Professional Documents
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Jean Decety
University of Chicago
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University of Minho
In this article, we define the construct of empathy and its relevance for counseling psychology. The
importance of deficits in empathic processes for most of the psychological disorders is presented within
the context of the social brain hypothesis (Frith, 2007). We provide a review of empirical research about
the neural correlates of empathy in terms of both the central and peripheral nervous system. We present
recent evidence on the cortical and subcortical regions involved in different dimensions of empathy
emotional contagion, cognitive and emotional empathy, and self-regulation. Regarding the autonomic
correlates of empathy, we present evidence about the correlates of sympathetic arousal associated with
empathic processes and review data supporting the idea of the physiological linkage or synchrony as
indicator of empathy in interpersonal relationships. The implications of these findings for counseling
psychology, particularly for the psychotherapist client relationship and for context of intimate relationships or couples therapy, are discussed.
Keywords: empathy, neuroscience, interpersonal relationships, counseling psychology
Joana Fernandes Coutinho and Patrcia Oliveira Silva, Neuropsychophysiology Laboratory, Cipsi School of Psychology, University of Minho;
Jean Decety, Department of Psychology and Department of Psychiatry and
Behavioral Neuroscience, University of Chicago.
Correspondence concerning this article should be addressed to Joana
Fernandes Coutinho, School of Psychology, University of Minho, Campus
de Gualtar 4710-057, Braga, Portugal. E-mail: joanafpc@gmail.com
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the great majority of psychopathological disorders are characterized by any type of alteration in social behavior. Paradigmatic
examples of disorders characterized by social impairments are
psychopathy (e.g., Blair, 2005) and autism (e.g., Lim, Bielsky, &
Young, 2005), which may be seen as manifestations of an antisocial brain in the case of psychopathy and an asocial brain in the
case of autism. Many other mental disorders are characterized by
severe problems on the functioning of the social brain. Social
phobia is marked by very high levels of anxiety in social interactions (Chambless & Gillis, 1993), schizophrenia is characterized
by severe social anhedonia and/or paranoid ideation in the context
of social interactions (Horan & Blanchard, 2003), depression is
associated with perceived social rejection and isolation (Cacioppo
et al., 2006), and borderline personality defined, among other
features, by the fear of abandonment and the difficulty in establishing stable relationships (Benjamim, 1996).
The crucial role of social functioning in counseling psychology
is evident not only because, as mentioned before, several psychopathological disorders are characterized by social difficulties but
also because interpersonal problems per se constitute one of the
major and more frequent reasons that people seek psychotherapy
(Horowitz, Rosenberg, & Bartholomew, 1993). In fact, the promotion of clients social abilities, such as effective communication
skills, ability to regulate emotions in the context of intimate
relationship, and ability to deal with conflicts, is one of the most
important and challenging tasks required of the counselor. However, empathy facilitates the development of the therapeutic alliance (Horvath & Bedi, 2002), which is known to be one of the
most robust predictors of therapeutic success. Several decades ago,
Carl Rogers (1957) pointed out that empathy is a necessary and
enough of a condition for change in psychotherapy. More recently,
the role of empathy as a crucial feature of an effective counselor
has been demonstrated in several studies (e.g., Lambert & Barley,
2002; Wampold, 2001). In fact, empathy between the therapist and
the client may constitute in itself an explanation for the process of
change in psychotherapy. Previous studies conducted by us demonstrated that when therapists empathic abilities are compromised, ruptures in the alliance emerge and tend to lead to therapeutic dropout (Coutinho, Ribeiro, Fernandes, Sousa, & Safran, in
press; Coutinho, Ribeiro, & Safran, 2010). The more empathically
the therapist is able to respond to the clients needs, the more likely
it is the clients experience of being understood and validated (e.g.,
Bohart & Greenberg, 1997). In fact, it is through the empathic
response that the therapist will attend to and satisfy the needs
expressed by the client during the session. Thus, it is the therapists
empathic response perceived by the client that is critical for the
process of change (Horvath & Luborsky, 1993). This was also
suggested in another previous study conducted by us (Coutinho,
Ribeiro, Hill, & Safran, 2011). In the present review article, we
argue that two fields counseling psychology and cognitive neuroscience have both been accumulating evidence for the importance of empathy processes. Thus, both research areas can benefit
from the establishment of a dialog between them. Specifically, in
their attempt to deal with the problems presented by their clients,
counseling psychologists may inform their interventions with
knowledge about the neurobiology of the social behavior coming
from cognitive neuroscience.
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
direction, Thomsen and Gilbert (1998) found that, during conflictual interactions, couples in which partners patterns of heart rate
and skin conductance were synchronous with one another had
higher ratings of marital satisfaction. This is particularly relevant
for couples therapy, particularly in conflict situations in which the
need to empathize with negative feelings is more likely to alter the
pattern of physiological activation of each element of the dyad.
The context of intimate relationship is one of the main interpersonal contexts in which empathy appears to be critical for the
couples capacity to succeed or fail (Levenson & Gottman, 1985)
and for romantic relationship satisfaction (e.g., Duncan & Jowett,
2010).
The physiological linkage has also been observed in the psychotherapeutic relationship. In a classical study from DiMascio,
Boyd, and Greenblatt (1957), the authors concluded that the heart
rates of psychotherapists and their clients during interviews moved
in opposite directions when the client expressed antagonism toward the therapist. In the same year, Malmo, Boag and Smith
(1957) found that the amplitude of the electromyogram obtained
from the chin of the examiner and the client during a diagnostic
test both fell following praise and remained constant following
criticism. More recently, Marci, Ham, Moran, and Orr (2007)
found that the syncrony in the skin conductance level was associated with the clients perception of therapists empathic responses
and also with more positive socioemotional interactions for both
clients and therapists.
Taken together, these studies indicate that in order to respond in
an empathic manner to their clients, therapists should be open to
feel the emotional experience of their clients at the physiological
level, serving like a mirror of the clients distress. However, after
an initial period, in which the therapist matches the clients autonomic response, more empathic therapists are likely those better
able to biologically modulate their own and their clients autonomic level of sympathetic arousal. In other words, it may be the
case that biofeedback handles will allow more empathic clinicians
to modify their own autonomic arousal, which in turn will modulate the clients activation, leading to a synchronized and dynamic
autonomic dance between both elements, instead of a rigid
autonomic linkage in which both get stuck in high levels of
sympathetic activation.
The therapists ability to self-regulate his or her own affective
arousal is related with the personal costs, both physiological and
cognitive, of being empathic. These costs are particularly relevant
for professional helping relationships (Gleichgerrcht & Decety,
2011). Both functional imaging studies (Cheng et al., 2007) and
event-related potential studies (Decety et al., 2010) have shown
that physicians do not react to the pain of others in the same way
as nonphysicians. Specifically, they tend to activate more brain
areas involved in executive functioning and self-regulation. Moreover, as pointed out by Yamada and Decety (2009), the emotional
resonance with the other persons suffering and associated response of autonomic arousal may work against empathic concern
or prosocial behavior. This is so because to fully experience the
others suffering activates fear and concerns for our own safety,
which are usually associated with avoidance or self-protective
behavior (e.g., Muraven & Baumeister, 2000). Moreover, the
affective arousal experienced by the empathizer spends attentional
and cognitive resources that can no longer be directed to attend to
the others suffering (Eisenberg & Eggum, 2009).
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Concluding Remarks
Human interpersonal relationships can both create and cure
psychological disorders. Psychotherapeutic relationships are healing interactions that can trigger changes in the brain through a safe
and supportive relationship that is able to reshape neural networks
(Cozolino, 2006). Our knowledge about the neural networks involved in the different dimensions of empathy is still developing;
however, we think that the rapid increase of knowledge in socialcognitive neuroscience will provide the clinician with important
cues about the neuronal systems that are impaired and leading to
their clients social problems. In a not-too-distant future, this will
allow therapists to identify the type of psychological processes that
must be enhanced in order to modulate the activity of those
neuronal systems, promoting a process of positive neuroplasticity.
In other words, in the future, the psychotherapist will be more
close to assuming the role of a neuroscientist who investigates
what in the brain needs to change and how. The application of
neuroscience methods to counseling research will also offer an
alternative empirical validation of therapeutic efficacy by providing the scientific community with new indicators of effective
therapeutic skills. Innovative studies like the one by Barsaglini,
Sartori, Benetti, Pettersson-Yeo, and Mechelli (in press), which
demonstrated that brain networks found to be dysfunctional in
psychological disorders were normalized after effective psychotherapeutic intervention, have already pursued this line of research.
We are just beginning to understand how the architecture of the
brain can help us to understand individuals and their relationships.
We believe that the research on the neural correlates of empathy
will have important clinical implications for the development of
effective interventions of empathy promotion with couples and
other populations, namely, for psychopathological disorders
marked by the deficits in the empathic abilities such as autism and
personality disorders.
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