Face-oriented acts of empathy in psychotherapy

Using Conversation Analytic (CA) methods, the present study attempts to analyze the various functions of face-based therapist empathy, and how they are sequentially realized in different psychotherapeutic settings. Four types of face-based therapeutic functions are discussed; more specifically, it is illustrated how therapist empathy may serve to maintain, enhance, threaten or even save the client’s face. The findings gained could contribute to a better understanding of the face-based therapeutic functions of empathy; also, the study may inspire researchers to further investigate other functions of therapist empathy in psychotherapy.

Common Factors in Psychotherapy

Common factors, or characteristics that are present across psychotherapies, have long been considered important to fostering positive psychotherapy outcomes. The contextual model offers an overarching theoretical framework for how common factors facilitate therapeutic change. Specifically, this model posits that improvements occur through three primary pathways: (a) the real relationship, (b) expectations, and (c) specific ingredients. The most-well-studied common factors, which also are described within the contextual model, include the therapeutic alliance, therapist empathy, positive regard, genuineness, and client expectations. Empirical studies have demonstrated that a strong therapeutic alliance, higher ratings of therapist empathy, positive regard, genuineness, and more favorable outcome expectations are related to improved treatment outcomes. Yet, the long-standing debate continues regarding whether psychotherapy outcomes are most heavily determined by these common factors or by factors specific to the type of therapy used. There have been calls for an integration of the two perspectives and a shift toward evaluating mechanisms as a way to move the field forward. Nonetheless, the common factors are valuable in treatment delivery and should be a focus in delivering psychotherapy.

Empathy

Empathy refers to understanding what another person is experiencing or trying to express. The chapter begins by discussing definitional issues and presenting an integrative definition. It then reviews measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. Clinical examples illustrating different forms of therapist empathy and empathic response modes are then presented. The core of the review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .28 (equivalent of d = .58) for 82 independent samples and 6,138 clients. In general, the empathy–outcome relation held for different theoretical orientations and client presenting problems. The chapter considers the limitations of the current data and concludes with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy.