must be supported by adequate evidence.

To help with the intellectual process of perspective-taking, instead of focusing exclusively on what you’d feel if you were in your client’s shoes, you can expand your repertoire in at least three ways:

  1. Reflect on how other clients have felt or might feel
  2. Reflect on how your friends or family might feel and think in response to this particular experience
  3. Read and study about experiences similar to your clients’.

Based on Rogers’s writings, Clark (2010) referred to intellectual approaches to expanding your empathic understanding as objective empathy. Objective empathy involves using “theoretically informed observational data and reputable sources in the service of understanding a client” (Clark, 2010, p. 349). Objective empathy is based on the application of external knowledge to the empathic process—this can expand your empathic responding beyond your own personal experiences.

Rogers (1961) also emphasized that feeling reflections should be stated tentatively so clients can freely accept or dismiss them. Elliot et al., (2011) articulated the tentative quality of empathy very well: “Empathy should always be offered with humility and held lightly, ready to be corrected” (p. 147)

From a psychoanalytic perspective, it’s possible to show empathy not only for what clients are saying, but also for their defensive style (e.g., if they’re using defense mechanisms such as rationalization or denial, show empathy for those):

Client: “I don’t know why my dad wants us to come to therapy now. We’ve never been able to communicate. It doesn’t even bother me any more. I’ve accepted it. I wish he would.”

Therapist: “Coming into therapy now doesn’t make much sense to you. Maybe you had feelings about your lack of communication with your dad before, but it sounds like you feel pretty numb about the whole situation now.”

Client: “Yeah, I guess so. I think I’m letting go of my relationships with my parents. Really, I don’t let it bother me.”

Therapist: “Maybe one of the ways you protect yourself from feeling anything is to distance yourself from your parents. Otherwise, it could still bother you, I suppose.”

Client: “Yeah. I guess if I let myself get close to my parents again, my dad’s pathetic inability to communicate would bug me again.”

This client still has feelings about her father’s poor communication. One of the functions of accurate empathy is to facilitate the exploration of feelings or emotions (Greenberg, Watson, Elliot, & Bohart, 2001). By staying with the client’s feelings instead of projecting her own feelings onto the client, the therapist is more likely to facilitate emotional exploration.

A second way in which Carkhuff’s (1987) empathy question is simplistic is that it treats empathy as if it had to do only with accurately reflecting client feelings. Although accurate feeling reflection is an important part of empathy, as Rogers (1961) and others have discussed, empathy also involves thinking and experiencing with clients (Akhtar, 2007). Additionally, Rogers’s use of empathy with clients frequently focused less on emotions and more on meaning. Recall that in his original definition, Rogers wrote that empathy involved: “. . . being sensitive, moment by moment, to the changing felt meanings which flow in this other person. . .” (p. 142). And so empathic understanding is not simple, it involves feeling with, thinking with, sensing felt meanings, and reflecting all this and more back to the client with a humility that acknowledges deep respect for the validity of the client’s own experiences.

More to come on this tomorrow in “Exploring Empathy” Part II.

References

Akhtar, S. (Ed.). (2007). Listening to others: Developmental and clinical aspects of empathy and attunement Lanham, MD, US: Jason Aronson.

Carkhuff, R. R. (1987). The art of helping (6th ed.). Amherst, MA: Human Resource Development Press.

Clark, A. J. (2010). Empathy: An integral model in the counseling process. Journal of Counseling & Development, 88, 348-356.

Greenberg, L. S., Watson, J. C., Elliot, R., & Bohart, A. C. (2001). Empathy. Psychotherapy: Theory, Research, Practice, Training, 38(4), 380-384.

Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.

Rogers, C. R. (1980). A way of being. Boston: Houghton Mifflin.

Stocks, E. L., Lishner, D. A., Waits, B. L., & Downum, E. M. (2011). I’m embarrassed for you: The effect of valuing and perspective taking on empathic embarrassment and empathic concern. Journal of Applied Social Psychology, 41(1), 1-26. doi: http://dx.doi.org/10.1111/j.1559-1816.2010.00699.x

 

Author, Speaker, University of Montana Professor