EMPATHIC INTERVENTIONS – Part 2

by Martha Stark, MD / Faculty, Harvard Medical School

Empathic statements are experience-near – not experience-distant – and are designed to validate or reinforce the patient’s actual experience in the moment – in other words, what’s in her consciousness or, perhaps, her preconscious – they are not designed to target her unconscious.

 

Indeed, I find that the flow of a session will be much smoother if I honor what the patient is telling me and don’t try to read between the lines or to interpret what I think might lie beneath the surface. In other words, I focus more on the manifest content (what the patient is saying, what is experience-near for her) than on the latent content (what the patient is not saying, what is experience-distant for her, what lies hidden and perhaps defended against).

 

I have other tools in my therapeutic armamentarium that target what the patient is not saying, but my default mode are these empathic statements that focus more on helping the patient to feel understood than on helping her to understand. When the patient feels deeply understood, she will be more inclined to engage more authentically in the therapeutic process – both more deeply and more broadly – and in a heartfelt, less heady, fashion.

 

With that said, because empathic statements highlight not only the patient’s “affect” in the moment but also the “story” that goes with it – “so painful to be feeling so misunderstood,” “so fearful of being judged,” “so worried about how others are experiencing you” – ongoing use of these statements will not only enable the patient to feel understood, validated, and supported but also start to give shape to the filters through which the patient is interpreting her world.

 

…because these empathic statements are making explicit the maladaptive, disempowering narratives that the patient had constructed as a young child in a desperate attempt to make sense of the deprivation and neglect / the trauma and abuse to which she was being exposed – “so afraid of being punished,” “so painful to be feeling always so invisible,” “so heartbreaking to be feeling so unlovable,” “so enraging to be feeling never good enough” – stories the patient had made up in an effort to understand – but made-up stories that have now generalized from the small (her nuclear family) to the all (the world around her) – narratives that have become the go-to distorted filters, or lenses, through which she experiences her life.

 

Let us imagine that the patient comes in, stating that she is very upset about something that had happened the night before but also stating very clearly that she does not want to talk about it. Of course we could say, gently, “Oh dear! What happened?” – not a bad thing to say but definitely not honoring what the patient has just said, namely, that she does not want to talk about it. We might therefore justify our question with – “Well, she wouldn’t have brought it up but for the fact that some part of her did want to talk about it!”

 

But a more empathic (experience-near) response might be – “The thing that happened last night is simply too upsetting to talk about right now.” …to which the patient might respond with, “…and I’m afraid to talk about it because I feel so ashamed.” …to which we might then respond with, “You worry about how you might be judged” or, focusing on the transference, “You worry about how I might judge you.”

 

And, at a later point, we could offer the more general, “You find yourself often worrying about how you might be judged.” Or we could highlight the probable genetic origins, “You have always found yourself worrying about how you might be judged – after all, your dad was such a harsh critic.”

 

Again, we are beginning to make explicit some of the old bad narratives about self, others, and the world that the patient had constructed early on – beginning to highlight the specifics of outdated, maladaptive narratives that are probably more important than the specifics of what had actually happened the previous evening

 

old bad narratives that are disempowering, distorted, and limiting and will eventually need to be updated and replaced with new good narratives that are more empowering, more reality-based, more affirming – and offer greater freedom.

 

Parenthetically, once it has been made explicit that the patient was hesitating for fear of being judged (a self-sabotaging narrative that has limited the expansiveness of her growth since childhood), she will probably end up talking about what had really happened the previous night anyway!