Mental health did not escape the asylum system until after the Second World War and apparently many therapists are still trapped in that world. The subconscious intoxication of our professional mystique leads many of us, in the mental health profession, to forget that our clients only need us because of their suffering. They come to us because they seek symptom reduction, improved coping, and clearer understanding of their problems.
As psychotherapy spontaneously spawns more and more Esoteric and Delphic therapeutic models, never before have we needed a conversation about the fundamentals of our profession.
In the first article of this three-part series, I discussed the dichotomy between the clinical definition of the term ‘empathy’ and its culturally axiomatic form ‘Empath’. I posited that a neurocentric view of the mind has led to “the scientific consensus”, over the last few decades, ignoring any evidence that the mind is not generated by the brain and that this, rather unscientific habit, was getting more and more untenable.
In this article, I will examine the question, ‘does empathy make you a better therapist’ and go on to show that true empathy is not only vital in therapy but it has layers of depth, from the superficial to the profound, which are vital in the recovery from complex early trauma.
Professor Carl Rogers, at a time when most people in the industry still had the whiff of disinfectant about them, promoted ‘empathy’ and the importance of the ‘therapeutic relationship’. And it was his descriptions of empathy that I focussed on in my last article.
Carl Rogers emphasised that healing comes from within the client and the therapist is only there to facilitate that healing (I paraphrase). In ‘On becoming a person’ Rogers wrote:
In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?”
He went on to say:
“No approach which relies upon knowledge, upon training, upon the acceptance of something that is taught, is of any use.” (Rogers, On Becoming a Person, 1961, p. 32)
In many ways Carl Rogers seemed to recognise a glimmer of something that humans have always known: that for psychological healing you need the help of someone you can trust, that knows you and sees through you.
So before everything else, the therapeutic relationship was foundational but for Rogers the relationship was, purposely, both passive and superficial. In many ways Person Centred Therapy had to be limited in this way in order to survive in the academic system of the time. However, these artificial restrictions to the therapeutic relationship reduced his empathy to an empty performance.
For Carl Rogers’ his empathy was, for him, demonstrated by constantly repeating what the client had just said by way of paraphrase and for many, well argued reasons, he also pointedly avoided providing guidance, clarification or direction to his clients, which further limited the therapeutic relationship.
For the purposes of this discussion, I suggest we refer to a film, Three Approaches to Psychotherapy, made in 1965 by the University of Chicago in which Carl Rogers of Person Centred Therapy, Fritz Perls of Gestalt Therapy and Albert Ellis of Rational Emotive Behavior Therapy took turns to interview Gloria Szymanski, a volunteer.
You can watch the full video here:
The Fritz Perls interview with Gloria starts at 53:58. I would recommend watching the whole film if you have the time.
Paradoxically, Fritz Perls demonstrated deep insight and identified the fact that Gloria, as she presents herself, was a mask worn by a damaged child. Unfortunately, he failed to create an effective therapeutic relationship because of his combative and aggressive style. He also failed to realise the significance of his insight.
The Albert Ellis’ interview starts at 1:28:39
Albert Ellis deals directly with the mask Gloria presents as if that were the real person and shows no sign of empathy but, to be fair, that was obviously due to the fact that Gloria was flirting with him and they both were much the same age.
The interview with Carl Rogers starts at 10:24.
Rogers’ ignores Gloria’s previous therapy and her recent divorce and the emotional problems of a nine year old girl and focuses on the presented question, “should I tell Pammy I sleep with other men?” The entire exchange revolves around the wisdom of telling her daughter, Pammy, the truth about Gloria’s sexuality.
Rogers, at the end of the interview, gets to some depth when he touches on Gloria’s relationship with her father but that is coincidental. Compared to Fritz Perls and Albert Ellis it seemed that Rogers’ relationship got closer to the client but neither the presented question about Pammy nor Gloria’s sexuality were addressed in end.
In many ways, Fritz Perls demonstrated a greater depth of empathy (cultural definition) but it was of no use to Gloria.
I am not alone in seeing a forth possibility, I believe many have commented on it and I am sure that the empaths among you will have already seen it.
“Pammy” was never the problem! Gloria’s sexual preference for “Icky men” was a way to self-sooth her pain and punish her father. More importantly, she was addicted to casual sex.
Let me talk you through my thinking – addiction, strictly defined, involves:
- impaired control:
- persistent behaviour despite harm
- salience and preoccupation
- craving or strong urge
- functional impairment
In the transcript, Gloria makes the following comments:
“I’m just newly divorced… one of the things that bothers me the most is especially men and having men to the house and how it affects the children… I want so bad to for her to accept me (Pammy).
I first found out my mother and father made love it was dirty and terrible and I didn’t like her anymore for a while.
I’m all sweet and motherly and I’m a little ashamed of my Shady Side too… there are times when I feel so guilty like when I have a man over, I even tried to make a special setup so that if I were ever alone with them the children would never catch me.
I have these desires … it’s my guilt.
I feel guilty afterwards I hate facing the kids I don’t like looking at myself and I rarely enjoy it and this is what I mean… I can’t stop these desires.. I won’t do it anymore but then I resent the children I think ‘why should they stop me from doing what I want’ and it’s really not that bad…
I could say not normal because there is something about me that says that’s not very healthy to uh just go into sex because you feel physically attractive or something or a physical need so something about it tells me that’s not quite right… I feel like I can’t control myself.. it’s yeah I thought of this the other day why do I always have to be so perfect I know why he(Her father) always wanted me to be perfect I always had to be better”
In these extracts we can see that Gloria:
- Gloria feels out of control and is compelled to have sex in the home with random men
- Despite the risk to her health, the risk of pregnancy, the risk to her existing children from strange men. The damage to her reputation that makes it harder to find a long term relationship.
- The effort to create situations to satisfy her lust and her tendency to blame the children for her abstinence.
- Feeling badly about herself for indulging her desire and for not indulging her desire.
From the point of view of DMN-Informed Neuroplastic Schema Therapy, Gloria has a dysfunctional relationship with her father leading to emotional deprivation, defectiveness and shame, impaired autonomy leading to a suspicion of complex early trauma.
The fact that Gloria was suffering from maladaptive schema was obvious throughout the three interviews.
In DMN-I NST and Schema Therapy, in general, the schema is seen as a conscious and sub-conscious framework of feelings, assumptions and beliefs that together constitute a mode of perceiving and inhabiting the world. The schema sits above, cognitively speaking, the unconscious pre-linguistic, pre-conceptual self-model that is so vulnerable to early complex trauma.
We can see that the therapist has to be aware of the client in-the-moment: what they say and don’t say but to get to the root of the damage that has been done to the client, it is necessary for the therapist to go beneath thought, to the feelings and cognitions that bubble up out of the silence between the words.
However, it is vital to treat any insights that you might have of the client’s inner life as sacred and deeply personal. Always remember that a person often will not see what he is not ready to see.
Above all, do not use your insight to prove your authority! Be gentle and respectful and always treasure the therapeutic relationship.
I believe I have given you several examples of why empathy within the therapeutic relationship is vital and why you have to be able to go deeper than just what the client chooses to present.
In my next article, I will explain how it is possible to train the mind to be more empathic.