 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 94 of The Therapy Show behind closed doors with myself, Jackie Jones and the wonderful Mr Bob Cook. Yes, so what we're going to be talking about this week, Bob, is the cultivation of empathy for effective therapy. A brilliant topic. Yeah, brilliant topic in itself. So when you think of that, what do you think of, Jackie? When you think of cultivating empathy as a prerequisite for effective psychotherapy, what do you think of? I mean, what's your thoughts? Empathy is a good one. I think we need to be empathic, but we need to be mindful of burnout if we're too empathic, if that makes sense. If you've seen 20 clients in a week and you're overly empathic with all of them, it's really, you need to look after yourself in this process. That's my initial thought. Okay, it's a good thought to have. Just to clarify, there's even more for me. What do you mean by overly empathic? When we overly associate with our clients or the transference thing, to me, empathy can kind of be part of that, or transference can be part of empathy, whichever way you want to look at it. So what you mean is, I think what you're saying is, is when we identify with the client. Yeah, yeah. I think I've said it before that the universe has this wonderful way of sending us clients that kind of mimic what we're going through in our own personal life sometime. Yeah, okay, so I certainly agree with you that if you exhaust yourself through over identification, then that's not a good place to be. Yeah. And for me, there's always a question around sympathy and empathy, and what's the difference? And knowing what that difference is, sort of being alongside somebody in their journey. Well, let me ask that question. Yeah, my response to that question between the sympathy and empathy. I think sympathy come, I'm going to use transaction analysis to give my responses. Hopefully all the listeners will at least know the PAC model. Yeah. For my response. sympathy, I think comes from the parent ego state. Okay. And often a quite, might be even a suffocating, nurturing part of the parent ego state, but it's often from a parent place, whereas empathy will come from the adult. Yeah. That's a good way of describing it. I've never only described that way before, Bob. So I think there's a great difference. Yeah. Because sympathy from the parent can often to the, you know, the client or the receiver feel quite plastic. In other words, might even feel unfortunately, and though the person doesn't necessarily intended that way, may feel quite patronising. Yeah. Yeah, I can see that. Yeah. And it comes from the parent part often, often comes from the, might even come from the compulsive, rescuing part of the parent. Yeah. And often feels, as I say, quite plastic or patronising on may even feel not real. Yeah. By the receiver. Whereas empathy, I think comes from the adult ego state might borrow from some of the spontaneity of the child. But I think it's more from the adult ego state. It's an attempt to get into the skin of the other person. Yeah. So if you're going into counselling or psychotherapy or anything like that, is a person likely to be empathic anyway? No. Okay. Absolutely not. Okay. Thank you for clearing that up. I was thinking whether it's a certain type of person that does those sort of careers. Do you know what I mean? It's never been asked me before. So really good question, brother. And I said, I said, interestingly, I said no very quickly. And I'll still hold by that. And in the same ballpark, people who are empathic and have the ability to be able to transport themselves, if you like, into the skin of the other person, may be attracted to actually working in the help of professions. So though I said no very quickly, I think I'm added that caveat, actually. But people who are empathic by nature may go into many careers where they're dealing with people. Or, you know, it doesn't have to be necessarily helping professions. I was, you know, I can think of many other professions where you deal with people. And they may go somewhere else all together. I don't think it necessarily follows, but I understand the question I think on this further reflection that people who are particularly good at empathy, they may be attracted more perhaps to helping professions. So how do we cultivate it then? If we haven't got it, which I presume we all have the ability to be empathic. Although do we? Now I've said that out loud, I'm not sure we do. Well, it's a discussion we're having on the podcast and no interesting questions you're asking really. I think they're important ones. Yes, I can only go with my belief systems here. I think we all have the potential to express empathy. So I just certainly believe that. But I think what gets into what stops it happening really is a person's history. If they haven't had parents that have been particularly empathic to them, then they won't learn empathy particularly. But if it hasn't been modelled or haven't received empathy, then empathy can get repressed or at its best, isn't allowed to flourish. So I think the person's history has a particular part to play in the cultivating of empathy, if you like. I think my daughter, she's been brought up with two psychotherapists, for example. And she, I think, is empathic and also she, interestingly enough, is in a helping profession job. Yeah. With helping the youth and mental problems, health problems. And people, you know, her own partner might say she's too empathic and that's a whole other story. But I think she's had two therapists who model empathy and she's been on the receiving end of empathy. Yeah. So I think a person's history has a lot to do with the cultivating of the ability of empathy. Yeah. So how does empathy show up in the therapy room? Or how do we use it in the therapy room? Well, I think there's different types of empathy as well before I go on to saying that. So, you know, I think there's also learned empathy. So I think people, I think some particular people in helping professions, who I'm not sure are naturally empathic, I think they've learned empathy from either the therapy journey they've been on, helping organisations that have been in, reading what they think should be the social responses. And I experienced them coming from a learned empathy position. So that's not necessarily destructive, but I think there's a difference between what I would call natural empathy, which has been allowed to flourish from a very young age. And they've received empathy and all the things I've just talked about. And people who have learned empathy. So people that come, I'll give you another example of this. So people who are attracted for whatever reason to want to be psychotherapists and come to our training courses, you know, they have to be doing their own therapy for at least four years. Yeah. And their natural empathy, I don't experience it particularly, say, at interview stage. I'm not even sure that they've been allowed to express empathy, but anyway. But after four years of therapy, you might find that, you know, that they have a learned empathy. Because their therapist has modeled empathy, they've learned how to respond. And they've learned that that's the way forward in terms of social discourse and healthy relationships. Yeah. So I think people can learn empathy. Yeah. If that makes sense. Yeah. Definitely. Yeah. Even if it's not being part of bringing or whatever. Yeah. Yeah. I think that's important to think about. Because when people train to be psychotherapists, I believe it's certainly in the training of psychotherapists that I'll introduce you anyway. Empathy is such an important quality to have in terms of communicating with the Child Eager State particularly. Yeah. Also an aid of communication with the other person, i.e. the client in this case. So the client feels accounted for. There's a sense of attunement. And there's a sense of a person come from the other person's frame of reference. That ties often learn empathy, not only for themselves, as I said, but also as a way forward in the therapy process. Yeah. Yeah. Because that connection and that it's kind of an understanding that the other person gets you, Somo, with empathy. It kind of validates that they understand you, Somo. Yeah. Well, I think it somehow is actually can be explained. I think it's the therapist in this case, we're talking about, is actually able to get into this, get alongside the skin of the other person. Yeah. Some models might say the person has the same terms of reference as the other person. But I think empathy is more than that. I think it's actually being attuned, being able to, as I say, get into the psychic skin of the other person. And it aids building up a relationship. Yeah. Definitely. Yeah. It aids complementary transactions, it aids the other person feeling accounted for. So it's a very good, if you want to use the word tool, you can do in the aid of helping, of building a positive relationship and being able to come alongside the younger self or the child ego state of the other person. Yeah. So in therapy training, particularly, there's a huge emphasis in cultivating empathy for those reasons. Yeah. So in your training, did you have to do a 100 hour placement? Yeah. You did a voluntary placement, didn't you? No, no, not a voluntary placement. I worked in the low cost clinic that you used to. Yeah. Well, that's what I did. Yeah. Yeah. In able to do that, you had to have a clinical endorsement to practice and in your training, got into triads to deliver clinical competencies. Yes. Yeah. Yeah. And one of those competencies is that the student can use empathy. So there's an emphasis on cultivating empathy. Yeah. In helping the working relationship with the client be more robust and positive. And when they go to supervision, when a person goes to supervision with their clients, for example, there is also the same process in terms of looking at using empathy as a way of actually coming alongside the child ego state or the younger self. Yeah. So empathy is cultivated in psychotherapy training. Yeah. I'm just looking back on to my training. And I think it probably weaved its way through, but I'm not sure we ever did like a weekend on empathy or anything. It was kind of just amongst it all. Yeah. Yes. And there would have been a weekend on working with a child ego state. Yes. Oh, yeah. Yeah. Now in that weekend, you are correct. What if one of the weaving through bits would have been how to use empathy? Yeah. Now, it's also would have been weaved through other things like the competencies, like how to build up working relationships. So you are correct that the cultivating of empathy would have been central probably throughout the different training years. Yeah. And especially, I think, working with the younger self or the child ego state. Yeah. Or helping the person develop a healthy, you know, in a child, if you like, or working within a child. Yeah. Because the other person's younger self needs to feel that the therapist understands them. Yeah. Or at least, you know, has a, you know, motivation to do that. Which that the attunement and the connection and everything, I think is vitally important for the therapy process. It has, yeah. Yeah. And if that's not there, therapy becomes much harder. Yeah. And like you mentioned earlier on about, you know, it's sometimes feeling inauthentic or a bit plastic if it's not genuine empathy. You know, that's going to make the relationship, the therapeutic relationship a lot more difficult. Yeah. Because it was by Richard Erskine, who was one of my mentors, called Beyond Empathy. It's a bit of an expensive book. So it's up to the listeners to reflect on that. However, in that book, he takes clinical cases and talks about how empathy is used in the aid of effective psychotherapy and where that leads to. And it's a very interesting book. Many books, I'm sure, on empathy, but I like that one. And that's Richard Erskine. Yeah. Yeah. And in fact, I have got it here, somewhere around it, but I'm looking at it now. Wow. I mean, if you're on my YouTube channel, there it is. But for people not on my YouTube channel, it's a lovely big brown book with a keyhole in the front of it. And it says Beyond Empathy. And it's full of clinical cases where the author describes his use of empathy and other methods. See, I quite like a book that does that, that uses clinical cases or real life situations. Yeah, that's true. It's one of the most popular books he's written. And it's very interesting because it does exactly what you just said. It looks at clinical cases and sees how empathy is used and other things. Yeah. Yeah, because you can't fake it, can you? No, you see, I think the faking it often maybe received a sympathy. Yes. Yeah. And once you get into the world of sympathy, the receiver often feels as parent driven. And once they get into that process, then they may feel that they're not actually seen or counted for from, you know, a different place. Yeah. Or they may feel suffocated, or by what they may perceive as parental led sympathy rather than adult inquiry. Yeah, because somebody once said something to me and it kind of stuck with me years and years and years ago, even before probably I started my training that, you know, if somebody's been through something and they're having feelings and, you know, the council or the therapist tries to take those feelings away from the client, it's kind of disempowering to them. That's not up to us to take on board the suffering, if you want to call it that. No, it's much more healthy to witness the process. Yeah. Or be with them. Yes. Yeah. Somehow rob them. Which I kind of see that as being empathic is to be alongside them while they're, you know, experiencing whatever it is that they're experiencing, but not trying to take it on board or take it away from them, because it's not always to do that. Correct. Yeah. Absolutely correct. And an important point you've made there and really is important. So that's kind of how I see I would use empathy in the therapy room personally is to, yeah. Yeah. And it's such an important point because a lot of therapists and I don't want to discount the listeners here, but they may not understand what to do with feelings of the client. Yeah. So then they sort of panic and may go cognitively or they may move to a sympathy position or they may actually do many other things, but not allow the person to feel their feelings and be on them to be on the journey with them. It's usually a therapy issue. Yeah. And again, an experience issue as well. I think in the early days I was probably frightened of excessive emotions by the clients. Yeah. And yeah, maybe there's an experience issue and I think it's all sort of to do the person's history. Yeah, maybe, maybe. Yeah. It's both, isn't it? Yeah. So we need to learn, I think, as therapists, usually we start off in the training. If it's a relationally integrative training or a humanistic training, there will be an emphasis on, you know, how to use empathy in some way. Yeah. And how to cultivate that process because without that tool, if you like, therapy is much harder. Yeah. Yeah. So there's just something at the back of my mind about, you know, different personality types and that there are certain people like, I don't know, people with, on the autistic spectrum and things like that that aren't very good at reading social skills and that would have difficulty being empathic. Oh, absolutely. But it doesn't mean I agree completely with you. And that's very true with people, yeah, on the Asperger style or people who perhaps have ADHD or see things in black and white may struggle to be empathic. Yeah. Because they're not wired that way. Yeah. So I understand that completely. And it doesn't mean that the therapist can't be empathic, even if it's only cognitive, even if it's only cognitive empathy. Yeah. So it might need to be modelled differently with different clients, dependent on where they are. Yeah. Yeah. Just somebody who's histrionic, for example, who sees the world through feelings, then the empathy is going to be at a feeling level, isn't it? Yeah. Yeah. Somebody who's obsessive compulsive, which is all about thinking, he may be at an empathic cognitive level. Yeah. Somebody like we just talked about who struggles with empathy, or sees things in black and white type, then it's going to be a different type of empathic approach. Yeah. It's not all about feelings. No. It's about empathy is about helping. Empathy is much more, like I said at the beginning, getting into the psychological skin of the other person. So the other person feels understood by them. Yeah. Now that may demand different types of empathy and will do it. It's actually will do it, not might do it. Yeah. And I suppose in a session, the attunement and the pacing and you learn to judge whether you are in the same place as what the client is, as in the general feeling and the communication and the connection during that session, you kind of pick up on whether you're matching them. Yeah, you do. And clients will tell you actually. So, I mean, even if we talk, even if we went into cost as always, talking to your friends or outside the therapy room, people will know when another person is not empathic. Yeah. They'll feel a disconnect. Yeah. Or they'll feel that the person doesn't understand them. And it's exactly the same in the therapy room. Yeah. And then they will do something. They'll do things like they'll either tell the person or you don't actually understand me. You're not listening to me or you're not getting me. Yeah. Interrupting me, all those sorts of things. In fact, that happened to me the other day and I think I'm particularly empathic but I was in an assessment and, you know, it was no doubt that I was moving away from an empathic place and she said, don't interrupt me. And so, you know, it was somebody who come from an assessment. And rightly so, by the way, because I wasn't, I wasn't being empathic at all. I was coming from a place of, I'm not quite sure. I wanted to hold the assessment on, I think, and asked lots of ridiculous silly questions. So empathy does come with pacing. You're correct. It does come with attunement but delivered accurately, then that is a, you know, a wonderful template for effective therapy. Yeah. Yeah. And it's interesting that you say, do you know what I mean? Even outside the therapy room, you kind of know with your friends or family or work colleagues or whatever, whether they're empathic or, you know, yeah, definitely. It's a good experiment to do. One of the things that I've learned over time is to listen to my feelings and trust my instincts and my gut. If it doesn't feel right, then it probably isn't right. You're absolutely correct. And I think it's a very, very good point that. And also going back to the earlier point, which is, that's a little bit more about when you were talking about different types. Now, if somebody's highly narcissistic. Yeah, I was thinking about their social personality. Yeah. Because they aren't able to leave their ego outside the room. So the therapist is highly narcissistic, hasn't done that therapy, will struggle with empathy because they'll still be caught up with their own ego. Yeah. Yeah. And that, that is quite a big thing for me. And having, you know, if you've got a client that's anti-social, again, it's a feeling that you get that they're not, they're not on the same level. They're not getting it. Now, do you mean the client's not getting it? Yeah. Yeah. Yeah. So if clients aren't getting it, I think you said not on the same level, then I think the therapist needs to step, take a step back. Yeah. Trying to find a way to understand where the person's coming from. Yeah. And to make the connection a different way, maybe. And to make the connection a different way, maybe. Yeah. Yeah. Because it can be, I suppose, you know, scary and overwhelming to some clients to have that connection of feelings if they're not used to it and to have somebody that is empathic and showing empathy to them if they're not used to receiving it, it can be a little bit overwhelming sometimes. So maybe we do need to scale it back at times. And might be very scary. Yeah. Yeah. Yeah. So you're absolutely correct. So that's a clinical concern, you know, to be taken to account. Yeah. And I think cultivating empathy can lead to a template for effective therapy. Yeah. Yeah. Because I've been in a situation as a client in a therapy room, you know, when I was doing my training where the therapist was very, probably very empathic, but very nurturing as well. And because I wasn't used to that in my upbringing, I had a reaction to it because it was just too full on for me. You know, literally the hers were standing up on the back of the neck to have the reaction. That's right. So if the therapist was truly empathic and was attuned to you, they would realise that was happening. Yeah. Yeah. And again, that's a skill that, you know, that being in attuned with and noticing a shift or a change, you know, even subtle things like a therapist cocking the head to one side and dropping the voice to me, I reacted to it. So it's about being mindful of all of these sorts of things as well. Yeah. And I think with true empathy comes attunement. Yeah. I'd like to think so. Yeah. And that makes therapy a lot more effective. Because when we are attuned or we're picking up on the subtleties of the relationship and the connection and the communication, it does make therapy a whole lot easier. It's absolutely true. So if you can cultivate that tool, that technique, that part of yourself, then that's a wonderful, you know, place to go to as a psychotherapist. Yeah. Now, you are correct about over empathy, if you like, where the therapist can go to. But I actually think it's more when there's positive, there's, I can explain this, personal identification of the therapeutic issue, which leads to the therapist being exhausted. Yeah. It's an interesting one. Is that over empathy? Is that a therapist being an over empath? You can look at it that way. Sure. You can look at it that way. Yeah. Because I think, you know, maybe it's a topic for another podcast or whatever. But, you know, it's like compassion fatigue. And when we're too compassionate and empathic and feeling a lot of feelings in it, you know, it burns us out. Yeah. So we need to be aware of all those things you're talking about. Yeah. At the same time, I think the empathy is so important. And I think the client will feel understood. Yeah. The relationship will be more effective, you know, in the process we're talking about. Yeah, definitely. I agree. Thank you for that, Bob. Another wonderful podcast. No, I enjoyed talking about that. And it's, of course, I think I probably had natural empathy, but it was repressed. Or I repressed that part of myself because of the high critical parent in the head in my head. Now, as I did more therapy and learned to have an observing self that was more compassionate with myself, I allowed that part of myself to flourish more. So I think my ability to empathize, okay, I learned through training, but I became more natural in it, if you want to put it that way. Yeah. Once I descaled down the attacking parent in my head, so the spontaneity, genuineness, freedom of expression was more evident. Yeah. That's quite a powerful thing to say, Bob, you know, to me that, yeah, you were suppressing it. And once that was taken away, and you were allowed to be, well, you felt more able to be that, because I suppose we can feel quite vulnerable in that situation as well by showing our own emotions and connections to what's going on in the therapy room. It's not always a comfortable thing to do. It often isn't. And if you have a critical parent in your head, it's even more uncomfortable. Yeah, yeah. So if we can start to replace that with a nurturing narrative on observing compassion itself, then I think empathy will flourish. Yeah. Yeah. Because I think in the beginning of the early stages of being a therapist, I thought I couldn't show my emotions in the therapy room. Oh. Whereas, you know, now sometimes I have no option because they just pop up. And I'm okay saying to them, I feel really emotional when I hear you saying that, or I see the way that that's affected you or whatever it is, I'm okay them knowing that it's actually impacted me. Yeah. And those are empathic transactions. Yeah. But it didn't feel comfortable at the beginning. I thought I couldn't show any emotion because I was a professional and whereas actually that breaks down an awful lot of barriers in the therapy room now, I think. Yeah. And it's great to hear the use of empathic transactions because, you know, the clients often have lived in a barren world criticism rather than empathy. Yeah. So to have their therapist use empathic transactions in the service of the client or the service themselves is a marvellous permission to be different, I think. Good. I'm glad it's okay, Bob, because I do it quite regularly. I think it's more than okay. It's like if you're working that empathic way with empathic transactions in the service of helping release the client to model the therapist, sorry, the client to be different, it's more than okay. It's what I think effective therapy is. Hmm. Yeah. See, this is one of the reasons why I love this podcast, Bob, and I hope that the listeners get something from it. Because as a therapist, we don't know what happens in other therapy rooms. We don't get the option to, you know, see inside how somebody else does therapy, if that makes sense. Perfect. And fortunately, I move in the world of meeting a lot of therapists through supervision and other places where I think what wonderful therapy they've been doing it. And then sometimes I hear examples saying, good, gosh, that's really happening that way. I hear more examples of positive psychotherapy, but you're absolutely right. Supervision, by the way, especially tape supervision, is where we can share with our supervisor. The supervisor can hear in the inner world of the process and can talk about it that way. And also, you are correct. We often accept through training and supervision, all the things we're just talking about here. Don't know what really happens in the therapy room. Yeah. Because I know why I do therapy, but I'm not sure why other people do therapy. It's like, I know, you know, where I trained, we were all trained the same way. So I'd like to think that, you know, the basic, the core values are the same. But how we implement that, we always add our own personality on it. Yes. So we're all going to be slightly different anyway. But, you know, I'm quite open in sharing how I am in the therapy room. But there's always that part of me, especially in these podcasts, Bob, that I'm getting it right. Because, like I said, you're my mentor, you're my guru. So always a bit dubious. You just talked about empathic transactions. I think that's a really wonderful way to do therapy. Oh, thank you. So, and I like the way we started podcast, when you talked about the difference between sympathy and empathy. And I do think you do think, and you didn't say this, but I do think many people think they're being empathic when they're being sympathetic, well, actually, they're coming from different parts of themselves. And the see them, I see it as sympathy is more parent driven. Yeah, I'm glad you gave the opportunity to say what I think is the difference. Because I think I would repeat it again. I think that some therapists might think that being empathic, but actually, they're coming from completely different parts of themselves. And the clients often feel it's sympathy. And that they feel missed. Yeah. Yeah. Which is a shame, because we don't want our clients to feel missed or not seen. And often the therapist doesn't want that either, but they don't actually know the difference between empathy and sympathy. Yeah. Yeah. Wonderful. Okay. Yes. Love it. Okay. Thank you. So what we're going to be doing in the next episode, Bob, is something that you touched on a couple of sessions ago. And I was just intrigued by it. Is therapy a middle class profession? Yes, I'm laughing to myself because I did. And I have such a lot to say on that subject. So I look forward to the next podcast. Me too. It's going to be a good one. Until next time, Bob. Thank you. Thank you. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.