By Dr. Dale G Larson, Edited by Grace Wilkie
Let’s think a bit together about counseling and therapy, specifically about that classic therapy staple: the empathic reflection.
I write extensively about empathy in The Helper’s Journey and continue to explore its role in counseling. If you think reflection is simply parroting back what your client said, our latest meta-analysis suggests you might be missing the forest for the trees.
Robert Elliott, Arthur Bohart, Peter Muntigl, Olga Smoliak, and I analyzed decades of data examining how therapist reflections impact client outcomes, and the results threw us for a loop.
The data revealed that simply counting how often a therapist reflects has a near-zero correlation with overall success. The overall frequency or quantity of reflections was statistically unrelated to global client outcomes across within-session, post-session, and post-therapy metrics.
Blindly tracking how much you reflect tells us nothing about clinical effectiveness, with two exceptions. More reflections targeting change talk did show meaningful, positive promise. This is when we actively listen for and reflect a client’s desire or reasons for change to help them navigate deep ambivalence.
Also effective when delivered in greater numbers was offering summary reflections in which we connect distinct threads into overarching narratives to provide clarity and session closure.
But if sheer quantity in general doesn’t matter, what does?
The magic happens in what conversation analysts call the empathy sequence. We saw that it is best to think of empathy as a sequence of interactions jointly negotiated by both parties, rather than a one-way therapist intervention.
In this sequence, clients tell their troubles, therapists formulate an empathic response, and then clients confirm or disconfirm the accuracy of the therapist’s response. Reflections typically fail when a therapist makes an inferential leap too far from the client’s stance or under-reflects their emotional intensity.
Based on our research review and clinical experience, we recommend that therapists:
- Listen for and reflect client change talk, especially with clients struggling with ambivalence about self-damaging activities.
- Synthesize via summaries that pull together what you and the client have talked about, and when possible formulate narratives about how their difficulties unfold.
- Anchor your reflections in genuine empathic understanding and positive regard for the client.
- Don’t miss the opportunities for empathic reflections when clients express emotion when telling their troubles or other important experiences.
- Offer empathic reflections particularly when clients are confused or uncertain about their feelings, in order to enhance their self-understanding.
- Reflect not only what the client is saying and feeling but also how intensely they are saying or feeling it, and try to match this intensity in the manner of the reflection.
- Match the delivery of reflections to their distance from the client’s main message: The further away a reflection is from the client’s expressed experience, the more careful, tentative or humble it needs to be.
- Pay close attention to how clients immediately respond to reflections. Treat a client’s subtle hesitations, long pauses, or heavy sighs as clear signs of failed empathy, and pivot immediately to repair the alliance.
- Correct empathic reflections when this happens and perhaps acknowledge having initially missed the client’s meaning or experience.
The recommendations above are quoted and adapted from Elliott et al. (2023b).
Empathy cannot be rushed or quantified.
Step back quietly. Slow, soft, and simple should be the guiding principle. Wait with patience and learn from the client’s immediate reactions. When you maintain your own emotional balance, remain present, and practice these principles, empathy becomes a bridge toward compassion.
Recent research shows that compassionate states do not lead to burnout; rather, they support personal and professional growth in helpers and foster positive change in the people we serve.
So let go of the count, lean into the silence, and allow your empathy to be the bridge that connects you both.
References
Elliott, R., Bohart, A., Larson, D., Muntigl, P., & Smoliak, O. (2023a). Empathic reflections by themselves are not effective: Meta-analysis and qualitative synthesis. Psychotherapy Research, 33(7), 957–973.
Elliott, R., Bohart, A. C., Larson, D. G., Muntigl, P., & Smoliak, O. (2023b). Empathic reflection. In C. E. Hill & J. C. Norcross (Eds.), Psychotherapy skills and methods that work. (pp. 99–137). Oxford University Press