The Journal of Psychology, 2002, 136 70 Empathy Theory and Practice: A Survey of Psychologists and Counselors ALFRED F. CARLOZZI KAY S. BULL School of Applied Health and Educational Psychology Oklahoma State University LAWRENCE B. STEIN KELLY RAY Counseling Education Program Oklahoma State University LAURA BARNES School of Educational Studies Oklahoma State University ABSTRACT. Psychologists and counselors completed questionnaire devised by the authors to explore the relationships between their extent of endorsement of empathy defini- tions, their use and views of empathy, and their identification with theories of psychothera- py. Results from 565 respondenis suggested that those who identified with humanisticlexpe- Tiential and psychodynamic theories seemed to have similar views of how empathy is defined and viewed and reported that they use empathy more than those with other theoret- ical inclinations. These findings suggest that there is some consistency between theoretical {identification and definition, as well as reported use and views of empathy. Key words: definitions of empathy, empathy and theories of counseling/psychology EMPATHY has been an object of considerable debate among researchers and practitioners. Most of the attention has focussed on what empathy is or how to define it, For example, some argue that empathy is an internal condition ot trait, and others consider it a communication skill (Davis, 1996; Duan & Hill, 1996). It appears that various definitions of empathy are based to some extent on the theories of psychotherapy from which they are derived. For example, in a cognitive-behavioral theory (Beck, Rush, Shaw, & Emery, 1979) empathy is defined as a process that fosters a collaborative alliance; in a humanistic theory Address correspondence to Alfred F. Carlozzi, Graduate College, 202 Whitehurst, Okla- hhoma State University, Stillwater, OK 74078; alear@ okstate.edu (e-mail). 161162_ The Journal of Psychology (Rogers, 1957) empathy is sensing another person’s feelings as if one were that other person. In a psychodynamic theory, empathy is defined as experiencing the inner life of another while retaining objectivity (Kohut, 1984). Hackney (1978) argued that empathy is more an internal condition, a characteristic that depends ‘on qualities intrinsic to one’s personality rather than a communication skill. ‘Though definitions of empathy in the literature are consistent with the theo- ries of psychotherapy from which they are derived, the consistency between prac- titioners’ definitions and their identified theories of psychotherapy has not been examined. Do practitioners define empathy in a manner that is consistent with the theories of psychotherapy they endorse? Given the trend toward eclecticism among psychotherapists and the tendency to value what works regardless of its consistency with theory (Barlow, 1996), it may be presumptuous to assume that there would necessarily be consistency between how they define empathy and their identification with various theories of psychotherapy. The question of how practitioners define empathy and the congruence between these definitions and their identification with various theories of psychotherapy is open to scrutiny. In their reviews of the literature on counseling relationships, Gelso and Carter (1994) and Sexton and Whiston (1994) addressed the connection between theories of psychotherapy and the emphasis placed on the importance of the ther- apeutic relationship. It seems plausible that if there is a connection between one’s theoretical orientation and view of the centrality of the therapist—client relation- ship in psychotherapy, there might also be a connection between one’s theory and the emphasis one places on the importance of empathy. Since Rogers (1957) first described empathy as the most important of the core conditions in the therapeu- tic relationship, it has been considered by many to be a central ingredient in the relationship between therapist and client, indeed a defining factor in what makes a relationship therapeutic. Fischer, Paveza, Kickertz, Hubbard, and Grayston (1975) are the only researchers who have examined the relationship between theoretical orientation and therapist empathy. Their results indicated that therapists’ ability to empathize was not related to their identification with theories of psychotherapy. It is clear that further research is warranted to better und. he importance that thera- pists assign to empathy, how they define and use this therapeutic tool, and how all of this may relate to their identification with theories of psychotherapy. ‘A recent and exhaustive rev ¢ current state of empathy research has concluded that there has been a shift away from studying empathy to investigat- ing other therapeutic factors, such as the working alliance (Duan & Hill, 1996). Nevertheless, Hill and Corbett (1993) argued that although there is disagreement concerning the definition of empathy and the centrality of its importance in the practice of psychotherapy, there is a need to return to the study of empathy. In this study, we explored the relationships between practitioners’ endorse- ‘ment of various definitions, of empathy derived from major psychotherapy theo- ries and their identification with these theories. A second goal was to investigateCarlozi, Bull, Stein, Ray, & Barnes _163 the relationships between reported use and views of empathy and identification with theories of psychotherapy. We raised two questions in this study. What are the relationships between empathy definitions and identification with specific theories? What are the relationships between the reported use and views of empa- thy and identification with specific theories? Method Sample We surveyed 600 psychologists randomly selected from the American Psy- chological Association (APA) and 1,000 counselors from the American Counsel- ing Association (ACA). A total of 565 participants completed surveys, yielding a return rate of 35% (the return rate for APA members was 53.5% and for ACA. members was 24%). In our final sample, 57% were APA members and 43% were from the ACA; 42% were men and 58% were women. Participants’ mean age was 49, Professionally, 38% were counseling psychologists, 22% were clinical psy- chologists, 32% were counselors, and 8% were undefined; 50% held Ph.D. degrees, 14% had Ed.D. degrees, 3% had Psy.D. degrees, 32% had masters degrees, and 14% were undefined. The majority of respondents (52%) were pri- vate practitioners. Instrument and Procedure The survey used in this study consisted of demographic items and questions devised by the authors regarding psychotherapy theory and practice. Respondents rated their endorsements on a Likert-type scale of 5 theoretical orientations and 15 theory-specific definitions of empathy. These definitions were derived from the professional literature and reflect the perspectives of the 5 theoretical orientations (behavioral, cognitive/behavioral, humanisticlexperiential, psychodynamic, and systemic). Also included in the survey instrument were various statements regard- ing the respondents’ use and views of empathy. These included such statements as “Empathy is central to my therapeutic practice”; “As a rule, I have little difficulty ‘putting myself in other peoples’ shoes””; “Therapists should feel what their clients feel”; and “Therapists should show empathy toward their clients.” ‘We mailed a pre-postcard to the selected psychologists and counselors 7 days before the cover letter and questionnaire. The cover letter requested partic: ipation in the study, described informed consent, and briefly described the ques- tionnaire; it was mailed as part of the survey to the selected counselors and psy- chologists. In addition, a stamped, self-addressed return envelope was included, and all responses were promised anonymity. As a reminder, we also mailed a post-postcard 7 days after the questionnaires were sent to increase the likelihood of a good return rate,Results We conducted two sets of analyses to answer the research question “What are the relationships between empathy definitions and identification with spe- cific theories?" The first was a factor analysis of respondents’ ratings of agree- ment with the definitions of empathy. Five factors with eigenvalues greater than 1.0 were rotated to final solution using varimax rotation. These five factors did not align specifically with the five theoretical models. However, two factors with theoretical value were retained because they had the highest factor loadings of the five and seemed (o more clearly distinguish between the various defini- tions of empathy and the theories typically associated with them. These factors were identified as Feeling Focused (e.g., the ability to vicariously experience what others feel) and Communicative Process (e.g., a communicative process of experiencing and responding to another who then feels understood). See Table 1 for the two factors and the loadings associated with each of the definitions. The second method for answering this question used respondents’ ratings of the extent to which they identified with each theory (factor) in two separate full- model regression analyses to predict their scores on the two definition factors (see Table 2). Results of both regression models were statistically significant, although theoretical identification accounted for only about 5% of the variance in the defi- nition factors. For agreement with a feeling focused definition of empathy, identi- fication with humanistic/experiential and psychodynamic theories were significant predictors. Humanistic/experiential and psychodynamic theoretical identifications were significant predictors of a communicative process definition of empathy. TABLE 1 Factor Loadings of Definitions of Empathy Feeling Communicative Definition focused process Vicarious experiencing n 06 Resonating with feelings expressed by others n 08 Experiencing the inner life of others while retaining objectivity 63 00 A trait that enables understanding 30 27 Ability to take another's view 28 14 Collaborative alliance 00 55 ‘Communicative process 02 50 Expression of another's experiences 24 37 Understanding the experiences of others 25 37 Eigenvalue 327 1.84 % of variance 17 84 a 683 621Carlozzi, Bull, Stein, Ray, & Barnes _165 TABLE 2 ‘Multiple Regression Analysis of Empathy Definitions, Definition B t 1 significance R Feeling focused os" Systemic 0035 0.781 435 Cognitive-behavioral 0035 0.633 527 ‘Humanisticfexperiential 0.165 3.612* 000 Psychodynamic 0.131 2.648" 008 Behavioral 0.619 1.517 247 ‘Communicative process 05" Systemic 8.123 0.018 985 Cognitive-Behavioral 0.020 0371 710 Humanistic/experiential 0.162 3.581 .000 Psychodynamic O.1S1 2.283 022 Behavioral 0.193 0.478 633 p<.05. **p <.001. TABLE 3 Factor Loading of Empathy Reported Use and Views Statements Empathy Centrality enhanced by Caring of empathy Empathy Empathy as experience Statement connection to practice as a skill innate ability and training Clients should ccare for the therapist at end of therapy. 95 0 -14 .00 0 Clients should care for the therapist during therapy. 78 ~12 16 00 o1 Therapists should feel what their clients feel 35 =10 -15 09 33 Empathy is central to my therapeutic practice, <1 83 o o7 0 (table continues)166___The Journal of Psychology ‘TABLE 3—continued Empathy Centrality enhanced by Caring of empathy Empathy Empathy as. experience Statement connection to practice as askill innate ability and training Therapists should show empathy towards their clients =04 n AS 09 15 Therapists should care for their clients. 20 34 10 25 13 Thave a natural talent for influencing people. 08 =02 06 St 4 always con- sider a client’s feelings before Tdo something, 00 2 o7 AB 16 Asanule, Lean put myself in ‘other people's shoes. 09 un Az 31 02 Since complet- ing school, my empathic abilities have increased, 0 15 09 12 42 Empathy training was included as part of my therapeutic training 00 03 09 o4 36 Eigenvalue 244 2.10 1.35 127 113 a. 70 66 50 a2 37 ‘To answer the question “What are the relationships between reported use and views of empathy and identification with specific theories?” we conducted two sets of analyses similar to those described earlier. First, a factor analysis was used to identify clusters of statements about views and the reported use of empathy (see Table 3). Five clusters were defined (empathy as caring connection, centrality ofCarlozzi, Bull, Stein, Ray, & Barnes 167 TABLE 4 Multiple Regression Analysis of Reported Use and Views of Empathy and Identification With Theories of Counseling/Psychotherapy Use and view B t 1 significance R Caring connection oor Systemic 04 0.95 34 Cognitive-behavioral 04 0.79 42 Humanistic/experiential -07 151 13 Psychodynamic =00 1.02 86 Behavioral =05 0.05 30 Centrality of empathy 018" Systemic 06 1.21 20 Cognitive-behavioral 02 0.47 65 Humanisticlexperiential 09 215* 03 Psychodynamic 05 1.09 a Behavioral or 013 80 Empathy as a skill ose Systemic =05 -1.08 27 Cognitive-behavioral 10 1.09 06 Humanistic/experiential =I 2.40" 02 Psychodynamic =10 221" 02 Behavioral 1 2.10" 03 Empathy as an innate ability os* Systemic 0.123 0.018 985 ‘Cognitive-behavioral 0.020 0371 710 ‘Humanistic/experiential 0.162 3.581"* 000 Psychodynamic oust 2.283* 22 Behavioral 0.193 0.478 633 Enhanced by experience and training o1* Systemic 02 -0.64 52 Cognitive-behavioral 01 1.95 05 Humanistic/experiential =05 17 24 Psychodynamic -01 031 75 Behavioral 05 1.09 2 Ammount of empathy utilized oa Systemic 25 0.62 54 Cognitive-behavioral 03 0.65 SI Humanistic/experiential 16 3.628" 00 Psychodynamic n 2.39" 1 Behavioral -04 0.88 37 *p <.05. "4p <.001168 _ The Journal of Psychology empathy to practice, empathy as a skill, empathy as an innate ability, and empa- thy enhanced by experience and training). A sixth utilization variable was a sin- gle item that asked respondents to rate the amount of empathy they usually demonstrate in therapy (see Table 4), Extent of agreement with the theoretical models was used in a series of regression analyses to predict views and the reported use of empathy (Table 4). Humanisticlexperiential identification was positively associated with the view that empathy is central to the practice of counseling and psychotherapy. Human- istic/experiential and psychodynamic identifications were significant negative predictors of viewing empathy as a skill that can be acquired and shaped through training, whereas a behavioral orientation was a significant positive predictor of empathy as a skill. Identifications with humanistic/experiential and psychody- namic theories were significant predictors of empathy as an innate ability. Final- ly, humanistic/experiential and psychodynamic identifications were positively associated with a greater degree of reported empathy demonstrated in treatment. Discussion The results of this study suggest that definitions, views, and the use of empa- thy by practitioners are fairly consistent with their degree of identification with specific theories of psychotherapy. Humanistic/experiential and psychodynamic identifications appear (o be related to the endorsement of two broad definitions of empathy: empathy as feeling focused and empathy as a communicative process. It is no surprise, then, that those who endorse these two theories would report that they communicate more empathy in therapy. Humanistic/experiential and psychodynamic identifications were also sig- nificant predictors of agreement with the view that empathy is an innate ability. Those who identified more with humanistic/experiential and psychodynamic the- ries were less likely to view empathy as a skill, whereas those who endorsed behavioral theory were more likely to view empathy as a skill. These findings suggest that there is some consistency between theoretical identification and def- inition as well as the use of and views of empathy. On the basis of these results, those who identify with humanistic/experien- tial and psychodynamic theories seem to have similar views about how empathy is defined and viewed and report that they use empathy more than those with other theoretical inclinations. Although humanistic/experiential and psychody- namic orientations are distinct in many ways, those who endorse these theories appear to place sufficient value on the therapeutic relationship to afford empathy a central role in their work with clients. Its important to underscore that what practitioners report to be the extent to which they use empathy in their clinical work and how much they actually use ‘empathy may not be the same. Indeed, they could be overestimating or underes- timating their use of empathy simply to experience congruence between theirCarlozzi, Bull, Stein, Ray, & Barnes _ 169 theories and associated beliefs about empathy and their views of how empathic they are with their clients. Although it would be difficult to study psychologists’ and counselors’ use of empathy in actual practice, the present study could be extended to include obse vations (live or videotaped) of a random sample of practitioners, with ratings assigned by trained judges to the therapists’ responses, to determine the frequen- cy and even the quality of empathic responses in the course of therapy. These rat- ings could then be compared with the estimations of the use of empathy report- ed by practitioners on a survey such as ours. Such research could provide evidence pertinent to the reports or claims made by counselors and psychologists about their use of empathy in their work with clients. Also, the clients of practitioners could be surveyed regarding their percep- tions of their therapists’ use of empathy to determine the congruency between practitioners’ estimation of how much they empathize with their clients and their clients’ perceptions of how empathic their therapists are in their counseling ot psychotherapy sessions. Such studies are suggested as logical next steps to the research presented here and would extend our understanding beyond the singu- lar perceptions and self-report of counselors and psychologists. This study represents a modest but nevertheless meaningful effort to compre- hend the connections between identification with theories of counseling or psy- chotherapy and definitions, views, and the use of empathy as reported by practi- tioners. 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The Counseling Psy chologist, 22, 6-18, Received November 13, 2000Copyright © 2002 EBSCO Publishing