Skip to main content
Log in

Therapist Experience, Personal Therapy, and Distressing States of Mind: Regulation and Resonance as Dialectics of Therapeutic Empathy

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

The current study is based on the notion of an empathic dialectic, marked by states of emotional resonance and regulation, which has been described by contemporary theories of therapeutic empathy and empirically supported by research on non-therapists. We operationalized emotional resonance as personal distress empathy, and we sought to examine how activities promoting self-regulation impact the association between personal distress empathy, and other facets of poor self-regulation. This was accomplished through an online study, which administered several self-report instruments to a sample of 158 non-therapists and 139 therapists of various levels of experience, collecting participants’ demographic information, attachment status, level of shame-proneness, the fear of invalidity, and personal distress empathy. We examined the impact of several moderators on the paths from attachment anxiety, shame-proneness, and the fear of invalidity to personal distress empathy; and, thus, on the indirect effect between attachment anxiety and personal distress empathy. For our first hypothesis, we expected therapist status to significantly moderate the paths in this proposed meditation. For our second hypothesis, we anticipated personal therapy sessions would significantly moderate this meditation. For our third hypothesis, we expected that both personal therapy and therapist experience level would moderate this mediation. Most notably, our results indicated that the fear of invalidity explained the association between attachment anxiety and personal distress empathy, and this mediation was stronger among non-therapists when compared to therapists. Yet, personal therapy did not similarly impact the relationships among these variables. Implications for future research are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Badenoch, B. (2018). Safety is the treatment. In S. W. Porges & D. Dana (Eds.), Clinical applications of polyvagal theory. New York: W.W. Norton Company Inc.

    Google Scholar 

  • Batson, D. C., Fultz, P., & Schoenrade, P. A. (1987). Distress and empathy: two qualitatively distinct vicarious emotions with different motivational consequences. Journal of Personality, 55(1), 19–39.

    Article  CAS  PubMed  Google Scholar 

  • Britton, P. C., & Fuendeling, J. M. (2005). The relation among varieties of adult attachment and the components of empathy. Journal of Social Psychology, 145(5), 519–530.

    Article  PubMed  Google Scholar 

  • Buechler, S. (2008). Making a difference in patients’ lives. New York: Routledge.

    Book  Google Scholar 

  • Davis, M. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44(1), 113–126.

    Article  Google Scholar 

  • Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy, 48(2), 198–208.

    Article  PubMed  Google Scholar 

  • Decety, J., & Lamm, C. (2009). Empathy versus personal distress: Recent evidence from social neuroscience. In J. Decety & W. Ickes (Eds.), The social neuroscience of empathy (pp. 199–213). Cambridge, MA: MIT Press.

    Chapter  Google Scholar 

  • Dozier, M., Cue, K., & Barnett, L. (1994). Clinicians as caregivers: Role of attachment organization in treatment. Journal of Consulting and Clinical Psychology, 62(4), 793–800.

    Article  CAS  PubMed  Google Scholar 

  • Ehrenberg, D. B. (1992). The intimate edge: Extending the reach of psychoanalytic interaction. New York: W.W. Norton & Company.

    Google Scholar 

  • Elliot, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410.

    Article  Google Scholar 

  • Fülöp, E., Devecsery, A., Hausz, K., Kovács, Z., & Csabai, M. (2011). Relationship between empathy and burnout among psychiatric residents. New Medicine, 4(1), 143–147.

    Google Scholar 

  • Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A comparative analysis of six pre-conceptions about internet questionnaires. American Psychologist, 59(2), 93–104.

    Article  PubMed  Google Scholar 

  • Goubert, L., Craig, K. D., & Buysse, A. (2009). Perceiving others in pain: Experimental and clinical; evidence on the role of empathy. In J. Decety & W. Ickes (Eds.), The social neuroscience of empathy (pp. 153–165). Cambridge, MA: MIT Press.

    Chapter  Google Scholar 

  • Griffin, D. W., & Bartholomew, K. (1994). Metaphysics of measurement: The case of adult attachment. In K. Bartholomew & D. Perlman (Eds.), Advances in personal relationships (Vol. 5, pp. 17–52)., Attachment processes in adulthood London: Jessica Kingsley Publishers.

    Google Scholar 

  • Hall, J. A., Davis, M. H., & Connelly, M. (2012). Dispositional empathy in scientist and practitioner psychologists: Group differences and relationship to self-reported effectiveness. Psychotherapy, 37(1), 45–56.

    Article  Google Scholar 

  • Hassenstab, J., Dziobek, K., Rogers, K., Wolf, O. T., & Convit, A. (2007). Knowing what others know, feeling what others feel: A controlled study of empathy in psychotherapists. Journal of Nervous and Mental Disease, 195(4), 277–281.

    Article  PubMed  Google Scholar 

  • Hatcher, S. L., Favorite, T. K., Hardy, E. A., Goode, R. L., Deshetler, L. A., & Thomas, R. M. (2005). An analogue study of therapist empathic process: Working with difference. Psychotherapy: Theory, Research, Practice, Training, 42(1), 198–201.

    Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.

    Google Scholar 

  • Holmes, J., & Slade, A. (2018). Attachment in therapeutic practice. Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  • Joireman, J. A., Needham, T. L., & Cummings, A.-L. (2002). Relationships between dimensions of attachment and empathy. North American Journal of Psychology, 4(1), 63–80.

    Google Scholar 

  • Karyagina, T. D., Kukhtova, N. V., Olifirovich, N. I., & Shermazanyan, L. G. (2017). Professionalization of empathy and predictors of helping professionals burnout. Konsul’tativnaia Psikhologiia i Psikhoterapiia, 25(2), 39–58.

    Google Scholar 

  • Kline, R. B. (1998). Principles and practice of structural equation modeling. New York: Guilford Press.

    Google Scholar 

  • Kohut, H. (1959). Introspection, empathy, and psychoanalysis: An examination of the relationship between mode of observation and theory. Journal of the American Psychoanalytic Association, 7(1), 459–483.

    Article  CAS  PubMed  Google Scholar 

  • Kurdek, L. A. (2002). On being insecure about the assessment of attachment styles. Journal of Social and Personal Relationships, 19(6), 811–834.

    Article  Google Scholar 

  • Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., et al. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74(6), 1027–1040.

    Article  PubMed  Google Scholar 

  • Lopez, F. G. (2001). Adult attachment orientations, self-other boundary regulation, and splitting tendencies in a college sample. Journal of Counseling Psychology, 48(4), 440–446.

    Article  Google Scholar 

  • Lopez, F. G., Gover, M. R., Leskela, J., Sauer, E. M., Schirmer, L., & Wyssmann, J. (1997). Attachment styles, shame, guilt, and collaborative problem-solving orientations. Personal Relationships, 4(2), 187–199.

    Article  Google Scholar 

  • Lynch, J. S., Hill, E. D., Nagoshi, J. L., & Nagoshi, C. T. (2012). Mediators of the shame-guilt- psychological adjustment relationship. Scandinavian Journal of Psychology, 53(5), 437–443.

    Article  PubMed  Google Scholar 

  • Main, M., Hesse, E., & Kaplan, N. (2005). Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age: The Berkeley longitudinal study. In K. E. Grossmann, K. Grossmann, & E. Waters (Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 245–304). New York: Guilford Press.

    Google Scholar 

  • Marmarosh, C. L., Schmidt, E., Pembleton, J., Rotbart, E., Muzyk, N., Liner, A., et al. (2015). Novice therapist attachment and perceived ruptures and repairs: A pilot study. Psychotherapy, 52(1), 140–144.

    Article  PubMed  Google Scholar 

  • Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44.

    Article  PubMed  Google Scholar 

  • McClintock, A. S., Anderson, T., Patterson, C. L., & Wing, E. H. (2018). Early psychotherapeutic empathy, alliance, and client outcome: Preliminary evidence of indirect effects. Journal of Clinical Psychology, 74(6), 839–848.

    Article  PubMed  Google Scholar 

  • Mehrabian, A., & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40(4), 525–543.

    Article  CAS  PubMed  Google Scholar 

  • Mikulincer, M., Gillath, O., Halevy, V., Avihou, N., Avidan, S., & Eshkoli, N. (2001). Attachment theory and reactions to others’ needs: Evidence that activation of the sense of attachment security promotes empathic responses. Journal of Personality and Social Psychology, 81(6), 1205–1224.

    Article  CAS  PubMed  Google Scholar 

  • Mikulincer, M., Shaver, P. R., Bar-On, N., & Ein-Dor, T. (2010). The pushes and pulls of close relationships: Attachment insecurities and relational ambivalence. Journal of Personality and Social Psychology, 98(3), 450–468.

    Article  PubMed  Google Scholar 

  • Norcross, J. C. (2005). The psychotherapist’s own psychotherapy: Educating and developing psychologists. American Psychologist, 60(8), 840–850.

    Article  PubMed  Google Scholar 

  • Obegi, J. H., & Berant, E. (2009). Attachment-informed psychotherapy research with adults. In J. H. Obegi & E. Berant (Eds.), Attachment theory and research in clinical work with adults (pp. 461–489). New York: Guilford Press.

    Google Scholar 

  • Pletzer, J. L., Sanchez, X., & Scheibe, S. (2015). Practicing psychotherapists are more skilled at downregulating negative emotions than other professionals. Psychotherapy, 52(3), 346–350.

    Article  PubMed  Google Scholar 

  • Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: W.W. Norton & Co.

    Google Scholar 

  • Rangganadhan, A. R., & Todorov, N. (2010). Personality and self-forgiveness: The roles of shame, guilt, empathy and conciliatory behavior. Journal of Social and Clinical Psychology, 29(1), 1–22.

    Article  Google Scholar 

  • Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationships: As developed in the patient-centered framework. In J. S. Koch (Ed.), Psychology: A study of a science (Vol. 3, pp. 184–526)., Formulations of the person in the social context New York: McGraw-Hill.

    Google Scholar 

  • Rogers, C. R. (1975). Empathic: An unappreciated way of being. The Counseling Psychologist, 5(2), 2–10.

    Article  Google Scholar 

  • Roisman, G. I., Padrón, E., Sroufe, L., & Egeland, B. (2002). Earned-secure attachment status in retrospect and prospect. Child Development, 73(4), 1204–1219.

    Article  PubMed  Google Scholar 

  • Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30(1), 5–44.

    Google Scholar 

  • Rubino, G., Barker, C., Roth, T., & Fearon, P. (2000). Therapist empathy and depth of interpretation in response to alliance ruptures: The role of therapist and patient attachment styles. Psychotherapy Research, 10(4), 408–420.

    Article  CAS  PubMed  Google Scholar 

  • Safran, J. D. (1993). Breaches in the therapeutic alliance: An arena for negotiating authentic relatedness. Psychotherapy, 30(1), 11–24.

    Article  Google Scholar 

  • Simpson, J. A., Rholes, W. S., & Nelligan, J. S. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62(3), 434–446.

    Article  Google Scholar 

  • Sze, J. A., Gyurak, A., Goodkind, M. S., & Levenson, R. A. (2012). Greater emotional empathy and prosocial behavior in late life. Emotion, 12(5), 1129–1140.

    Article  PubMed  Google Scholar 

  • Tangney, J. P., Dearing, R. L., Wagner, P. E., & Gramzow, R. (2000). Test of self-conscious affect-3 (TOSCA-3). Fairfax, VA: George Mason University.

    Google Scholar 

  • Thompson, M. M., & Zanna, M. P. (1995). The conflicted individual: Personality-based and domain-specific antecedents of ambivalent social attitudes. Journal of Personality, 63(2), 259–288.

    Article  CAS  PubMed  Google Scholar 

  • Trusty, J., Ng, K.-M., & Watts, R. E. (2005). Model of effects of adult attachment on emotional empathy of counseling students. Journal of Counseling & Development, 83(1), 66–77.

    Article  Google Scholar 

  • Tucker, D. M., Luu, P., & Derryberry, D. (2005). Love hurts: The evolution of empathic concern through the encephalization of nociceptive capacity. Development and Psychopathology, 17(3), 699–713.

    Article  PubMed  Google Scholar 

  • Van de Mortel, T. F. (2008). Faking it: Social desirability response bias in self-report research. Australian Journal of Advanced Nursing, 25(4), 40–48.

    Google Scholar 

  • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. New York: Routledge.

    Book  Google Scholar 

Download references

Acknowledgements

Statistical support was provided by data science specialist Dr. Steven Worthington, at the Institute for Quantitative Social Science, Harvard University.

Funding

The authors did not receive funding for the research or publication of this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shannon L. McIntyre.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project has been approved by the Institutional Review Board at Long Island University, New York.

Informed Consent

Informed consent was obtained from all individual participants involved in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McIntyre, S.L., Samstag, L.W., Haden, S.C. et al. Therapist Experience, Personal Therapy, and Distressing States of Mind: Regulation and Resonance as Dialectics of Therapeutic Empathy. J Contemp Psychother 49, 213–221 (2019). https://doi.org/10.1007/s10879-019-09431-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-019-09431-w

Keywords

Navigation