The Power of Empathy. Mia Leijssen

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What helps you to develop nonjudgmental listening?

Reflecting on your own experience of close relationships and times where you feel hurt or anxious, to
what extent do you use specific strategies to disconnect from others (when you might be better off
staying in connection)? You can reflect on this question with the help of Mick Cooper’s “Disconnection
Inventory”.

For me to develop nonjudgmental listening, I must first consider my own reality. It means I must full grip
of my senses. It is also means I must be in touch of what the world offers me and the consequences of it.
Second is, I must consider his/her reality as such. It means, I must acknowledge his/her own struggle,
virtues, and anything that he can offer. Third, to bridge the two realities, the process must be carefully
build in a person-centered way of relating in such a way, there is a real dialogue. About the
Disconnection Inventory, very much of the list I did it. I was kind a surprise to check all the lists it means,
I did various things to cope and strategies myself to be balance and connect.

The power of empathy. Mia Leijssen


When describing the characteristics of a helping relationship Carl Rogers based his
ideas largely on the practice of psychotherapy. However, he makes it clear that the
same attitudes apply in all forms of interpersonal contact that are designed to
encourage growth, recovery, development or healing.

Research has given rise to empirical evidence that empathy is one of the most
important components of any helping relationship, regardless of the therapist’s
theoretical framework. Person-centered therapists, who have a long tradition of using
the therapeutic relationship as a lever for change, are in a good position to explain this
basic attitude and how it works.

Empathy allows you to bridge the vast gap between the more general knowledge you
have of someone and the complex realities of this particular individual. In an empathic
conversation you endeavor to evaluate the situation from the other’s perspective. This
implies a series of mental activities in which you ask yourself: what might I think, what
might I want, and what might I feel when I imagine myself as this person?

Empathic interventions are meant to validate the other person’s experience.  Specific
interventions are, however, secondary to empathic relating.

The basic attitude of empathy is the bedrock for interventions of all kinds, which might
take a variety of forms, such as asking questions, reflecting, interpreting, etc. Good
empathy is not tied to particular interventions, but to the overall context in which the
interaction takes place. In this respect, a confrontation could be experienced as highly
empathic. But communication is crucial. The patient has little to gain if the clinician
merely sympathizes and silently understands. The explicit expression of empathy is
necessary.

The kind of verbal response that is offered can further differentiate empathic
interventions. It is worth identifying four levels of person-centered empathy: 

1. giving attention to what the person expresses explicitly; 

2. explicating underlying cognitions, motivations and emotions; 

3. digging deeper and more confrontational empathy; 

4. empathic interventions which reveal new meanings.

In the paper, I will illustrate each level of empathy in the context of physical symptoms
and problems with a psychosocial background. 

Embodied empathy. Mick Cooper


Mick Cooper refers to whole-bodied empathy as ‘embodied empathy’. In this mode of
embodied attunement, the therapist is not resonating with specific thoughts, emotions or
bodily sensations, but with the complex, gestalt-like mosaic of the client’s embodied
being, that initial primal thrust of the client’s experiencing as it emerges into the world.
At this level, the whole of the therapist’s body is alive in the interaction, moving and
vibrating in tandem with the client’s experiencing. They experiences an all over unity
and a most basic sense of being there in the world with another. 

Exercise: with a “talker” and a “listener”

 10 mins each way, then 10 minutes de-briefing (talking about experience). 

 Talker: talk about something meaningful in your life at present or a concern --


ideally something with some emotional content.

If you really don’t feel comfortable with that, then role play a client.

Listener:

 Try to listen with your body.

 Let yourself ‘breathe in’ what the talker is saying.

 Give yourself time to ‘resonate with’/‘attune to’ the talker’s being-in-the-world.

 Don’t focus on what you are going to say in response.


 Be aware of what you feel in your body as you ‘take in’ the talker.

 Try to respond when you feel something ‘within’ in response to the talker: e.g.
sadness alongside talker, or slight feeling of being unnerved.

 When you feel moved to say something, keep it brief, and ‘own’ it: e.g. ‘I get a
real sense of anxiety in my stomach when you say that.’ Or  ‘Listening to all that
pressure gives me a sense of a great weight on my head’ or  ‘I can really feel tears
welling up in my eyes.’

 You may not feel moved to say much the whole period -- no problem

De-briefing:

 How did that feel as the talker?

 How did that feel as the listener?

mpathy as Dialogical process and Embodied Understanding.


Mathias Dekeyser, Robert Elliott, & Mia Leijssen  
We present an account of empathy in psychotherapy that is based on a more general,
multidisciplinary understanding of everyday empathic interaction. We argue that, for two
reasons, this approach can contribute to a better understanding of the processes of
empathy in the therapeutic context. 

Neurological studies and social psychology research have demonstrated the power and
complexity of interpersonal influence on a physical, nonverbal level, a complexity that is
sometimes ignored by therapists. Examples of such influences are emotional contagion
and automatic vigilance. 

Second, understanding problems in client-therapist interaction requires us to examine


how clients both understand and misunderstand their therapists, including their
therapists’ intentions, emotions, and other internal states. These problems are grasped
with more coherence when they are described using parallel concepts for the client and
the therapist. For example, it is easier to understand and tackle severe communication
problems in psychosis treatment when both the client’s and the therapist’s “sides” of the
communication are considered. 

Try for a week to be empathic (reflecting, checking if you understood right using your own words,
making empathic guesses…) to as many people as possible (your partner, parents, friends, boss…)
without them knowing you are doing this exercise. Write something about your experiences and how
people in your environment reacted.

How and when do you experience that “embodied empathy” feels natural for you?  
Last week, I tried to be more emphatic and my subject is my wife. The experience was very surprising
and wonderful! Last week, her aunt died on a heart attack. Her aunt is most dear to her, and at those
time of grieving, I was just there, able to be present in her grieving. My words usage almost about life,
death, hoping and careful utterance of love which my wife felt the most of all with me. It was a
wonderful experience and spiritual at the same time. The experience allows me to be embodied
empathy and I am kind a grown into it gradually. Now, being a husband and able to connect to my wife
with empathic self-makes me more love my wife.

Authenticity and Different Schools in Person-centered Therapy. Mia


Leijssen
"Thus our sharply different therapists achieve good results in quite different ways. For
one, an impatient, no-nonsense, let's put-the-cards-on-the-table approach is most
effective, because in such an approach he is most openly himself. For another it may
be a much more gentle, and more obviously warm approach, because this is the way
this therapist is. Our experience has deeply reinforced and extended my own view that
the person who is able openly to be himself at that moment, as he is at the deepest
levels he is able to be, is the effective therapist. Perhaps nothing else is of any
importance" (Rogers, 1967, p. 186). 

Authenticity as a basic therapeutic attitude is explained from the perspective of different schools
in Person-centered therapy: 

 the Classical approach where authenticity essentially means that the therapist has access
to all facets of their own personal experiencing; 

 the Experiential school where the therapist has more freedom to express themselves and
introduce their own knowledge and experience; 

 the Interactional approach where authenticity is used as a powerful confrontational and


pre-emptive intervention; 

 the Existential school where therapist transparency is part of the therapist’s personal
presence and the encounter as a whole. 

In this article you can find many examples from clinical practice of a variety of
interventions inspired by the different Schools.

Case-study Personality Disorder.  Mia Leijssen and Heidi


Adriaensen.
A client diagnosed with ‘Avoidant Personality Disorder’ is taken as a case-example to
demonstrate how authenticity can lead to specific interventions as well as how a
powerful range of interactions is available to a counselor who engages with the client in
a Person-centered manner.  

When considering this case example, we briefly mention a few principles that Person-
Centered authors draw upon when working with personality disorders. However, our
focus is primarily those moments where authenticity appears to be a ‘therapeutic lever’.
Using transcribed extracts from live therapy sessions, we hope to provide counselors
with more of a guideline regarding the possible uses of authenticity. 

The case-study is part of the training course for the specialized study in Person-
centered psychotherapy at the University of Leuven. Heidi Adriaensen is the counselor
in training who provides the therapy. An important personal detail is that she is blind due
to a congenital visual handicap. Mia Leijssen is Heidi’s trainer and supervisor. 

In the first year of the training a lot of attention is given to counselor’s personal growth
and training in basic attitudes for counseling. The trainee counselors use the repertoire
of basic attitudes when starting their first sessions under supervision. This means that
virtually no advanced techniques are used during these sessions. As part of the training,
counselors and clients fill out questionnaires that reflect on the helpful and disruptive
elements in the therapy. In this case-example, the client’s responses emphasize the
crucial contribution of the counselor’s authenticity. This is why we selected these
particular excerpts from an array of material where authenticity is clearly present. 

We provide a sketch of the client and his development through the 38 sessions of
therapy. We restrict our focus to interactions that illustrate how authenticity is expressed
during the initial, the middle and the final phase of this therapy and how the specific
problems of the client’s ‘personality disorder’ affected the therapeutic process.

In the discussion we reflect on the power and the vulnerability of inexperienced


caregivers. The case-study illustrates that caregivers’ expertise is not simply reduced to
the use of treatment plans. Crucial recovery will occur through an appropriate
therapeutic relationship. The client is very clear in the post-therapy questionnaire about
how much he appreciated the work of the counselor: “For Heidi, I was not a number.
She said what she had to say. That’s why I could trust her more and more. She was so
open, I dared to say more and more to her. That’s how she helped me see what I
wanted to say and how I could do that.” The case-study illustrates in a way that is
sometimes very touching that the fundamental attitudes need to be seen in the context
of their interaction with client variables. Here, it is the client who challenges the
counselor's vulnerability to relate honestly with him and it is the counselor who then acts
on the client’s openness in a facilitative manner. 

Therapist Genuineness from the Client’s Perspective. Jutta


Schnellbacher and Mia Leijssen
We analyzed 6 clients’ experiencing of the overall significance of therapist genuineness
in their therapy. Both qualitative and quantitative data were gathered and analyzed
using the technique of pattern matching. 

Genuineness, or authenticity , is defined as “the ability and willingness to be what one


truly is” toward oneself and the other in the mutual relationship. We describe therapist
genuineness as being

aware of one’s own experience (self-awareness); being emotionally involved in the


client’s story and the here-and-now interaction, being personally present; and being
willing to intentionally and verbally reveal personal feelings, thoughts, impressions,
experiences, facts, views, values, and methods of working (self-disclosure).
Consequently, therapist genuineness is an inner attitude, a relational experience, and a
dynamic process between client and therapist.

The findings imply that whether and how genuineness is crucial for change also
depends on the individual client.

The findings from 2 clients support strongly the hypothesis that genuineness is the most
crucial therapeutic process. However, the findings need to be nuanced. One client adds
that the interaction disclosure could only be helpful because of the accepting and
respectful attitude of her therapist. The other client pointed out that besides the
moments of reciprocity and encounter that resulted from her therapist’s self-disclosures,
she felt acceptance and attention to inner experiencing were crucial therapeutic
processes. 

It is obvious that 4 clients experience other processes than genuineness as most crucial
for healing and personality change: 2 clients reported that they experienced increased
insight and self-knowledge and newly acquired ways of thinking as particularly helpful
and 2 clients point to the crucial significance of Focusing (interventions that help the
client to contact her bodily felt experience and make it more explicit. See Section 3 and
7). 

Thus, we cannot conclude that genuineness is the most crucial therapeutic process for
healing and personality change. However, the empirical data give sufficient evidence
that the client’s experiencing therapist genuineness can be a crucial process for healing
and personality change. In 5 of the 6 cases, therapist genuineness appears as a
significant therapeutic process.

In all 6 cases it appears that the clients experienced the therapist’s attitude of
acceptance as the most helpful or an important therapeutic process. We define
acceptance as an open and receptive attitude toward the client experience, the absence
of judgment, and respect for the client as a human being. 
The article describes the research findings in detail, illustrated by many examples from
clinical practice. In the discussion we reflect on important implications for practice.

A person-centered counselor learns to be sensitive to the underlying interactional needs


of the client.

Underlying interactional needs in the relationship with the counselor are for example:  

 Need for affection: the need to be loved, respected and accepted by important
others for oneself, not for ones achievements. 

 Need for inclusion: the need to be of importance to others, to play a role in their
life, to belong to others. 

 Need for a reliable relationship: the need for a trustworthy relationship. 

 Need for solidarity: the need that the other stands behind you, supports you,
gives support if necessary. 

 Need for autonomy: the need to be accepted in your self-determination, self-


definition and self-development. 

 Need for territorial inviolability: the need to have own limits and the needs that
these are respected by others.

Why is authenticity (not) important in your life?  

What touched you when you read the case-study of the client with a “personality disorder”?

“Genuineness, or authenticity , is defined as “the ability and willingness to be what one truly is”
toward oneself and the other in the mutual relationship” this sentence really evaluates my life
right now. Am I authentic to my wife, my students, co-teachers and the rest of the people whom
I shared my life with? For me, authenticity is the way I could be true to myself and the natural
condition for authentic life is mattered on my very conscious decisions and how I take my
existence go beyond to what is given in an illusionary world.
For me, the case-study moved me to seeking what really is authenticity, and how can I be
authentic in my life. The same phrase which I am reflected upon is the willingness to be what
one truly is. To be true is very difficult in that case but knowingly that the possibility of
authenticity is really there, it takes some sound therapy and intense meditation, focusing and
the actual liberating of the mind.

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