Counseling Today, Knowledge Share

Creative and novel approaches to empathy

By Ed Neukrug February 2, 2017

Near the end of Carl Rogers’ life, he wrote a scathing article noting that his conceptualization of empathy had little to do with the popularized notion of empathy that had become known as “reflection of feelings.” He may have been particularly angry because there were some apocryphal stories circulating about Rogers’ work with clients. One of them goes something like this:

Rogers is seeing a client in his office on the 10th floor of a building. The client tells Rogers that he is really depressed, and Rogers says, “Sounds like you’re really depressed.” The client goes on to say that he is thinking of killing himself, and Rogers responds, “You’re so depressed that you’re even thinking you might take your life.” This “reflection” goes on and on for quite a while until the client eventually declares, “I’m so depressed I’m thinking I might jump out of that window.” Rogers again reflects back, almost verbatim, what the client just said, at which point the client goes over to the window, opens it and says, “I’m so depressed, I’m going to jump out of this window.” Rogers says, “You’re so depressed you might jump out of that window.” Exasperated, the client stands on the ledge, and the last thing out of his mouth as he jumps is, “Ahhhhhh!” Rogers, left in the office alone, repeats, “Ahhhhhh.”

You can understand why Carl Rogers, the person who popularized empathy in the 20th century, was pretty upset by this distorted image of his work. In fact, his actual definition of empathy was much more nuanced than “reflection of feelings.” Rogers suggested that empathy is the ability to understand another person’s experience in the world, as if you were that person, without ever losing the “as if” sense. He also noted that empathy entails letting the person know that you understand his or her experience. However, he never suggested that one should rely solely on reflection of feelings to show this understanding. In fact, he implied there were many ways to show your clients that you have understood them.

The five levels of responding

During the 1960s and 1970s, microcounseling skills were popularized. Although these preprogrammed methods of teaching basic counseling skills were pretty effective, they reinforced the notion that counselors should mostly reflect back feelings and content to be empathic. Models developed by such well-known authors as Gerard Egan, Allen Ivey and Robert Carkhuff flourished at this time, and their work, and similar work by others, continues to dominate the ways that counselor trainees learn basic counseling skills.

The downside of these models was that many counselors grew to believe, and continue to believe, that empathy and reflection of feelings are pretty much synonymous. The upside was that counselors could learn this one form of empathic responding pretty quickly. Because empathy has been shown to be related to positive client outcomes, and because students can learn how to be empathic (or at least good at demonstrating this one type of empathy) in a relatively short amount of time, counselor educators have been generally satisfied to continue using these approaches.

All of the microcounseling skills models were pretty similar, but I was always partial to Carkhuff’s model because he suggested there were five levels of responding. Level 1 is when the counselor is simply horrible, reflects little if any of the feelings and content, and may even be critical of the client. Level 2 is when the counselor misses the mark by using a feeling that is not quite on target (e.g., saying “You feel upset” when “You feel depressed” would be more accurate) or uses content that does not quite capture the meaning of what the client said. Level 3 is when the counselor is on target, reflecting back feelings and content that capture exactly what the client was saying.

Level 4 is when the counselor “subceives” feelings just below what the client was outwardly expressing and accurately reflects those feelings back to the client. For example, “So, I’m sensing that in addition to your anger, you feel pretty hurt …”

Level 4 responses can also demonstrate complex and critical thinking that helps the client gain awareness about his or her life: “It seems like every time you get close to someone, you get scared — similar to how you felt when you were rejected by your parents.” These responses reflect understanding, not a “guess” or an interpretation.

Another Level 4 response is when the counselor reflects back a dilemma that the client may be experiencing but is not seeing directly. For instance, “So on one hand, I hear your deep attraction to this person in your office, but on the other hand, I also hear your ongoing love for your spouse.”

Level 4 responses are like icing on the cake — bringing more depth and clarity to the client’s experience — but they are not essential. In fact, I usually tell beginning counselors to shoot for Level 3 responses, and if a Level 4 response happens to pop into their consciousness, then go for it.

Level 5 responses occur when the counselor is “with” the client in his or her deepest moments of pain and demonstrates this in some way with the client. These are relatively rare responses, usually made in long-term counseling relationships, so I won’t go into depth about them in this article.

Because microcounseling skills models train students effectively and quickly at making basic empathic responses, they have become the gold standard in the field. However, they lack the nuance and complexity that can be offered by creative and novel empathic responses. Rogers alluded to this complexity and creativity when he said, “Gradually my understanding of empathy extended to an intuitive capacity for empathy, where I would find something rising in myself that wanted to be said. It might be bizarre. It might be out of context. But I found that if I voiced it, it often rang a real bell with the person and opened up all kinds of areas that had been dimly sensed by the client but not really experienced.”

Ten creative and novel empathic responses

Enamored of this definition of empathy from Rogers, and personally being a little burned out by the reflection of feelings formula, I began to look at other ways to operationalize empathy. I eventually came up with 10 empathic responses that I call creative and novel empathy.

1) Reflecting nonverbal behaviors: The most basic of the advanced responses, most counselors likely have already made such empathic rejoinders simply by acknowledging a client’s nonverbal behaviors. The following is a brief example of such a response:

Client: I’m not even sure where to begin today. So much has been going on.

Counselor: Well, just looking at your nonverbal behaviors, I can see that you have probably gone through a lot this past week. Your slouching body just looks depressed, and I can see you’re on the verge of tears.

Such basic but important responses acknowledge, through reflection of body language, what the client is saying and cuts through the verbal jargon about the client’s feeling state.

2) Reflecting deeper feelings: This type of advanced empathic response is similar to Carkhuff’s understanding of a Level 4 response, when the counselor is subceiving feelings beyond what the client is outwardly saying. It is important to note that these are not interpretive responses in which the counselor is hypothesizing about what the client is feeling. These responses are when the counselor actually experiences a feeling of which the client is unaware that resides just below the surface. For example:

Client: I’m at my wits’ end. I’m so frustrated with my spouse. No matter what I do, nothing seems to work. I keep offering new ways to try and work things out, but he doesn’t seem to care. I feel like throwing something at him.

Counselor: Your frustration really shows. You’ve tried so many different things, yet nothing seems to work. But most of all, I think I hear the sadness in your voice — sadness about the lack of connection that you feel with your husband.

In the example, look at how the counselor first reflects the frustration the client is clearly feeling, but then moves on to reflect sadness. Not outwardly stated by the client, this sadness was subceived by the counselor. If the counselor is on target, the client will respond accordingly.

3) Pointing out conflictual feelings and thoughts: Also an outgrowth from the Carkhuff model, this response enlightens the client’s understanding of self by pointing out different and conflicting parts of self with which the client is struggling. These contradictory parts of self are often responsible for a client feeling stuck in life. It is only through awareness of these conflicting parts of self that one can make smart choices about how to move forward in life. For instance:

Client: You know, I love my wife so much that the thought of being without her is incredibly painful. She is my rock and makes my life so much easier.

Ten minutes later

Client: I went out to lunch with my co-worker the other day, and I know she was flirting with me. When I’m around her, I feel lifted out of my depression. I so wish that I had someone like her in my life, and I’m even thinking I could have an affair with her.

Counselor: I’m hearing two parts of you. One that feels as if your spouse is your bedrock — a person who keeps you grounded — and another that wishes there were more excitement and vibrancy in your life.

All of us have feelings and thoughts that conflict with one another, and counselors can highlight these conflicts. Once these dilemmas are faced squarely, they can be understood more fully. Otherwise, individuals go through life bouncing from one conflicting thought or feeling to another, and they have a difficult time making sense of it all. Imagine what the conversation might be like if the client in the example talked about his or her conflicting feelings.

4) Using visual imagery: Using visual imagery reaches a client through different neural pathways than does traditional talk therapy. For instance, imagine working with a client who has been so bullied by friends and family that the client has considered suicide. As you sit with your client, an image floats into your consciousness that you share with your client.

Counselor: You know, as you’re telling me about your situation, I imagine you lying on the ground, surrounded by friends and family as they hover over you and barrage you with negative statements. You feel like you can’t move. You’re looking for an escape route, but none comes to mind.

Powerful images such as this show the client that you understand the gravity of his or her situation. They also help the client understand the intensity of the situation in a new and dramatic manner, potentially leading to the client generating ways of freeing himself or herself from the situation.

Another visual image was used with me. I was depressed and kept trying different change strategies, but nothing seemed to work. My therapist looked at me and said, “Sounds like you’re rearranging chairs on the Titanic.” On the surface this may seem like a pretty dismal state of affairs, but at least in my situation, it gave me hope. I knew that I had to get off this ship. And, indeed, it led me to make significant changes in my life.

5) Using analogies: Like visual images, analogies reach clients through different neural pathways than those used with basic reflections. Analogies use a logical analysis to compare a person’s situation to another situation that has a similar theme but different content. This allows the client to see the situation from a slightly removed and alternative position — a perspective that is sometimes more palatable for the client. For instance:

Client: I work in this huge office, and every day I go in and sit in my cubicle. There are literally dozens of people around me, and yet I feel like I’m alone. It’s almost more depressing than actually being by myself — all of these people around me and no one acknowledging, talking with or interacting with me. Sometimes I get so low, I just want to kill myself right there in my cubicle, but no one would probably even notice.

Counselor: It’s kind of like you’re an ant in an ant colony. All the ants are busy, busy, busy, and they don’t see you, hear you or touch you. You could just disappear, right there, and none of the rest of the colony would know you’re gone.

In the example, the counselor builds an image that can be related to the client’s situation but is clearly different visually. This allows the counselor to use different words than the client has used and also allows different channels of understanding.

6) Using metaphors: As with the use of visual images and analogies, metaphors also allow clients to receive information in a different form than the typical reflections used in traditional talk therapy. In this case, however, the counselor uses a figure of speech that is symbolic or representative of the client’s situation.

Client: Things have been going so well for me. Since I’ve been coming here, I just feel like everything has changed. I’m happier, I’m more in touch with myself and, best of all, I have met all these new people and have had all these new experiences. I am just flying.

Counselor: You certainly found the light and now seem to have an infinite spectrum of possibilities.

Here we see the counselor using a figure of speech (rather than a logical comparison as in analogies) to make a comparison between the client’s situation and the counselor’s response. This allows the counselor to reflect back a meaningful understanding of the client’s situation without having to use the client’s same words. It also reaches the client at a deeper level.

Here is another use of metaphor:

Client: I have been so busy lately that I can hardly keep track of what I’m doing. It’s a great relief in some ways because I don’t think about my problems and I kind of feel refreshed — like nothing is sticking to me. I mean, the usual problems I deal with don’t seem to take hold. I kind of like it.

Counselor: That makes me think about that old saying, “A rolling stone gathers no moss.”

Again we see a figure of speech being used to make a comparison between the client’s situation and the counselor’s response. This particular response is short and to the point and allows the client simply to think about what is going on in his or her life.

7) Using targeted self-disclosure: Revealing an aspect of self that parallels what the client is experiencing can be an important way to demonstrate understanding. In addition, clients will sometimes assume that if their counselor was able to overcome a struggle similar to theirs, then they can also be successful. One type of self-disclosure includes the counselor revealing feelings in the moment. Often called immediacy, this response demonstrates understanding of the client’s feelings and also models how the client can share his or her innermost thoughts and feelings with someone close.

Client: I’m at my wits’ end. I’m as depressed as ever. I keep trying to change my life, but nothing works. I try communicating better, I change my job, I change my looks … I even take antidepressants, but nothing helps.

Counselor: As you talk, I feel sad and anxious. Sad, because I can tell how hard this is for you, and anxious, because I feel the frustration of nothing working.

Content self-disclosure, on the other hand, reveals an event about a counselor’s life that mimics the client’s experience. This type of response shows the client that you understand him or her and that such struggles can be overcome.

Client: I’m at my wits’ end. I’m as depressed as ever. I keep trying to change my life, but nothing works. I try communicating better, I change my job, I change my looks … I even take antidepressants, but nothing helps.

Counselor: You know, there was a time in my life when I really struggled. I remember how difficult it was for me to get through that time.

Here, the revelation about the counselor’s life demonstrates that the counselor understands the client’s struggles. Notice the nonspecifics of this response. The counselor clearly does not want to reveal too much about his or her life. Targeted self-disclosure should be done carefully and used only to show a client that he or she is being heard, not because the counselor gets something out of self-disclosing. I often say that if it feels good to self-disclose, then you are probably doing so for your own benefit.

8) Reflecting media: Sometimes a client’s situation might remind the counselor of a particular movie, book or popular story. To show the client that the counselor recognizes his or her situation, the counselor references the media. For example:

Client: I had everything. I just bought a new home, was about to go into business for myself and simply had a wonderful life. Then the tornado took it all away.

Counselor: What you have gone through reminds me of the book The Old Man and the Sea. After catching the fish of his life that will lift the man out of poverty, he ties it to his boat, but sharks attack it, and the man’s treasure is lost.

Here’s another example:

Client: I’m going to avenge my brother’s attackers. I will do whatever I can to make sure they are caught and brought to justice.

Counselor: You remind me of Luke Skywalker, ready to take on injustice.

These responses can sometimes lead to more involved discussions about the characters, and analogies can then be made to the client’s life. For instance, The Old Man and the Sea ends with the defeated and worn-out fisherman saying that he promises to fish again with a young boy who has taken him on as a father figure. This story can provide hope to the client who has lost everything in the tornado.

9) Reflecting tactile responses: Using the counselor’s own physical reactions to the client’s disclosures can also demonstrate empathy. Here, the counselor closely monitors his or her bodily sensations and reflects those to the client in an attempt to mirror the client’s own experience.

Client: Anytime I’m around my partner, he harasses me with negative statements. I try my best to be what he wants me to be but just can’t live up to his expectations. Even when I think I’m doing what he wants me to do, it’s not good enough. I’m lost.

Counselor: When you just told me what you’re going through, I felt a gripping bite in my jaw and my stomach twist and turn. I imagine this is how you must be feeling.

Acknowledging a client’s physical state can assure the client that you understand the gravity of the situation. However, such responses are not limited to sad or negative emotions.

Client: I went into work today and, out of the blue, my boss came up to me, told me what a great job I was doing and said she was recommending me for a raise. I was elated!

Counselor: I just felt this chill go through my body when you told me about your experience with your boss. I know how difficult your work situation has been, and your boss’s feedback must have been an incredible high.

10) Using discursive responses: Based in narrative therapy, discursive empathy assumes that part of the client’s experience is based on older, historical and, possibly, cultural narratives. Clearly, one has to possess knowledge of the client’s old narratives, historical roots and cultural experiences.

For example, when conducting a workshop on empathy, I role-played a real situation in my life about having had cancer. I noted that I wished I had been “stronger” when facing my potential death. Asking for workshop participants to respond empathically to me, one said something akin to this: “The pain you felt in facing death seems like it may be related to a broader, more historical event in your life.”

Being Jewish, I immediately thought of the Holocaust and the kinds of messages I received growing up. I realized that “death” was something that was pervasive in my life as a child, and it continued to have an impact on me as an adult. I began to sob, realizing that my death was more than the death of my “self” — it also included the death of a people. It turns out that the person who made the response was the child of Holocaust survivors and saw in me some themes she had experienced. It was quite a powerful response.

Here is another example of discursive empathy:

Client: You know, I feel like wherever I go, I’m treated as a second-class citizen and I don’t get the same opportunities that Whites get.

Counselor: I wonder if I’m hearing how pervasive racism has been in your life as you were growing up — and even today — and how it has impacted your view of the world in such an important way.

Of all the responses I have introduced in this article, discursive empathy has the most potential for abuse because it makes assumptions about a client’s past. Thus, it should be used only if the counselor has a good feel for and understanding of the client’s historical themes.

Final thoughts

Creative and novel empathic responses can bring new energy to sessions as they help clients understand their situations through new modalities and in different ways. However, I always caution that these responses should be made spontaneously, as opposed to trying to manufacture them in the moment. My experience has been that when one becomes expert at basic empathy (e.g., Level 3 empathy on the Carkhuff scale) and has some understanding of creative and novel approaches, then these advanced responses will become a natural part of the counselor’s repertoire.

For those readers who regularly use such responses, you know how fulfilling they can be, both to the client and the counselor. For those who are new to such responses, it is akin to having an “aha” experience. When you offer these empathic responses, you know that you have given your clients a new way to look at their experiences and have likely broadened their depth of knowledge about self.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Ed Neukrug is professor of counseling at Old Dominion University. A well-known author of 10 books in counseling and human services, he has worked in a variety of settings, including agencies, schools and private practice, and has been active in numerous professional associations over the years. He maintains a variety of open access websites, including one in which visitors can assess their theoretical orientations, another that features oral stories about famous therapists and a third that features animations of famous therapists discussing their theories (see odu.edu/~eneukrug). Contact him at eneukrug@odu.edu.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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