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Thursday, January 4, 2018

What is Empathic Failure in Psychotherapy?

Most licensed psychotherapists are individuals who are credentialed and skilled in their areas of expertise.  I believe the vast majority of psychotherapists are ethical and empathetic individuals who have their clients' best interests at heart and help their clients to overcome their psychological problems. But there can be big differences in terms of skills and experience from one psychotherapist to the next, and I believe that clients should be informed consumers, which is why I'm focusing on this issue.  Psychotherapists are also human and, like everyone else, they make mistakes in therapy.  In this article, I'm focusing on a particular mistake called "empathic failure" where this is not an occasional problem but a recurrent problem with some psychotherapists (see my article: Why is Empathy Important in Psychotherapy?).

What is Empathic Failure in Psychotherapy?

What is Empathy?
Empathy involves a psychological process where you're able to put yourself in other people's shoes and get a sense of what they're feeling.  For instance, if your friend is upset because her dog died, even if you never had a dog in your life, you can put yourself in your friend's shoes and understand why she's upset about the loss.  You can tap into your friend's feelings and sense what she's feeling and resonate with her sadness about the loss.

What is Empathic Failure in Everyday Relationships?
Empathic failures occur all the time between friends, spouses, family members, students and teachers and so on.  Except when dealing with highly insensitive people, I believe that most instances of empathic failure occur inadvertently.

For instance, a husband might forget that his wife told him that she would like a particular perfume for her birthday. Instead, he buys her a vacuum cleaner and he feels proud of himself because it's energy efficient.

He expects that his wife will be thrilled.  But his wife's reaction is the complete opposite of what he expected--she is upset and angry because she feels he didn't hear her when she told him what she wanted.  She also feels that he sees her only as a "housewife" who cleans the apartment rather than a sensual woman.

While this might be very disappointing for his wife and it's an empathic failure, this isn't a reason to get a divorce if he is usually empathetic and they have a good relationship most of the time.  They can work out this problem and the husband can be more aware next time.

What is Empathic Failure in Psychotherapy?
When clients begin psychotherapy, they usually have a certain degree of trust that the psychotherapist is a credentialed mental health professional who will be attuned to their needs in therapy and help them to overcome the emotional problems.

Aside from all the other clinical skills that psychotherapists learn, one of the most important is how to be empathetic towards clients in therapy.  This is a skill that is honed in graduate school and, if the psychotherapist goes to postgraduate training, this skill usually developed even more.

I believe that most psychotherapists are empathetic individuals and those who go to graduate school who lack this skill are weeded out by supervisors and instructors.  That's not to say that there aren't some people who somehow make it through the screening process at times.

Even the best psychotherapists make mistakes in therapy at times, including empathic failures.  But there's a difference between a therapist who makes occasional mistakes related to empathic failure and those who do it habitually. So, let's start by defining what an empathic failure is in therapy:

An empathic failure occurs in therapy when the psychotherapist isn't attuned to the client.  This can occur in many ways:
  • Forgetting important details about the client's life
  • Confusing the client's history with another client
  • Forgetting what the client and the therapist discussed in the prior session
  • Forgetting an appointment with the client
  • Focusing on the psychotherapist's life instead of focusing on the client's problems
  • Projecting the psychotherapist's needs, wants, and problems onto the client
  • Being dismissive of the client's needs
  • Failing to be attuned to the client's emotions and mislabeling these emotions
  • Failing to take responsibility for the mistakes that the psychotherapist made in therapy
and so on.

As I mentioned, even the best psychotherapists commit empathic failures at times.  For instance, a therapist, who is usually punctual and organized, can confuse his appointment schedule if the therapist is going through a very stressful time in his life.  If things were going smoothly before that, assuming that the therapist takes responsibility for the mistake, most clients would accept an apology and the therapy would continue (see my article: Ruptures and Repairs in Psychotherapy).

The empathic failures that I'm most concerned about are the ones that occur on a regular basis with a client who might have grown up with parents who lacked empathy for him.

Since this client grew up in an environment with chronic empathic failure, he might not recognize that he is in an unhealthy situation with his therapist.  It might seem "normal" to him because this is all that he knows.

The following fictional vignette illustrates how empathic failure can occur between a client and a therapist and steps that the client can take to take care of him or herself.

Fictional Vignette:  Mistakes Psychotherapists Make in Psychotherapy: Empathic Failure

Mike
Mike began therapy after a recent breakup. He told his new therapist that he felt unlovable and not good enough for most of his life.  This began in early childhood when his mother let him know that neither she nor his father wanted to have children, and Mike was "an accident."

He grew up feeling like he was "an inconvenience" to his parents, who paid very little attention to him.  As soon as he was old enough, they sent him to boarding school, which was a lonely experience for Mike.

When Mike looked up, he saw that his therapist had fallen asleep.  He wasn't sure what to do, so he cleared his throat hoping to wake the therapist up.  The therapist was startled by the sound and woke up with a jolt, "Oh, ah...what were you saying?"

Mike wasn't sure how much his therapist missed, so he started again at the beginning to describe his breakup and his family history.

Over the next few weeks, there were several other incidents.   There were a couple of times when Mike's therapist double booked appointments and Mike had to go home instead of seeing the therapist.

There was an incident where the therapist seemed to completely forget what Mike had told him about his family history and about the breakup, so Mike had to tell the therapist about these issues again.  Then, there was one day when Mike showed up for his regularly scheduled appointment and the therapist wasn't there.  Mike checked his voicemail to see if the therapist had left a message, but there were no messages.

Later that evening, when Mike met his close friend, Larry, and told him what had happened when Mike went to his therapist's office and the therapist wasn't there, Larry asked him questions about the therapy and if there were other problems in the therapy before this.

Mike thought about it for a minute and then told Larry about the other incidents.  While Mike spoke, Larry, who had good experiences in therapy before, listened carefully.  After Mike told him about the incidents, Larry told Mike that he needed to find another therapist because his current therapist seemed irresponsible and not attuned to Mike.

Since Larry knew Mike a long time, he also knew about Mike's childhood history and knew that Mike's experiences with his therapist were harmful.  He told Mike that he thought Mike's therapist wasn't treating him well and gave him all the reason why he thought this.  Mike listened, realized that what Larry was telling him resonated with him and that he probably had a blind spot about this.

When he went to his next session, Mike explained to his therapist why he thought the therapy wasn't working out for him and specifically why he felt he wasn't being treated well by the therapist.  His therapist looked uncomfortable, but he acknowledged that he had made mistakes with Mike.

Mike thought about it and decided that he ought to have consultations with other psychotherapists.  After two other consultations, Mike chose to work with another psychotherapist who seemed much more attuned to him.

He had one more session with his current therapist for closure and then began to meet regularly with the new therapist.  During that therapy, Mike began to understand why he had a blind spot in his former therapy.

He was also able to make connections between his history of emotional neglect with his family and the empathic failure that he experienced with his previous therapist.  This work helped Mike to feel that he deserved to be treated better in all areas of his life.

Conclusion
As I mentioned earlier, I believe that most psychotherapists are empathetic individuals who got into the mental health field to help people.

There can be empathic failures in any relationship.  Ideally, they are few and far between and when they occur, the person who made the mistake is able to admit it so there can be emotional repair.

An occasional mistake can occur in therapy, and the therapist should acknowledge the rupture and make an effort to repair the therapeutic relationship.  But when there are consistent empathic failures in psychotherapy with a particular psychotherapist, the client would do well to address these issues in therapy and to make a decision as to whether s/he wants to stay or find a different therapist.

Unfortunately, clients who grew up being emotionally neglected or abuse often have a blind spot for empathic failures because it seems "normal" to them.

Although this is a blog article and of necessity it's short, I hope it will be helpful to clients who might be experiencing consistent empathic failures in their therapy to become more aware of it and to take care of themselves by finding a therapist who can meet their needs.

Getting Help in Therapy
If you are struggling with an emotional problem that you have been unable to resolve, you could benefit from seeing a licensed mental health professional.

A consultation or two with a therapist (or more than one therapist) can help you to decide if you and the therapist are a good match (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy to individual adults and couples (see my article: Integrative Psychotherapy).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.

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