During my second year of graduate school, I volunteered as a therapist in an off-campus research project that was studying the use of "empathy" as a therapeutic tool. This is not to be confused with sympathy, sometimes labeled as "feeling sorry" for someone. Theorists have varying definitions of these terms but one of my graduate professors put it best. To paraphrase:
"Sympathy is when you ask yourself 'how would I feel if this was happening to me,' and you experience certain hypothetical emotions. Empathy is much more powerful. Empathy is trying to get into others' shoes to feel what they feel. You don't necessarily ignore your own emotions but your goal is to try to be in their unique experience, in their psychology. When you are truly empathic, you feel connected to the client and attached to his or her experience. In turn a client feels understood, accepted and validated. Then he is open to hearing a fresh opinion, a new perspective or a unique approach to solving a problem. Empathy is the glue that holds the therapy experience in place."
Certain problems lend themselves to be empathized with. A grieving widow, a person who becomes depressed after being laid off, a victim of abuse. Can most therapists come close to understanding what the client is experiencing when hearing about problems like these? Usually. These are very painful and unfortunately, common problems seen in life. Ones that therapists themselves may have experienced and can relate to. Through practice and a general caring of the human condition, most of us can convey a strong sense of empathy for these clients.
Using an example from grief work with a spouse who has lost her husband, a common empathic exchange to build a strong working relationship might look something like this:
Client: I know he's not coming back but I still expect him to. That's what always happened. He came home, into the damn living room, our living room, everyday after work!
Therapist: So it's like, "even though I know it's not reality, I expect him to come home, walk through that Goddamn door after work, because that's the way it's always been, and that's the way it should be! It's almost...wrong that it's not working out that way." Is that right?
Client: Yes, yes it's like that. It's just...wrong that it's not the way it should be.
Not all problems lend themselves to the empathic experience. For the research study, I was assigned an early 50's, African-American male, "Scott," who was grappling with Dysthymic Disorder. This is a low-intensity depression that lasts for at least two years. It is often described by clients as a "case of the blahs" that a person just can't shake off.
Scott was well over 6'4'' and was disheveled, overweight and constantly perspiring. He began many of his sentences with "fuck" and arrived to sessions in t-shirts that were too tight for his belly, white sneakers with black socks. His hands were always very clammy and he insisted on shaking when entering the therapy room.
Scott desperately needed to take better care of himself. He suffered from hypertension, high cholesterol and diabetes. This is a common feature of depressive conditions. People lose interest in many things including taking care of themselves and their health slips. While Scott labeled his focus areas of therapy as "get better with people" and "be with a family," my hope was that working together would allow him to drink less and start to exercise.
Clients who are part of experimental therapies are often required to consent to their sessions being audio and/or videotaped. This allows for the dialogue to be transcribed and studied and can also serve as a training tool for student therapists. Scott and I used audiotape. As part of the research protocol, we used the first session to better understand and develop his goals for the treatment. Later, I sat with my professor and we listened to the tape:
Rob: Scott, I'd like to know more about what you mean when you say "be with a family" as one of your goals.
Scott: I've been with a woman for about 12 years, but we're not married. She can't have any more children.
Rob: So you have children?
Scott: No, she has 2 kids. I guess I'm a stepfather of sorts, a pretty good one actually.
Rob: But are you saying that you'd like to have biological children?
Scott: Fuck yeah, who wouldn't?
Rob: Okay, so does that mean that you will break up with your partner to find someone who can have kids?
Scott: No, fuck no, I love her. Her daughter is a virgin, so when the time comes we'll just use her for my seed.
Stop. Rewind. Replay. Stop.
"What the hell is he talking about?" asked Dr. X, my supervisor.
"I think you need to listen more."
Dr. X stared at me with a combination of confusion and suspicion, then pressed Play.
Rob: I see. Wait...what?
Scott: Her daughter is 14, and a virgin.
Scott: And what?
Rob: And what does that have to do with your 'seed'?
Scott: My partner and I agreed that when her daughter turns 18, I'll fuck her and she'll have my baby.
Rob: Um...I see.
Stop. Rewind. Replay. Stop.
"Jesus," said Dr. X, kind of shuddering at the old tape recorder. "What do you think?"
"I think it's creepy. They're mentally grooming her to be the mother of this guy's child."
"What happens next? Just fill me in."
"I know I'm supposed to be asking about his goals but I was afraid that they might be sexually abusing her," I said. "I asked who else knew about this, and he said no one, just he and his partner. The girl doesn't know and when she turns 18, if she doesn't want to, they won't try to force anything on her. They are just going to simply ask for her to be a surrogate. Is that legal?"
"It doesn't sound like they're doing anything illegal. It's a bit bizarre, but not illegal."
"It's more than bizarre, it's scary to me."
"Hmmm," said Dr. X, rubbing his bearded chin in that clichéd therapist way. "It's like an arranged marriage, like in Eastern cultures."
"No, it's like an arranged fuck, like in fucked-up cultures."
"Let's look at this. This man, you don't like him?"
"I wouldn't say that. There are things about him that I don't like." I said.
"Okay, that's fine. It's not possible to like everything about everyone you work with. But what, specifically, do you not like about him?"
"Dr. X, there's a lot. I don't like that he doesn't take any pride in his health, or his appearance for that matter. He's somewhat crude. No, very crude, and he's mentally screwing a 14 year-old girl until she's of age! Oh, and she just happens to be the daughter of his girlfriend."
"Okay, now think about the study, think about empathy. What is this man experiencing?"
"Rob, get off of your high horse and use your brain for a second."
"Alright," I sighed, "fine. I...I don't know."
"Then instead of simply judging, go back in there next session and find out more about what he is experiencing. Find something in him to love, anything at all. It could be the way he feels about kids, a pet, even a tree. See something in him that is lovable or endearing. This will help you to see him as a whole person, not just a mental pedophile."
Dr. X, the professor who loves everyone. The Ned Flanders of the therapy world.
When Scott came back the following week, I was determined to do more listening and less judging:
Rob: Scott, let's talk more about family, and why you want it so much?
Scott: Fuck man, you don't want a family?
Rob: I don't know, to be honest. But even if I did, I want to know what is appealing to you about it.
Scott: I was always a fat kid. I never had many friends. My mom and dad were real good to me though. I could always defend myself because of my size, but it still fucking hurt, you know? To be made fun of for being fat. My mom and dad could see that it hurt me, and they didn't always know what to do, but every time, every fucking time man, I could count on them to take me out to the park or to the toy store, to buy me a soda or a pack of gum. Sometimes we'd just watch TV together and have popcorn, but we'd be together and I'd be safe. Fucking safe man. My mom always said "being a family man is the best kind of man." And I just knew that I should be a dad, a good dad. When they passed, it fucking hurt, and I only had my girlfriend. I don't know how I got lucky enough to even get her, she's a real sweet lady.
Rob: You don't want to marry her?
Scott: She'd already been married and doesn't want to do that again, said that it's just a piece of paper. I guess I understand that. And she knows I want a kid.
Rob: If she can't have children, why don't you adopt?
Scott: Rob, you think a black couple, unmarried, with hardly any money can adopt a kid? You might be getting a degree, but you are pretty naïve.
Rob: I'm sorry, I didn't mean to assume anything.
Scott: She doesn't want me to leave her for someone else, so she said that we'll see if her daughter would be willing to be my surrogate when the time comes. I know it's not normal, but it's all I can think of right now.
Dr. X stopped the tape. "How do you feel about all of that?"
"I feel like an asshole for being so judgmental. I labeled him as a freak, but he's just someone struggling to find something that will make him happy."
"I don't think that labeling him was an abnormal thing to do, I was thrown off as well at first. That doesn't make it right, but it's part of being human. Did you feel any empathy this second time around?"
"I felt depressed, sort of hopeless for Scott," I said.
"That sounds like empathy to me Rob. Maybe we'll make a Psychologist out of you yet."
"Great," I said, dripping with sarcasm. "What about Scott?"
"You're going to figure out a way to help him get through these emotions. If he can sense that you're no longer naïve and that you understand what he is experiencing, he'll be open to help."
Sure enough, Dr. X's words rang true. Listening closely, using my newly honed skills of empathy, and not being a judgmental and naïve neophyte helped Scott to feel understood and validated. This opened the door for new ways to look at his problems. Scott was ultimately able to move beyond seeing the father/child relationship is purely a "sperm and egg" issue, and embraced the role of stepfather completely, forgoing the plan of surrogate mother. Even though the family he wanted was already there, Scott needed to be able to see it for himself. He also started to take better care of himself, and became a healthier man for it.
For me, the experience really helped me develop my empathy, to the point that I am now able to work with other non-traditional and challenging clients, such as violent patients. I often choose to work with these clients not only because of the challenge, but because many other therapists will not. This is usually for the same reasons that I balked at Scott. It's not uncommon for therapists to see something in clients that they label as morally out of bounds and hesitate or refuse to work with them. This, however, leaves certain populations with fewer options for assistance. Perhaps if there were more teachers like Dr. X in the training rooms, this might not be the case.