Therapist empathy and client outcome: An updated meta-analysis.

Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our 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 (p < .001; 95% confidence interval [.23, .33]; 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; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

From There and Back Again.

This article describes my journey from being a radical, person-centered therapist in the 1960s to the present. In the 1960s, my colleagues and I saw therapy as a person-to-person encounter. Over the years I lost that notion and became corrupted by the idea that therapy is a process of intervening to make things happen in clients. In the 1990s, I found my way back to the idea of therapy as a meeting of persons because of a research review that showed that it was clients' investment and creativity that were primarily responsible for making therapy work and because of my experiences with clients. In the meantime, the field had aged and political developments within it, such as the empirically supported treatments movement, also influenced how I came to view myself. I conclude by giving my current view of therapy as a process in which I am not intervening but engaging in a person-to-person meeting, within which I am free to offer techniques and ideas from many different approaches if appropriate.

Empathy.

After defining empathy, discussing its measurement, and offering an example of empathy in practice, we present the results of an updated meta-analysis of the relation between empathy and psychotherapy outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .31 (p < .001; 95% confidence interval: .28-.34), for 59 independent samples and 3599 clients. Although the empathy-outcome relation held equally for different theoretical orientations, there was considerable nonrandom variability. Client and observer perceptions of therapist empathy predicted outcomes better than therapist perceptions of empathic accuracy measures, and the relation was strongest for less experienced therapists. We conclude with practice recommendations, including endorsing the different forms that empathy may take in therapy.

Introduction: The (overlooked) virtues of "unvirtuous" attitudes and behavior: reconsidering negativity, complaining, pessimism, and "false" hope.

The attitudes and behaviors examined in this special section-namely, negativity, complaining, pessimism, and "false" hope-have not typically been viewed as virtuous either in popular culture or in professional psychology. In reconsidering these attitudes and behaviors, each of the authors demonstrates how there may actually be virtue, or at least something positive, in what has typically been cast in a negative light.

Focusing on the positive, focusing on the negative: implications for psychotherapy.

Each of the contributions in this special section challenges some of our preciously held notions. We are challenged to be aware that an overfocus on positivity and optimism can be tyrannical, see the positivity in the negativity, realize that some pessimism can be adaptive, see that complaining has positive value, and be aware that false hope is not necessarily bad. Through an examination of these, I have suggested that (a) we have to be careful to deeply respect the individuality of our clients and to take seriously the possibility that there is some "ecological wisdom" in their apparently dysfunctional behavior, and (b) what is more important than optimism-pessimism, complaining versus not complaining, or false versus realistic hope is the degree to which the client adopts a task-focused orientation towards problems.