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Section 15
Empathy, Boundaries, & Sexually Abused Adolescents

Question 15 | Test | Table of Contents

In every relationship there are at least two people and each of those people has many parts to bring to the relationship. We also bring aspects of past relationships into our present relationships. In Chapter 7 I will reflect on transference and counter-transference as it impinges on our 'real' relationships in the here-and-now. In a previous chapter 1 have written about my own therapeutic journey which played an important part in the formation of myself as a counselor. My personal journey and my professional journey are inextricably linked, just as my personal self and my professional self are inextricably linked. Who I am in the relationship with my clients is who I am - and whatever is happening in my life cannot be ignored if I am to be fully present for my clients. That is not to say that my own life necessarily intrudes upon the work I do with clients. I believe that the more I am in touch with what might intrude, the less likelihood there is of intrusion. Kaufman (1996) offers an important guideline:

In my therapeutic relationships, I share only relevant and appropriate aspects from my own life that are already resolved, and only for the client's need, never my own. When a therapist shares current, unresolved conflicts, it burdens the client and misdirects the flow of the relationship. Therapists need to be emotionally available for their clients and not the reverse, just as parents need to be freely giving and genuinely responsive to their children and not the reverse. (Kaufman 1996, p.161)

And who is the client - how did they become the person I meet in the relationship? What developmental factors have influenced how they might relate to me? What do I need to think about in order to attempt to help them form a therapeutic relationship?

Empathy
There is common agreement among workers in the field that the relationship between the client and counselor is the most important factor in successful outcomes of counseling. Over thirty years ago Truax and Carkhuff (1967) described vital elements in any counseling relationships as accurate empathy, non-possessive warmth and genuineness. These echoed the earlier work of Carl Rogers (1961) who regarded the 'necessary and sufficient conditions for therapeutic change' being concerned with helpers having an attitude of 'unconditional positive regard' towards the client, as well as the client's perception of the relationship as helpful. It is therefore not enough for the counsellor to be empathic, understanding and genuine - the counsellor also needs to be able to communicate those qualities to the client. For communication to occur between two people, both 'selves' need to be present. Rogers (1961) quotes a study based on a behavioural approach in which the therapist 'permits as little of his own personality to intrude as is humanly possible' (p.47) and he explains the ineffectiveness of the work being related to that: 'To withhold one's self as a person and to deal with the other person as an object does not have a high probability of being helpful' (p.47).

So when a client comes to tell his story to a counsellor, he needs to feel empathically understood - to feel that the counsellor is able to imagine something of what it is like to be living his life and can respond to him with empathy. Empathy is not a psychological or emotional experience, nor a psychic ability to get inside the mind of another person, but it is an openness to and respect for the personhood of another (Levasseur and Vance 1993). It is a position we adopt in relation to another that stems from an openness and respect for our own personhood. Frank (1995) quotes a famous passage written by Albert Schweitzer after a period of illness resulting from his internment during World War 1: 'Whoever among us has learned through personal experience what pain and anxiety really are must help to ensure that those out there who are in physical need obtain the same help that once came to him' (p.35).

Empathy is different from identification, which is when we take on the other's pain as if it were our own. Empathy means that we experience the expressed emotion as the listener, so that we might accurately understand. In identification those emotions might burden or bias us, but if we cultivate a capacity for curiosity and resonance, we are more likely to be remain sufficiently object and reliable (Halpern 1993). Empathy helps us listen and understand better and therefore enhances our skills of assessment; empathy allows us to disentangle ourselves from some of the emotional reactions that might otherwise threaten our helping role.

Freud rarely referred to empathy in his early works - on the contrary he recommended (Freud 1912) to early psychoanalysts that they should remain 'emotionally cold' and put aside feelings and even human sympathy. However, by 1955 he was recommending that empathy was 'the mechanism by means of which we are enabled to take up any attitude at all towards another mental life' (Freud 1955, p.11 0). Jung accounted for empathy in terms of projection, when we merge with another and feel their feelings as though they are our own. However, other psychoanalytically oriented therapists began to recognize the healing power of empathy and de-emphasized the importance of gaining insight and understanding (Kohut 1984). Self-psychologists began to recognize that clients' suffering was caused by deprivation and by something going wrong in the course of their development. So the goal of the work became 'mature interdependence' nourished by 'empathic intunement' between the self and the sustaining aspects of the counsellor (Kramer 1993, p.lT7)

Rogers (1975) described empathy as 'entering the private perceptual world of the other and becoming thoroughly at home in it.. .you lay aside the views and values you hold for yourself in order to enter another's world without prejudice. In some senses it means you lay aside yourself' (p.2). My view is that we do not lay aside our 'selves', but rather that we have sufficient self-awareness that we can recognize that which belongs to us and that which belongs to the client - thus being able freely to enter into the client's experience without the threat of over-identification.

However, empathy may have its darker side. There may be an appealing, even an addictive quality about intimate attunement with another person (Kramer 1993). This allure often draws people into the helping role whose earlier life experiences have trained them in the ability to a sensitive attunement to underlying cues (I recognize myself in this description). Clients and colleagues alike often describe how, at an early age, they developed the ability to sense atmospheres or moods before they were made explicit. This heightened awareness of things not yet spoken, or even known by the other, may create situations where we might cause excessive discomfort to clients who are not yet ready to know what we may have perceived, or made known to them, in an empathic response. Clients' defense mechanisms may be over-ridden too quickly, causing them to be flooded with exposed negative feelings (Modell 1986). However, we can recognize well-used empathy by the client's response - it may elicit new material for the work and allow the unfolding of deeper levels of communication. Empathy may not always be soothing; sometimes the client will benefit from the challenge and stimulation such responses can evoke, when the challenge is balanced with caring.
- Etherington, Kim, Narrative Approaches to Working with Adult Male Survivors of Sexual Abuse, Jessica Kingsley Publishers London, 2000.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 250 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about empathy in the therapeutic relationship. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Child sexual abuse survivors: Differential complex multimodal
treatment outcomes for pre-COVID and COVID era cohorts

- Reeson, M., Polzin, W., Pazderka, H., Agyapong, V., Greenshaw, A. J., Hnatko, G., Wei, Y., Szymanski, L., & Silverstone, P. H. (2022). Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts. Child abuse & neglect, 134, 105926. https://doi.org/10.1016/j.chiabu.2022.105926


Peer-Reviewed Journal Article References:
Charak, R., Eshelman, L. R., & Messman-Moore, T. L. (2019). Latent classes of childhood maltreatment, adult sexual assault, and revictimization in men: Differences in masculinity, anger, and substance use. Psychology of Men & Masculinities, 20(4), 503–514.

Ellis, A. E., Simiola, V., Mackintosh, M.-A., Schlaudt, V. A., & Cook, J. M. (2020). Perceived helpfulness and engagement in mental health treatment: A study of male survivors of sexual abuse. Psychology of Men & Masculinities, 21(4), 632–642.

Hébert, M., Daspe, M.-È., & Cyr, M. (2018). An analysis of avoidant and approach coping as mediators of the relationship between paternal and maternal attachment security and outcomes in child victims of sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 402–410.

QUESTION 15
What is the darker side of empathy in the therapeutic relationship? To select and enter your answer go to Test.

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