The Importance of Empathy in the Therapeutic Alliance

By Feller, Candi P.; Cottone, R. Rocco | Journal of Humanistic Counseling, Education and Development, Spring 2003 | Go to article overview

The Importance of Empathy in the Therapeutic Alliance


Feller, Candi P., Cottone, R. Rocco, Journal of Humanistic Counseling, Education and Development


In this investigation of the construct of empathy, the authors report that the literature reflects strong evidence that empathy is an essential component of the therapeutic alliance across theories and that empathy is necessary in the counseling process. The concept of empathy continues to be a central component of new forms of counseling and therapy.

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Rogers (1957) conceptualized and specified six conditions that he considered to be both necessary and sufficient for therapeutic client change to occur. Rogers hypothesized that these six conditions apply to all psychotherapy, not just to client-centered therapy. These conditions require counselor congruence or genuineness in the therapeutic relationship, unconditional positive regard for the client (warmth), the ability of the counselor to empathize with the client in this relationship, and communication of empathy and unconditional positive regard to the client. Of the conditions defined by Rogers as both necessary and sufficient, empathy is the construct that has evoked the most attention from psychotherapy theorists and researchers.

The literature reflects considerable academic interest in providing empirical evidence to support the role of these core conditions in therapeutic outcome across counseling theories. Much of this exploration took place in the 1960s and 1970s, and was triggered by Rogers's groundbreaking theory (Bohart & Greenberg, 1997; Duan & Hill, 1996). Some of the pertinent research conducted in the 1970s suggested high correlations between the core conditions and positive therapeutic outcome. For example, Truax and Mitchell (1971) conducted objective ratings of audiotapes and found a strong relationship between empathy and positive therapeutic outcome. However, one criticism of this research, according to Bohart and Greenberg, was that it equated empathy with the technique of empathic reflection, a relationship that Rogers argued against. Since the 1970s, research on empathy or the core conditions has been sporadic (Bohart & Greenberg, 1997; Duan & Hill, 1996). However, these same core conditions are reflected in the literature referring to therapeutic alliance (i.e., Bohart & Greenberg, 1997) and common factors in counseling, which include variables that exist across counseling theories (Lambert, 1992).

We investigated the construct of counselor empathy within the therapeutic relationship in order to determine (a) the applicability of the construct of empathy across counseling theories (Rogers, 1957), (b) the empirical validity of empathy as important to the therapeutic alliance, and (c) current applicability of empathy in the field of counseling. The broader topics of therapeutic alliance and common factors in counseling was not a focus of this review. The terms psychoanalysis/analyst, therapy/psychotherapist, and counseling/counselor are used interchangeably, depending on the theoretical orientation under consideration. The terms patient and client are also used interchangeably.

HISTORICAL PERSPECTIVE

The centrality of the therapist-patient relationship in psychotherapy did not originate with Rogers, although Rogers's work stands as an important historical marker on this issue. The term therapeutic working alliance actually originated in psychoanalytic therapy (Bordin, 1979). Accordingly, one of the central features of alliance is the development of bonds between analyst and patient. Freud mentioned empathy as a tool that provided clues about the patient's unconscious dynamics. The patient-analyst relationship was to be a cordial interchange, but empathy was not used to establish a relationship that would foster a corrective emotional experience (Bohart & Greenberg, 1997). To a greater degree than drive and ego theorists (Hansen, 2000), object relations theorists within the psychoanalytic camp emphasized attachment, interpersonal conflict, and other issues related to human relationships. …

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