Empathy and Sympathy: Therapeutic Distinctions in Counseling

At various times in the treatment process, mental health counselors may inadvertently equate the concepts of empathy and sympathy. This confusion is understandable because there is ambiguity between the two terms that could contribute to miscommunication in counseling. This article clarifies the therapeutic distinctions between empathy and sympathy through the dimensions of aim, appraisal, apprehension, and agreement.






Latest articles from "Journal of Mental Health Counseling":

ACKNOWLEDGMENTS (April 1, 2014)

Integrated Primary Care: Why You Should Care and How to Get Started (April 1, 2014)

Integrated Health Care Best Practices and Culturally and Linguistically Competent Care: Practitioner Perspectives (April 1, 2014)

Lessons Learned from Designing and Leading Multidisciplinary Diabetes Educational Groups (April 1, 2014)

Behavioral Health Training Is Good Medicine for Counseling Trainees: Two Curricular Experiences in Interprofessional Collaboration (April 1, 2014)

Cultural Competency, Culturally Tailored Care, and the Primary Care Setting: Possible Solutions to Reduce Racial/Ethnic Disparities in Mental Health Care (April 1, 2014)

Mental Health Services in Primary Care: Implications for Clinical Mental Health Counselors and Other Mental Health Providers (April 1, 2014)

Other interesting articles:

IN PRAISE OF HOSTILITY: ANTIAUTHORITARIANISM AS FREE SPEECH PRINCIPLE
Harvard Journal of Law and Public Policy (January 1, 2012)

Under the Suns of a Million Everests
The Antioch Review (January 1, 2012)

In the Sparrow Hills
The Antioch Review (April 1, 2012)

"Haven't we heard this all before?": Contingent Faculty and the Unchanging Times
English Studies in Canada (March 1, 2011)

Take It to the Air: Radio as Public Art
Art Journal (October 1, 2011)

Merit Badge
Syracuse New Times (September 15, 2010)

-Ing supplementive clauses and narrative discourse referents
International Journal of English Studies (July 1, 2012)

Publication: Journal of Mental Health Counseling
Author: Clark, Arthur J
Date published: April 1, 2010

As expressions of caring and compassion, empathy and sympathy are sometimes confused by mental health counselors and may mistakenly be equated (Chismar, 1988). Although both involve attempts by a counselor to sensitively respond to what a client is experiencing, there are qualitative differences between the two processes that have therapeutic implications (Clark, 2007). Blurring the distinctions and failing to differentiate empathy from sympathy may contribute to misdirections in the treatment process.

Empathy offers a way for a mental health counselor to grasp the feelings and meanings of a client and convey this understanding to the client (Myers, 2000; Pearson, 1999). In contrast, sympathy is important in human relationships as an expression of concern or sorrow about distressful events in a person's life (Meier & Davis, 2008).

In the counseling and psychotherapy literature, empathy is widely recognized as a prominent variable in the development of a positive treatment relationship (Norcross, 2010; Lambert &Barley, 2002). In terms of the importance of the therapeutic alliance, Ridley and Udipi (2002) found that the quality of the client-counselor relationship was the most significant discriminating factor for predicting treatment outcome. With varying degrees of emphasis, empathy is endorsed and practiced in counseling across a diverse range of contemporary theoretical orientations (Clark, 2007, in press; Cochran & Cochran, 2006).

Although the use of empathy is broadly supported in counseling, it is essential for a counselor to be aware of both its strengths and its limitations (Feller & Cottone, 2003; Kohut, 1982). In particular, empathy is subject to misuse when a counselor semantically confuses empathy and sympathy. The uncertainty is understandable because in research, as in everyday life, lack of specificity in the meaning of the two terms can contribute to treatment misapplications (Aring, 1958; Gruen & Mendelsohn, 1986). The purpose of this article is to differentiate between and clarify the functions of empathy and sympathy in counseling.

THERAPEUTIC DISTINCTIONS BETWEEN EMPATHY AND SYMPATHY

Through the consideration of four comparative dimensions in the counseling experience - aim, appraisal, apprehension, and agreement - it is possible to distinguish empathy from sympathy.

Aim. In counseling, the primary intent in employing empathy is to express understanding of a client, whereas the focus of sympathy is a client's wellbeing in difficult or challenging circumstances (Black, 2004; Wispe, 1986). Empathy emphasizes an active sharing by the counselor of what a client is experiencing while maintaining some level of emotional detachment. In contrast, a counselor's sympathetic response has the more circumscribed function of expressing compassion for an individual's distressful condition or situation (Eisenberg, 2000; Olinick, 1984).

In a counseling example, Stanley, 46, an electrical engineer, expresses feelings of anger and dismay over the possibility of being relocated by his company. He has been an employee at the same manufacturing site for 12 years.

Stanley: I can't believe it. Because of my job, there is a possibility that 1 will have to move with my family to another part of the country. I'm so upset. I don't even want to talk about it.

Counselor (Sympathy): I am so sorry to hear this. Why don't we talk about something else that is less upsetting for you?

In reaction to the client's distress, the counselor demonstrates sympathy as a caring gesture by offering to change the topic of discussion. In this instance, it is not the initial expression of sympathy that is the problem ("I am so sorry to hear this"). It is the fact that the counselor then changes the focus of the session away from the essential issue in order to sympathetically protect the client's well-being and alleviate his immediate discomfort.

In the next example, the counselor communicates empathie understanding by acknowledging what the client is experiencing in a purposeful and sensitive way that may prompt him to continue discussing the troubling topic.

Counselor (Empathy): This is hard for you to talk about, and it doesn't make any sense to you. The prospect of this change seems overwhelming to you at this point.

Certainly, a counselor can get caught up in the feelings of a client in employing either empathy or sympathy. However, as a counselor strives to empathically understand what a client is experiencing while maintaining emotional detachment, this posture potentially provides a broader perspective that extends beyond a client's situational distress. Accordingly, the counselor's empathie understanding may at times evoke a therapeutic direction in the longer-range service of the client.

Appraisal. A counselor's empathy entails attunement with a client's feelings and meanings (Gruen & Mendelsohn, 1986; Pearson, 1999). Through a subjective process, a counselor may appraise a client's functioning by identifying with the person on a transitory basis (Clark, 2007, 2009, in press). In contrast, rather than involving a sharing of experiencing, sympathy instead proceeds from a counselor's judgment of a client's emotional needs. Sympathy is thus a reaction to a client's distress that becomes manifest in mild to intense expressions of feelings of sorrow for the plight of an individual (Gribble & Oliver, 1973; Switankowsky, 2000). A counselor may say, for example, "I'm sorry to hear about your recent loss of your cat." It is appropriate for the counselor to communicate this authentic response, even without a full understanding of the client's feelings toward the cat. In other instances, however, a counselor may express sympathy in a way that excessively focuses on his or her appraisal of the client. Judgmental statements, such as "You sure have it rough," "It pains me to see you going through all of this," or "This is a terrible thing for you," involve an evaluation that primarily reflects the counselor's perceptions.

To continue with the example, Stanley begins to disclose more about the potential effect of moving on his family if he has to change jobs.

Stanley: What this means is that my two kids will be uprooted and have to move over a thousand miles from home. I'm worried sick about what this would do to my children.

Counselor (Sympathy): That's so sad. There are so many things you are worrying about right now. I feel very badly for you.

This response overemphasizes the counselor's personal appraisal of Stanley's situation and diverts the focus of the session away from the client. The onesided line of discussion also inhibits momentum in moving forward with the therapeutic conversation.

In the next statement, the counselor expresses an empathie understanding of the client in a more balanced way that may prompt further discussion.

Counselor Empathy): This move involves a major change in the lives of your children, and it creates uncertainties that are troubling for you.

Although the examples set up a best case situation for empathy and a worst case for sympathy, counselors need to be aware of the possibility of overemphasizing their own reactions when expressing either response. Attempting to accurately evaluate a client's perceptions often facilitates a more open exploration of therapeutic issues.

Apprehension. A deeper way of knowing an individual is more likely to occur when a counselor attempts to empathically understand a client from multiple perspectives (Clark, 2002, 2004, 2007, 2009, in press). For instance, through their identification and imaginative capacities counselors can subjectively apprehend what clients are experiencing. From a different perspective, counselors may employ an interpersonal modality by striving to grasp the verbal and nonverbal communications of a client (Rogers, 1975). In contrast, when expressing sympathy it is not necessary for a counselor to "enter into" a client's experiencing or to have a deeper knowledge of the person in order for the process to be effective (Gribble & Oliver, 1973) - a counselor may only have a general understanding of a client's plight but still be able to be sympathetic.

However, in other instances, if a counselor does not more fully apprehend a client's experiencing and expresses sympathy in a perfunctory or superficial way, misdirections may occur. That is why highly sympathetic expressions, such as "I was a teenager once, and I know what you're going through" or "I went through a divorce, and I know how you feel," are often rejected because clients see them as presumptuous or shallow. Further, unless the counselor has a deeper understanding of a client, it is possible for the client to construe some sympathetic comments, such as "You have an inner strength that you can always call upon" or "Things will improve in time," as trite or too generalized to be valid. Although it certainly is possible for a counselor's employment of empathy to be inaccurate, apprehending a client's functioning from multiple perspectives frequently enhances empathie understanding.

In a continuation of the counseling example, Stanley discusses how he was informed about the relocation plans within his company.

Stanley: I can't believe how they told us about it. Last week, the higher-ups gathered us all together in a room and said that a number of employees would be reassigned to another plant. A couple of hours later, my supervisor told me I was on the list of people who would have to move. What an insult! I've given my heart and soul to my job.

Counselor Sympathy): That's really unfortunate, and I know exactly how you feel. Once when I was in the service, I was called into an office and told that I would be deployed within a month to a new post in a different part of the country.

Although the self-disclosure of a counselor could contribute to therapeutic gain, the technique may prove to be ineffective when counselors assume that their own experience matches or equates to that of the client (Egan, 2010; Ivey, Ivey, & Zalaquett, 2010). It is possible, for instance, that Stanley perceives the counselor's disclosure as focusing more on the needs and personal perspectives of the counselor. Also, for any number of reasons (the counselor was single; the counselor was young; or that's the way it is in the service), Stanley might dismiss or reject the counselor's disclosure.

In the next example the counselor expresses empathie understanding that is grounded in an immediate and extended apprehension of the client.

Counselor (Empathy): It hurts to be treated this way when you feel that you've been a devoted employee for so long.

Apprehending a client's subjective functioning, as in the illustration with Stanley, often involves an attempt to grasp the experiencing of the person within a broader context. Although a counselor may be less than accurate when employing empathy, striving to empathically understand a client's experiencing in a cultural context often lessens this possibility (Miville, Carlozzi, Gushue, Schara, & Ueda, 2006; Ridley & Udipi, 2002).

Agreement. A counselor's accurate and appropriate use of empathy involves expressing an empathie understanding without implying agreement with the client. In contrast, in expressing compassion and commiseration, it is possible for a counselor to sympathetically convey agreement with the views and perspectives of a client (Egan, 2010). With the intent of alleviating distress a counselor may side with a client and support the person's point of view (Szalita, 1976). As an unintended consequence, however, the counselor's perceived agreement with a client may subsequently hinder the exploration of alternative perspectives. It is also possible for a counselor to agree that a client should feel bad, angry, or even hopeless, and this implicit endorsement can contribute to the client's assuming a victim role (Knapp, 2007).

Continuing with the counseling example, Stanley relates additional information about his job relocation:

Stanley: I'm so ticked off about work. This week it got even worse because I found out that unless I take the position in the other plant, I could lose my job altogether. I was informed about this in an e-mail rather than face-to-face. I'm about ready to tell them all where to go.

Counselor (Sympathy): What a terrible way to treat you. How much more can you be expected to take? I don't blame you for being angry and wanting to tell them off.

In this interaction, the counselor intensely affirms the insensitivity of the message; however, it also makes it difficult for Stanley to reverse his confirmed choice without losing face or appearing inconsistent and weak.

In the next exchange, the counselor empathically responds to the client's communication without implying agreement. The counselor also conveys a more balanced and open reaction that seems to capture the client's meaning.

Counselor (Empathy): The prospect of having to either move or lose your job is even more painful for you when your supervisors seem to act in an impersonal way about it.

A counselor's undue expression of sympathy may negatively influence a client by appearing to agree with the client. Agreement with a client may have the detrimental effect of foreclosing the exploration of therapeutic issues.

SUMMARY

When a mental health counselor equates empathy and sympathy, this confusion may contribute to misdirections in counseling. Empathy is a prominent factor in promoting positive treatment outcomes; sympathy has an essential role in human relationships. It is possible to clarify distinctions between empathy and sympathy through the dimensions of aim, appraisal, apprehension, and agreement. A counselor's awareness of the appropriate use of empathy and sympathy has potential to foster therapeutic gain.

References:

Aring, C. D. (1958). Sympathy and empathy. Journal of the American Medical Association, 167, 448-452.

Black, D. M. (2004). Sympathy reconfigured: Some reflections on sympathy, empathy, and the discovery of values. International Journal of Psycho-Analysis, 85, 579-596.

Chismar, D. (1988). Empathy and sympathy: The important difference. The Journal of Value Inquiry, 22, 257-266.

Clark, A. J. (2002). Early recollections: Theory and practice in counseling and psychotherapy. New York: Brunner-Routledge.

Clark, A. J. (2004). Empathy: Implications of three ways of knowing in counseling. Journal of Humanistic Counseling, Education and Development, 43, 141-151.

Clark, A. J. (2007). Empathy in counseling and psychotherapy: Perspectives and practices. Mahwah, NJ: Lawrence Erlbaum Associates.

Clark, A. J. (in press). Empathy: An integral model in the counseling process. Journal of Counseling & Development.

Cochran, J. L., & Cochran, N. H. (2006). The heart of counseling: A guide to developing therapeutic relationships. Belmont, CA: Thompson Brooks/Cole.

Egan, G. (2010). The skilled helper: A problem-management and opportunity-development approach to helping (9th ed.). Belmont, CA: Thompson Brooks/Cole.

Eisenberg, N. (2000). Empathy and sympathy. In M. Lewis & J. M. Haviland-Jones (Eds.), Handbook of emotions (2nd ed., pp. 677-691). New York: Guilford Press.

Feller, C. P., & Cottone, R. R. (2003). The importance of empathy in the therapeutic alliance. Journal of Humanistic Counseling, Education and Development, 42, 53-61.

Gribble, J., & Oliver, G. (1973). Empathy and education. Studies in Philosophy and Education, 8, 3-29.

Gruen, R. J., & Mendelsohn, G. (1986). Emotional responses to affective displays in others: The distinction between empathy and sympathy. Journal of Personality and Social Psychology, 51, 609-614.

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2010). Intentional interviewing and counseling: Facilitating client development in a multicultural society (7th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.

Knapp, H. (2007). Therapeutic communication: Developing professional skills. Thousand Oaks, CA: Sage.

Kohut, H. (1982). Introspection, empathy, and the semi-circle of mental health. International Journal of Psycho-Analysis, 63, 395-407.

Lambert, M. J., & Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 17-32). New York: Oxford-University Press.

Meier, S. T., & Davis, S. R. (2008). The elements of counseling (6th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.

Miville, M. L., Carlozzi, A. E, Gushue, G. V, Schara, S. L., & Ueda, M. (2006). Mental health counselor qualities for a diverse clientele: Linking empathy, universal-diverse orientation, and emotional intelligence. Journal of Mental Health Counseling, 28, 151-165.

Myers, S. (2000). Empathie listening: Reports on the experience of being heard. Journal of Humanistic Psychology, 40, 148-173.

Norcross, J. C. (2010). The therapeutic relationship. In Duncan, B. L., Miller, S.B.E., and Hubble, M. A. (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed., pp. 113-141), Washington, D. C: American Psychological Association.

Olinick, S. L. (1984). A critique of empathy and sympathy. In J. Lichtenberg, M. Bornstein, & D. Silver (Eds.), Empathy I (pp. 137-166). Hillsdale, NJ: The Analytic Press.

Pearson, Q. M. (1999). Integrative empathy: Training counselors to listen with a theoretical ear. Journal of Humanistic Counseling, Education and Development, 38, 13-18.

Ridley, C. R., & Udipi, S. (2002). Putting cultural empathy into practice. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (5th ed., pp. 317-333). Thousand Oaks, CA: Sage.

Rogers, C. R. (1975). Empathie: An unappreciated way of being. The Counseling Psychologist, 5, 2-10.

Seligman, L. (2009). Fundamental skills for mental health professionals. Upper Saddle River, NJ: Pearson Education.

Switankowsky, I. (2000). Sympathy and empathy. Philosophy Today, 44, 86-92.

Szalita, A. B. (1976). Some thoughts on empathy. Psychiatry, 39, 142-152.

Wispe, L. (1986). The distinction between sympathy and empathy: To call forth a concept, a word is needed. Journal of Personality and Social Psychology, 50, 314-321.

Author affiliation:

Arthur J. Clark is affiliated with St. Lawrence University. Correspondence concerning this article should be addressed to Professor Arthur J. Clark, Coordinator, Counseling & Human Development Program, St. Lawrence University, 23 Romoda Drive, Canton, New York 13617. E-mail: aclark@st.lawu.edu.

The use of this website is subject to the following Terms of Use