empathy - The Professional Counselor

A Comparison of Empathy and Sympathy Between Counselors-in-Training and Their Non-Counseling Academic Peers

Nov 10, 2018 | Volume 8 - Issue 4

Zachary D. Bloom, Victoria A. McNeil, Paulina Flasch, Faith Sanders

Empathy plays an integral role in the facilitation of therapeutic relationships and promotion of positive client outcomes. Researchers and scholars agree that some components of empathy might be dispositional in nature and that empathy can be developed through empathy training. However, although empathy is an essential part of the counseling process, literature reviewing the development of counseling students’ empathy is limited. Thus, we examined empathy and sympathy scores in counselors-in-training (CITs) in comparison to students from other academic disciplines (N = 868) to determine if CITs possess greater levels of empathy than their non-counseling academic peers. We conducted a MANOVA and failed to identify differences in levels of empathy or sympathy across participants regardless of academic discipline, potentially indicating that counselor education programs might be missing opportunities to further develop empathy in their CITs. We call for counselor education training programs to promote empathy development in their CITs.

Keywords: empathy, sympathy, counselor education, counselors-in-training, therapeutic relationships

Empathy is considered an essential component of the human experience as it relates to how individuals socially and emotionally connect to one another (Goleman, 1995; Szalavitz & Perry, 2010). Although empathy can be difficult to define (Konrath, O’Brien, & Hsing, 2011; Spreng, McKinnon, Mar, & Levine, 2009), within the counseling profession there is agreement that empathy includes both cognitive and affective components (Clark, 2004; Davis, 1980, 1983). When discussing the difference between affective and cognitive empathy, Vossen, Piotrowski, and Valkenburg (2015) described that “whereas the affective component pertains to the experience of another person’s emotional state, the cognitive component refers to the comprehension of another person’s emotions” (p. 66). Regardless of specific nuances among researchers’ definitions of empathy, most appear to agree that “empathy-related responding is believed to influence whether or not, as well as whom, individuals help or hurt” (Eisenberg, Eggum, & Di Giunta, 2010, p. 144). Furthermore, empathy can be viewed as a motivating factor of altruistic behavior (Batson & Shaw, 1991) and is essential to clients’ experiences of care (Flasch et al., in press). As such, empathy is foundational to interpersonal relationships (Siegel, 2010; Szalavitz & Perry, 2010), including the relationships facilitated in a counseling setting (Norcross, 2011; Rogers, 1957).

Rogers (1957) intuitively understood the necessity of empathy in a counseling relationship, which has been verified by the understanding of the physiology of the brain (Badenoch, 2008; Decety & Ickes, 2009; Siegel, 2010) and validated in the counseling literature (Elliott, Bohart, Watson, & Greenberg, 2011). In a clinical context, empathy can be described as both a personal characteristic and a clinical skill (Clark, 2010; Elliott et al., 2011; Rogers, 1957) that contributes to positive client outcomes (Norcross, 2011; Watson, Steckley, & McMullen, 2014). For example, empathy has been identified as a factor that leads to changes in clients’ attachment styles, treatment of self (Watson et al., 2014), and self-esteem development (McWhirter, Besett-Alesch, Horibata, & Gat, 2002). Moreover, researchers regularly identify empathy as a fundamental component of helpful responses to clients’ experiences (Beder, 2004; Flasch et al., in press; Kirchberg, Neimeyer, & James, 1998).

Although empathy is lauded and encouraged in the counseling profession, empathy development is not necessarily an explicit focus or even a mandated component of clinical training programs. The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2016) identifies diverse training standards for content knowledge and practice among master’s-level and doctoral-level counselors-in-training (CITs), but does not mention the word empathy in its manual for counseling programs. One of the reasons for this could be that empathy is often understood and taught as a microskill (e.g., reflection of feeling and meaning) rather than as its own construct (Bayne & Jangha, 2016). Yet empathy is more than a component of a skillset, and CITs might benefit from a programmatic development of empathy to enhance their work with future clients (DePue & Lambie, 2014).

The application of empathy, or a counselor’s use of empathy-based responses in a therapeutic relationship, requires skill and practice (Barrett-Lennard, 1986; Truax & Carkhuff, 1967). Clark (2010) cautioned, for example, that counselors’ empathic responses need to be congruent with the client’s experience, and that the misapplication of sympathetic responses as empathic responses can interfere in the counseling relationship. In regard to sympathy, Eisenberg and colleagues (2010) explained, “sympathy, like empathy, involves an understanding of another’s emotion and includes an emotional response, but it consists of feelings of sorrow or concern for the distressed or needy other rather than merely feeling the same emotion” (p. 145). Thus, researchers call for counselor educators to do more than increase CITs’ affective or cognitive understanding of another’s experience, and to assist them in differentiating between empathic responses and sympathetic responses in order to better convey empathic understanding and relating (Bloom & Lambie, in press; Clark, 2010).

With the understanding that a counselor’s misuse of sympathetic responses might interrupt a therapeutic dialogue and that empathy is vital to the therapeutic alliance, researchers call for counselor educators to promote empathy development in CITs (Bloom & Lambie, in press; DePue & Lambie, 2014). Although there is evidence that some aspects of empathy are dispositional in nature (Badenoch, 2008; Konrath et al., 2011), which might make the counseling profession a strong fit for empathic individuals, empathy training in counseling programs can increase students’ levels of empathy (Ivey, 1971). However, the specific empathy-promoting components of empathy training are less understood (Teding van Berkhout & Malouff, 2016). Overall, empathy is an essential component of the counseling relationship, counselor competency, and the promotion of client outcomes (DePue & Lambie, 2014; Norcross, 2011). However, little is known about the training aspect of empathy and whether or not counselor training programs are effective in enhancing empathy or reducing sympathy among CITs. Thus, the following question guided this research investigation: Are CITs’ levels of empathy or sympathy different from their academic peers? Specifically, do CITs possess greater levels of empathy or sympathy than students from other academic majors?

Empathy in Counseling

Researchers have established continuous support for the importance of the therapeutic relationship in the facilitation of positive client outcomes (Lambert & Bergin, 1994; Norcross, 2011; Norcross & Lambert, 2011). In fact, the therapeutic relationship is predictive of positive client outcomes (Connors, Carroll, DiClemente, Longabaugh, & Donovan, 1997; Krupnick et al., 1996), accounting for about 30% of the variance (Lambert & Barley, 2001). That is, clients who perceive the counseling relationship to be meaningful will have more positive treatment outcomes (Bell, Hagedorn, & Robinson, 2016; Norcross & Lambert, 2011). One of the key factors in the establishment of a strong therapeutic relationship is a counselor’s ability to experience and communicate empathy. Researchers estimate that empathy alone may account for as much as 7–10% of overall treatment outcomes (Bohart, Elliott, Greenberg, & Watson, 2002; Sachse & Elliott, 2002), making it an important construct to foster in counselors.

Despite the importance of empathy in the counseling process, much of the literature on empathy training in counseling is outdated. Thus, little is known about the training aspect of empathy; that is, how is empathy taught to and learned by counselors? Nevertheless, early scholars (Barrett-Lennard, 1986; Ivey, 1971; Ivey, Normington, Miller, Morrill, & Haase, 1968; Truax & Carkhuff, 1967) posited that counselor empathy is a clinical skill that may be practiced and learned, and there is supporting evidence that empathy training may be efficacious.

In one seminal study, Truax and Lister (1971) conducted a 40-hour empathy training program with 12 counselor participants and identified statistically significant increases in participants’ levels of empathy. In their investigation, the researchers employed methods in which (a) the facilitator modeled empathy, warmth, and genuineness throughout the training program; (b) therapeutic groups were used to integrate empathy skills with personal values; and (c) researchers coded three of participants’ 4-minute counseling clips using scales of accurate empathy and non-possessive warmth (Truax & Carkhuff, 1967). Despite identifying statistically significant changes in participants’ scores of empathy, it is necessary to note that participants who initially demonstrated low levels of empathy remained lower than participants who initially scored high on the empathy measures. In a later study modeled after the Truax and Lister study, Silva (2001) utilized a combination of didactic, experiential, and practice components in her empathy training program, and found that counselor trainee participants (N = 45) improved their overall empathy scores on Truax’s Accurate Empathy Scale (Truax & Carkhuff, 1967). These findings contribute to the idea that empathy increases as a result of empathy training.

More recent researchers (Lam, Kolomitro, & Alamparambil, 2011; Ridley, Kelly, & Mollen, 2011) have identified the most common methods in empathy training programs as experiential training, didactic (lecture), skills training, and other mixed methods such as role play and reflection. In their meta-analysis, Teding van Berkhout and Malouff (2016) examined the effect of empathy training programs across various populations (e.g., university students, health professionals, patients, other adults, teens, and children) using the training methods identified above. The researchers investigated the effect of cognitive, affective, and behavioral empathy training and found a statistically significant medium effect size overall (g ranged from 0.51 to 0.73). The effect size was larger in health professionals and university students compared to other groups such as teenagers and adult community members. Though empathy increased as a result of empathy training studies, the specific mechanisms that facilitated positive outcomes remain largely unknown.

Although research indicates that empathy training can be effective, specific empathy-fostering skills are still not fully understood. Programmatically, empathy is taught to counselors within basic counseling skills (Bayne & Jangha, 2016), specifically because empathy is believed to lie in the accurate reflection of feeling and meaning (Truax & Carkhuff, 1967). But scholars argue that there is more to empathy than the verbal communication of understanding (Davis, 1980; Vossen et al., 2015). For example, in a more recent study, DePue and Lambie (2014) reported that counselor trainees’ scores on the Empathic Concern subscale of the Interpersonal Reactivity Index (IRI; Davis, 1980) increased as a result of engaging in counseling practicum experience under live supervision in a university-based clinical counseling and research center. In their study, the researchers did not actively engage in empathy training. Rather, they measured counseling students’ pre- and post-scores on an empathy measure as a result of students’ engagement in supervised counseling work to foster general counseling skills. Implications of these findings mirror those described by Teding van Berkhout and Malouff (2016), namely that it is difficult to identify specific empathy-promoting mechanisms. In other words, it appears that empathy training, when employed, produces successful outcomes in CITs. However, counseling students’ empathy also increases in the absence of specific empathy-promoting programs. This begs the question: Are counseling programs successfully training their counselors to be empathic, and is there a difference between CITs’ empathy or sympathy levels compared to students in other academic majors? Thus, the purpose of the present study was to (a) examine differences in empathy (i.e., affective empathy and cognitive empathy) and sympathy levels among emerging adult college students, and (b) determine whether CITs had different levels of empathy and sympathy when compared to their academic peers.

Methods

Participants

We identified master’s-level CITs as the population of interest in this investigation. We intended to compare CITs to other graduate and undergraduate college student populations. Thus, we utilized a convenience sample from a larger data set that included emerging adult college students between the ages of 18 and 29 who were enrolled in at least one undergraduate- or graduate-level course at nine colleges and universities throughout the United States. Participants were included regardless of demographic variables (e.g., gender, race, ethnicity).

Participants were recruited from three sources: online survey distribution (n = 448; 51.6%), face-to-face data collection (n = 361; 41.6%), and email solicitation (n = 34; 3.9%). In total, 10,157 potential participants had access to participate in the investigation by online survey distribution through the psychology department at a large Southeastern university; however, the automated system limited responses to 999 participants. We and our contacts (i.e., faculty at other institutions) distributed an additional 800 physical data collection packets to potential participants, and 105 additional potential participants were solicited by email. Overall, 1,713 data packets were completed, resulting in a sample of 1,598 participants after data cleaning. However, in order to conduct the analyses for this study, it was necessary to limit our sample to groups of approximately equal sizes (Hair, Black, Babin, & Anderson, 2010). Therefore, we were limited to the use of a subsample of 868 participants. Our sample appeared similar to other samples included in investigations exploring empathy with emerging adult college students (e.g., White, heterosexual, female; Konrath et al., 2011).

The participants included in this investigation were enrolled in one of six majors and programs of study, including Athletic Training/Health Sciences (n = 115; 13.2%); Biology/Biomedical Sciences/Preclinical Health Sciences (n = 167; 19.2%); Communication (n = 163; 18.8%); Counseling (n = 153; 17.6%); Nursing (n = 128; 14.7%); and Psychology (n = 142; 16.4%). It is necessary to note that students self-identified their major rather than selecting it from a preexisting prompt. Therefore, the researchers examined responses and categorized similar responses to one uniform title. For example, responses of psych were included with psychology. Further, in order to attain homogeneity among group sizes, we included multiple tracks within one program. For example, counseling included participants enrolled in either clinical mental health counseling (n = 115), marriage and family counseling (n = 24), or school counseling (n = 14) tracks. Table 1 presents additional demographic information (e.g., age, race, ethnicity, graduate-level status). It is necessary to note that, because of the constraints of the dataset, counseling students consisted of master’s-level graduate students, whereas all other groups consisted of undergraduate students.

Table 1

Participants’ Demographic Characteristics

Characteristic		n	Total %
Age	18–19	460	52.4
	20–21	155	17.9
	22–23	130	15.0
	24–25	58	6.7
	26–27	36	4.1
	28–29	27	3.1
Gender	Female	692	79.7
	Male	167	19.2
	Other	8	0.9
Racial	Caucasian	624	71.9
Background	African American/African/Black	101	11.6
	Biracial/Multiracial	65	7.5
	Asian/Asian American	40	4.6
	Native American	3	0.3
	Other	25	2.9
Ethnicity	Hispanic	172	19.8
	Non-Hispanic	689	79.4
Academic	Undergraduate	709	81.7
Enrollment	Graduate	152	17.5
	Other	5	0.6
Academic Major	Athletic Training/Health Sciences	115	13.2
	Biology/Biomedical Sciences/Preclinical Health Sciences	167	19.2
	Counseling	153	17.6
	Communication	163	18.8
	Nursing	128	14.7
	Psychology	142	16.4

Note. N

= 868.

Procedure

The data utilized in this study were collected as part of a larger study that was approved by the authors’ institutional review board (IRB) as well as additional university IRBs where data was collected, as requested. We followed the Tailored Design Method (Dillman, Smyth, & Christian, 2009), a series of recommendations for conducting survey research to increase participant motivation and decrease attrition, throughout the data collection process for both web-based survey and face-to-face administration. Participants received informed consent, assuring potential participants that their responses would be confidential and their anonymity would be protected. We also made the survey convenient and accessible to potential participants by making it available either in person or online, and by avoiding the use of technical language (Dillman et al., 2009).

We received approval from the authors of the Adolescent Measure of Empathy and Sympathy (AMES; Vossen et al., 2015; personal communication with H. G. M. Vossen, July 10, 2015) to use the instrument and converted the data collection packet (e.g., demographic questionnaire, AMES) into Qualtrics (2013) for survey distribution. We solicited feedback from 10 colleagues regarding the legibility and parsimony of the physical data collection packets and the accuracy of the survey links. We implemented all recommendations and changes (e.g., clarifying directions on the demographic questionnaire) prior to data collection.

All completed data collection packets were assigned a unique ID, and we entered the data into the IBM SPSS software package for Windows, Version 22. No identifying information was collected (e.g., participants’ names). Having collected data both in person and online via web-based survey, we applied rigorous data collection procedures to increase response rates, reduce attrition, and to mitigate the potential influence of external confounding factors that might contribute to measurement error.

Data Instrumentation

Demographics profile. We included a general demographic questionnaire to facilitate a comprehensive understanding of the participants in our study. We included items related to various demographic variables (e.g., age, race, ethnicity). Regarding participants’ identified academic program, participants were prompted to respond to an open-ended question asking “What is your major area of study?”

AMES. Multiple assessments exist to measure empathy (e.g., the IRI, Davis, 1980, 1983; The Basic Empathy Scale [BES], Jolliffe & Farrington, 2006), but each is limited by several shortcomings (Carré, Stefaniak, D’Ambrosio, Bensalah, & Besche-Richard, 2013). First, many scales measure empathy as a single construct without distinguishing cognitive empathy from affective empathy (Vossen et al., 2015). Moreover, the wording used in most scales is ambiguous, such as items from other assessments that use words like “swept up” or “touched by” (Vossen et al., 2015), and few scales differentiate empathy from sympathy. Therefore, Vossen and colleagues designed the AMES as an empathy assessment that addresses problems related to ambiguous wording and differentiates empathy from sympathy.

The AMES is a 12-item empathy assessment with three factors: (a) Cognitive Empathy, (b) Affective Empathy, and (c) Sympathy. Each factor consists of four items rated on a 5-point Likert scale with ratings of 1 (never), 2 (almost never), 3 (sometimes), 4 (often), and 5 (always). Higher AMES scores indicate greater levels of cognitive empathy (e.g., “I can tell when someone acts happy, when they actually are not”), affective empathy (e.g., “When my friend is sad, I become sad too”), and sympathy (e.g., “I feel concerned for other people who are sick”). The AMES was developed in two studies with Dutch adolescents (Vossen et al., 2015). The researchers identified a 3-factor model with acceptable to good internal consistency per factor: (a) Cognitive Empathy (α = 0.86), (b) Affective Empathy (α = 0.75), and (c) Sympathy (α = 0.76). Further, Vossen et al. (2015) established evidence of strong test-retest reliability, construct validity, and discriminant validity when using the AMES to measure scores of empathy and sympathy with their samples. Despite being normed with samples of Dutch adolescents, Vossen and colleagues suggested the AMES might be an effective measure of empathy and sympathy with alternate samples as well.

Bloom and Lambie (in press) examined the factor structure and internal consistency of the AMES with a sample of emerging adult college students in the United States (N = 1,598) and identified a 3-factor model fitted to nine items that demonstrated strong psychometric properties and accounted for over 60% of the variance explained (Hair et al., 2010). The modified 3-factor model included the same three factors as the original AMES. Therefore, we followed Bloom and Lambie’s modifications for our use of the instrument.

Data Screening

Before running the main analysis on the variables of interest, we assessed the data for meeting the assumptions necessary to conduct a one-way between-subjects MANOVA. First, we conducted a series of tests to evaluate the presence of patterns in missing data and determined that data were missing completely at random (MCAR) and ignorable (e.g., < 5%; Kline, 2011). Because of the robust size of these data (e.g., > 20 observations per cell) and the minimal amount of missing data, we determined listwise deletion to be best practice to conduct a MANOVA and to maintain fidelity to the data (Hair et al., 2010; Osborne, 2013).

Next, we utilized histograms, Q-Q plots, and boxplots to assess for normality and identified non-normal data patterns. However, MANOVA is considered “robust” to violations of normality with a sample size of at least 20 in each cell (Tabachnick & Fidell, 2013). Thus, with our smallest cell size possessing a sample size of 115, we considered our data robust to this violation. Following this, we assumed our data violated the assumption for multivariate normality. However, Hair et al. (2010) stated “violations of this assumption have little impact with larger sample sizes” (p. 366) and cautioned that our data might have problems achieving a non-significant score for Box’s M Test. Indeed, our data violated the assumption of homogeneity of variance-covariance matrices (p < .01). However, this was not a concern with these data because “a violation of this assumption has minimal impact if the groups are of approximately equal size (i.e., largest group size ÷ smallest group size < 1.5)” (Hair et al., 2010, p. 365).

It is necessary to note that MANOVA is sensitive to outlier values. To mitigate against the negative effects of extreme scores, we removed values (n = 3) with standardized z-scores greater than +4 or less than -4 (Hair et al., 2010). This resulted in a final sample size of 868 participants.

We also utilized scatterplots to detect the patterns of non-linear relationships between the dependent variables and failed to identify evidence of non-linearity. Therefore, we proceeded with the assumption that our data shared linear relationships. We also evaluated the data for multicollinearity. Participants’ scores of Affective Empathy shared statistically significant and appropriate relationships with their scores of Cognitive Empathy (r = .24) and Sympathy (r = .43). Similarly, participants’ scores of Cognitive Empathy were appropriately related to their scores of Sympathy (r = .36; p < .01). Overall, we determined these data to be appropriate to conduct a MANOVA. Table 2 presents participants’ scores by academic discipline.

Table 2

AMES Scores by Academic Major

Scale	Mean (M)	SD	Range
Athletic Training
Affective Empathy	3.20	0.80	4.00
Cognitive Empathy	3.80	0.62	3.33
Sympathy	4.34	0.55	2.67
Biomedical Sciences
Affective Empathy	3.12	0.76	4.00
Cognitive Empathy	3.66	0.59	3.00
Sympathy	4.30	0.61	2.00
Communication
Affective Empathy	3.18	0.87	4.00
Cognitive Empathy	3.80	0.62	2.67
Sympathy	4.27	0.69	3.00
Counseling
Affective Empathy	3.32	0.60	3.33
Cognitive Empathy	3.83	0.48	4.00
Sympathy	4.32	0.54	2.00
Nursing
Affective Empathy	3.37	0.71	3.67
Cognitive Empathy	3.80	0.59	2.67
Sympathy	4.46	0.49	2.00
Psychology
Affective Empathy	3.28	0.78	4.00
Cognitive Empathy	3.86	0.59	2.67
Sympathy	4.35	0.65	2.67

Note. N
= 868.

Results

Participants’ scores on the AMES were used to measure participants’ levels of empathy and sympathy. Descriptive statistics were used to compare empathy and sympathy levels between counseling students and emerging college students from other disciplines. CITs recorded the second highest levels of affective empathy (M = 3.32, SD = .60) and cognitive empathy (M = 3.83, SD = 0.48), and the fourth highest levels of sympathy (M = 4.32, SD = 0.54) when compared to students from other disciplines. Nursing students demonstrated the highest levels of affective empathy (M = 3.37, SD = .71) and sympathy (M = 4.46, SD = .49), and psychology students recorded the highest levels of cognitive empathy (M = 3.86, SD = 0.59) when compared to students from other disciplines. The internal consistency values for each empathy and sympathy subscale on the AMES were as follows: Cognitive Empathy (α = 0.86), Affective Empathy (α = 0.75), and Sympathy (α = 0.76).

We performed a MANOVA to examine differences in empathy and sympathy in emerging adult college students by academic major, including counseling. Three dependent variables were included: affective empathy, cognitive empathy, and sympathy. The predictor for the MANOVA was the 6-level categorical “academic major” variable. The criterion variables for the MANOVA were the levels of affective empathy (M = 3.24, SD = .76), cognitive empathy (M = 3.80, SD = .58), and sympathy
(M = 4.34, SD = .60), respectively. The multivariate effect of major was statistically non-significant:
p = .062, Wilks’s lambda = .972, F (15, 2374.483) = 1.615, η²= .009. Furthermore, the univariate F scores for affective empathy (p = .139), cognitive empathy (p = .074), and sympathy (p = .113) were statistically non-significant. That is, there was no difference in levels of affective empathy, cognitive empathy, or sympathy based on academic major, including counseling. Thus, these data indicated that CITs were no more empathic or sympathetic than students in other majors, as measured by the AMES.

We also examined these data for differences in affective empathy, cognitive empathy, and sympathy based on data collection method and educational level. However, we failed to identify a statistically significant difference between groups in empathy or sympathy based on data collection method
(e.g., online survey distribution, face-to-face data collection, email solicitation) or by educational level (e.g., master’s level or undergraduate status). Thus, these data indicate that data collection methods and participants’ educational level did not influence our results.

Discussion

The purpose of the present study was to (a) examine differences in empathy (i.e., affective empathy and cognitive empathy) and sympathy levels among emerging adult college students, and (b) determine whether CITs demonstrate different levels of empathy and sympathy when compared to their academic peers. We hypothesized that CITs would record greater levels of empathy and lower levels of sympathy when compared to their non-counseling peers, because of either their clinical training from their counselor education program or the possibility that the counseling profession might attract individuals with strong levels of dispositional empathy. Participants’ scores on the AMES were used to measure participants’ levels of empathy and sympathy. We conducted a MANOVA to determine if participants’ levels of empathy and sympathy differed when grouped by academic majors. CITs did not exhibit statistically significant differences in levels of empathy or sympathy when compared to students from other academic programs. In fact, CITs recorded levels of empathy that appeared comparable to students from other academic disciplines. This finding is consistent with literature indicating that even if empathy training is effective, counselor education programs might not be emphasizing empathy development in CITs or employing empathy training sufficiently. We also failed to identify statistically significant differences in participants’ AMES scores when grouping data by collection method or participants’ educational level. Thus, we believe our results were not influenced by our data collection method or by participants’ educational level.

Implications for Counselor Educators

The results from this investigation indicated that there was not a statistically significant difference in participants’ levels of cognitive or affective empathy or sympathy regardless of academic program, suggesting that CITs do not possess more or less empathy or sympathy than their academic peers. This was true for students in all majors under investigation (i.e., athletic training/health sciences, biology/biomedical sciences/preclinical health sciences, communication, counseling, nursing, and psychology), regardless of age and whether or not they belonged to professions considered helping professions (i.e., counseling, nursing, psychology). Although students in helping professions tended to have higher scores on the AMES than their peers, these differences were not statistically significant.

One might hypothesize that students in helping professions (especially in professions in which individuals have direct contact with clients or patients, such as counseling) would have significantly higher levels of empathy. However, counseling programs may not attract individuals who possess greater levels of trait empathy, or training programs might not be as effective in training their students as previously thought. Although microskills are taught in counselor preparation programs (e.g., reflection of content, reflection of feeling), microskill training might not overlap with material that is taught as part of an empathy training or enhance such training. Thus, microskill training might not be any more impactful for CITs’ development of empathy and sympathy than material included in training programs of other academic disciplines (e.g., athletic training, nursing).

Another potential reason for the lack of recorded differences between CITs and their non-counseling peers could be that counseling students are inherently anxious, skill-focused, self-focused, or have limited self-other awareness (Stoltenberg, 1981; Stoltenberg & McNeill, 2010). We wonder if CITs might not be focused on utilizing relationship-building approaches as much as they are on doing work that promotes introspection and reflection. Another inquiry for consideration is whether CITs potentially possess a greater understanding of empathy as a construct that inadvertently leads CITs to rate themselves lower in empathy than their non-counseling peers. Further, it is possible that CITs potentially minimize their own levels of empathy in an effort to demonstrate modesty, a phenomenon related to altruism and understood as the modesty bias (McGuire, 2003). Future research would be helpful to better understand various mitigating factors. Nevertheless, we suggest that counseling programs might be able to do more to foster empathy-facilitating experiences in counselors by being more proactive and effective in promoting empathy development in CITs. Through a review of the literature, we found support that empathy training is possible, and we wonder if there is a missed opportunity to effectively train counselors if counselor education programs do not intentionally facilitate empathy development in their CITs.

Counselor training programs are not charged to develop empathy in CITs; however, given the importance of empathy in the formation and maintenance of a therapeutic relationship, we propose that counseling training programs consider ways in which empathy is or is not being developed in their specific program. As such, we urge counselor educators to consider strategies to emphasize empathy development in their CITs. For example, reviewing developmental aspects of empathy in children, adolescents, and adults might fit well in a human development course, and the subject can be used to facilitate a conversation with CITs regarding their experiences of empathy development.

Similarly, because empathy consists of cognitive and affective components, CITs might benefit from work that assists them in gaining insight into areas of strengths and limitations in regard to both cognitive and affective aspects of empathy. Students who appear stronger in one area of empathy might benefit from practicing skills related to the other aspect of empathy. For example, if a student has a strong awareness of a client’s experience (i.e., cognitive empathy) but appears to have limitations in their felt sense of a client’s experience (i.e., affective empathy), a counselor educator might utilize live supervision opportunities to assist the student in recognizing present emotions or sensations in their body when working with the client or in a role play. Alternatively, to assist a student with developing a greater intellectual understanding of their client’s experience, a counselor educator might employ interpersonal process recall when reviewing their clinical work to help the student identify what their client might be experiencing as a result of their lived experience. To echo recommendations made by Bayne and Jangha (2016), we encourage counselor educators to move away from an exclusive focus on microskills for teaching empathy and to provide opportunities to teach CITs how to foster a connecting experience through creative means (e.g., improvisational skills).

Furthermore, the results from this study indicated that CITs possess higher levels of sympathy than of both cognitive and affective components of empathy. We recommend that counselor educators facilitate CITs’ understanding of the differences between empathy and sympathy and bring awareness to their use of sympathetic responses rather than empathic responses. It is our hope that CITs will possess a strong enough understanding between empathy and sympathy to be able to choose to use either response as it fits within a counseling context (Clark, 2010). We also encourage counselor educators to consider recommendations made by Bloom and Lambie (in press) to employ the AMES with CITs. The AMES could be a valuable and accessible tool to assist counselor educators in evaluating CITs’ levels of empathy and sympathy in regard to course assignments, in response to clinical situations, or as a wholesale measure of empathy development. As Bloom and Lambie encouraged, clinical training programs might benefit from using the AMES as a tool to programmatically measure CITs’ levels of empathy throughout their experience in their training program (i.e., transition points) as a way to collect programmatic data.

Limitations

Although this study produced important findings, some limitations exist. It is noted that the majority of participants from this study attended universities located within the Southeastern United States. As a result, the sample might not be representative of students nationwide. Similarly, demographic characteristics of the present study including the race, age, and gender composition of the sample limit the generalizability of the findings.

This study also is limited in that the instrument used to assess empathy and sympathy was a self-report measure. Although self-report measures have been shown to be reliable and are widely used within research, these measures might result in the under- or over-reporting of the variables of interest (Gall, Gall, & Borg, 2007). It is necessary to note that we employed the AMES, which was normed with adolescents and not undergraduate or graduate students. Although we recognize that inherent differences exist between adolescent and emerging adult populations, we believed the AMES was an effective choice to measure empathy because of Vossen and colleagues’ (2015) intentional development of the instrument to address existing weaknesses in other empathy assessment instruments. Nonetheless, it is necessary to interpret our results with caution.

Recommendations for Future Research

We recommend future researchers address some of the limitations of this study. Specifically, we recommend continuing to compare CITs’ levels of empathy with students from other academic disciplines, but to include a more diverse array of academic backgrounds. Similarly, we suggest future researchers not limit themselves to an emerging adult population, as both undergraduate and graduate populations include individuals over the age of 29. Further, researchers should aim to collect data from students across the country and to include a more demographically diverse sample in their research designs.

Additionally, it is necessary to note that limitations exist to using self-report measures (Gall et al., 2007), and measures of empathy are vulnerable to a myriad of complications (Bloom & Lambie, in press; Vossen et al., 2015). Thus, we encourage future researchers to consider using different measures of empathy that move away from a self-report format (e.g., clients’ perceptions of cognitive and affective empathy within a therapeutic relationship; Flasch et al., in press). Another area for future research is to track counseling students’ levels of empathy as they enter the counseling profession after graduation. It is possible that as they become more comfortable and competent as counselors, and as anxiety and self-focus decrease, their ability to empathize increases.

There is agreement in the counseling profession that empathy is an important characteristic for counselors to embody in order to facilitate positive client outcomes and to meet counselor competency standards (DePue & Lambie, 2014). Yet scholars have grappled with how to identify the necessary skills to foster empathy in counselor trainees and remain torn on which approaches to use. Although empathy training programs seem effective, little is known about which aspects of such programs are the effective ingredients that promote empathy-building, and we lack understanding about whether such programs are more effective than simply engaging in clinical work or having life experiences. Thus, we encourage researchers to explore if counseling programs are effective at teaching empathy to CITs and to further explore mechanisms that may or may not be valuable in empathy development.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

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Zachary D. Bloom is an assistant professor at Northeastern Illinois University. Victoria A. McNeil is a doctoral candidate at the University of Florida. Paulina Flasch is an assistant professor at Texas State University. Faith Sanders is a mental health counselor at Neuropeace Wellness Counseling in Orlando, Florida. Correspondence can be addressed to Zachary Bloom, 5500 North St. Louis Avenue, Chicago, IL 60625, z-bloom@neiu.edu.

An Exploration of the Personal Experiences and Effects of Counselors’ Crying in Session

Feb 9, 2015 | Article, Volume 5 - Issue 1

Miles Matise

This article describes a qualitative interview study of 11 counselors’ personal experiences of crying in session with a client and their perception of its effects on the therapeutic relationship. Semistructured interviews with counselors at a mid-sized university in the Midwest found that tears could be an appropriate response to a client’s unique situation and helpful in empathizing with the client. Themes of awareness, empathy, modeling and authenticity as well as implications for counselors are discussed.

Keywords: crying, empathy, self-disclosure, authenticity, therapeutic relationship

Crying is a response that all people have in common and one of the most powerful demonstrations of emotional expression in humans. Darwin’s (1872) early theories of emotions have greatly influenced the significance of studying tears. Emotional expression seems to be universal among humans and the expression of tears is innate, serving an important function for our welfare, as well as a form of non-verbal communication. The words “crying” and “tears” are used synonymously in this study to mean tearing up, as in the eyes filling with tears or running over as an expression of empathy.

Counselors are faced with a variety of emotionally charged situations that at times might be uncomfortable and unpleasant and, as a result, influence counseling behavior during a session. The rationale for this study was based on the paucity of research on counselors’ tearing up as an appropriate form of self-disclosure, when it genuinely and spontaneously occurs and is not the result of the counselor’s unresolved issues.

The main purposes for exploring the phenomenon of counselors’ crying were as follows: (a) to increase counselor self-awareness and reactions in emotionally intense situations, (b) to promote dialogue for counseling supervisors and educators, and (c) to discover the meaning a counselor places on personally significant crying experiences. Cornelius (1981) noted that researchers are a long way from developing a comprehensive theory of crying and that there is a need for more descriptive data before construction of a theory. The current study is a step toward providing such data on the phenomenon of counselors’ crying in session.

Individuals in helping roles are vulnerable to a wide variety of emotionally charged situations, which can be defined situations in which there is high potential for reactionary behaviors. These behaviors can lead to overt expressions, such as crying, screaming, angry outbursts and sometimes seemingly irrational demonstrations of emotion. Emotionally charged situations can be uncomfortable and unpleasant and can induce a state of anxiety, especially in professional situations such as counseling. When a counselor has an emotionally charged response to a client, feelings can intensify, resulting in a spontaneous reaction, even crying. However, a study by Curtis, Matise, and Glass (2003) suggested that crying with clients could be a genuine expression of emotions and facilitate the therapeutic relationship.

Crying has several advantages. Crying is a natural coping mechanism that helps to buffer against the pathogenic effects of stress (Davis, 1990; Frey, Desota-Johnson, Hoffman, & McCall, 1981). Crying not only has certain health benefits (Davis, 1990; Frey, Desota-Johnson, Hoffman, & McCall, 1981) such as relieving stress caused by the buildup of emotions, but also can enhance empathy and facilitate the therapeutic alliance (Horvath, 2001). Waldman (1995) suggested that a counselor’s crying could be therapeutic to a client. According to Frey et al. (1981), emotional stress alters the chemical balance of the human body. When the stimulation of the lacrimal gland in the brain increases due to emotional intensity, it results in the production of tears. Although the social expression of crying has differences in degree, for this study crying is defined as the state of lachrymose secretions pouring from the eyes in response to emotional stimulation.

Crying and Stress in the Counseling Situation

The connection between emotional stress and the biological process suggests that crying is a function of the body to maintain homeostasis by helping to relieve emotional stress. In a study on why adults cry, emotional tears seemed to be associated with tension reduction (Efran & Spangler, 1979). The researchers focused on the recovery aspect of tears and suggested that crying happens when a psychological barrier or perturbation disappears, signifying recovery and adaptation rather than continuation of distress or arousal, thus permitting the system to shift into recovery

Hill, Mahalik, and Thompson (1989) offered two explanations for a counselor’s emotional reaction of crying during a session. The first is self-disclosure, which refers to a counselor’s personal emotional response to the client. When self-disclosure is appropriate, the counselor shares a segment from his or her own life with the client for the purpose of either reassuring or challenging the client’s experience. Yet, the focus in this situation is on the client and not the counselor. When a counselor is in a situation that stirs powerful emotions, self-disclosure can deepen the counselor–client connection or can reflect the counselor’s inability to contain his or her own feelings.

A second explanation for a counselor’s emotional reaction of crying during a session is empathy, which refers to one’s active attention toward the feelings of others (Rogers, 1980). This concept emphasizes the therapeutic function of a counselor’s ability to fully experience the attitude expressed by the client and reflect to the client what he or she is experiencing. Empathy is considered a significant way to enhance and deepen the therapeutic relationship.

Sometimes counselors might discount the behavior of crying as an inappropriate reaction triggered by the experience of anxiety and discomfort or an overly sympathetic response. In order to reduce his or her reaction to an emotionally charged situation, a counselor might emotionally detach from the client in order to quell his or her own discomfort and limit a reactionary response in return. While the intention of this emotional detachment may help the counselor maintain a more objective perspective toward the client’s reaction, the result also may be to limit the counselor’s emotional availability and thus protect the counselor’s own needs over the needs of the client. By detaching, the counselor can unintentionally emotionally abandon the client at a time when the client most needs support.

The Therapeutic Effectiveness of Crying

Few studies have examined the effectiveness of counselors’ crying in session. Waldman (1995) and Counselman (1997) suggested that counselors’ emotional tears could be therapeutic to a client. Waldman (1995) interviewed ten licensed psychologists with at least 5 years of clinical experience each. Each psychologist discussed his or her perceptions and feelings related to an incident in which he or she cried with a client during a session. Waldman found that nine of the participants believed that their emotional tears were helpful in facilitating the therapeutic process. In contrast, one participant reported that emotional crying was the result of personal unresolved issues, which was not helpful to the client. With this in mind, it is possible that counselors’ crying can be the result of the counselor’s own struggles and countertransference. In this instance, objectivity could be lost and the therapeutic relationship hindered. Therefore, counselors might perceive crying as nontherapeutic and even unethical. Nevertheless, Waldman (1995) concluded that crying with clients enhanced the counselor–client connection and facilitated the client’s work in session.

Counselman (1997) conducted a case study exploring the therapeutic effectiveness of a counselor crying in session with a client. She reported on her work with a couple in which the wife was dying of cancer. After several sessions of marriage counseling relating to an affair by the husband, the author described crying when the couple disclosed that the wife’s breast cancer had recurred. Counselman (1997) admitted that her greatest fear was that she would not be able to stop crying and presumably might be viewed as unprofessional. However, she decided that her first priority was to be fully present with the couple, even if this meant crying with them in session. She reported that her willingness to share her emotions with this couple deepened the therapeutic relationship and facilitated the couple’s counseling goals all the way to her client’s death. She also indicated that this self-exposure “was healing for me in the way our work as counselors often is” (p. 237). Corey (2001) suggested, “If you use your own feelings as a way of understanding yourself, your client, and the relationship between the two of you, these feelings can be a positive and healing force” (p. 108).

Men in our society have consistently been taught not to cry and to downplay emotions. Counselors who find themselves on the verge of emotional tears may find the experience more profitable if they have had access to images that portrayed this behavior as acceptable and natural rather than a shameful and weak demonstration of emotions, especially for male counselors (Hoover-Dempsey, Plas, & Wallston, 1986).

Given that much therapeutic work is dedicated to helping clients express their deepest feelings, the lack of research regarding counselors’ tearing up in session lends significance to the study of professionals who encounter emotionally charged situations and their emotional availability to respond in authentic ways without diminishing their credibility.

Methods

Study Design

The present study was informed by life-world phenomenology (Ashworth, 2003) in order to gain information and to give voice to the lived experiences of counselors around the issue of intense emotional experiences in the counseling situation, which sometimes includes crying. A phenomenological approach with oral responses was consistent with the goals of the study and sensitive to the needs of the participants. Phenomenological research originated from Edmund Husserl’s phenomenology philosophy and aims to clarify a person’s lived experience through everyday life situations (Giorgi & Giorgi, 2008). The root of phenomenology is that of intentionality, which allows objects to appear as phenomena because the self and the world are inseparable components of meaning. The idea is to suspend all presuppositions and biases and closely capture an experience within the context that the experience takes place. This is attempted through the three steps of epoche, phenomenological reduction and imaginative variation (Willig, 2001).

Participants and Setting

Potential participants were contacted either by email or in person and asked to volunteer for a brief interview concerning crying with clients while in a session. The criteria for inclusion were based on licensure, certification and experience, as well as the ability to provide full descriptions of one’s personal experiences of crying in session. In total, 11 counselors and professionals with related experience were included in this study. Participants were between 25 and 71 years old; four participants were males and the remainder female. The sample consisted of licensed professional counselors, school counselors, national certified counselors, a licensed marriage and family counselor, and a psychologist, with a combined average of 15 years’ experience in their related fields. The participant’s theoretical perspectives were varied and consisted of the following: cognitive behavioral, family systems, existential, Adlerian and person centered. Open-ended questions provided a general guide to the interviews (see Appendix), while allowing for discussion of relevant material.

Data Collection

Data collection consisted of semistructured interviews varying in length from 30–120 minutes. Interviews were chosen in order to open up topics and receive the participants’ stories of crying in session with clients. Each interview was audio recorded and notes were taken during the interviews to facilitate transcription and future analysis. Repeat interviews were conducted with all but three of the participants, thus contributing to richer descriptions. The following topic areas were covered in the interviews: (1) What issues would make you cry in session? (2) What is your response to a client who starts crying in session? (3) How would crying be beneficial to the therapeutic relationship? (4) How do you keep yourself from crying in session with a client? (For more complete information, see Appendix.)

The data were processed in order to discern meanings and actions by first using a central idea or question relating to the research. The central questions used to guide this analysis were as follows:

What is the counselor’s internal experience of a client who cries in session?

What is the counselor’s internal experience of allowing him or herself to cry in session with a client?

Second, the author and a colleague brainstormed other terms that relate to the central concept of crying. This process led to further questions and terms, such as awareness, empathy, crying as choice, loss, grief, genuineness, control, equality, acceptance and permission. Third, connections were drawn among the various terms based on how the ideas related to each other, until ideas were exhausted about the central topic. Fourth, the findings were summarized and a graphical representation of the data was used to draw themes at face value, rather than explain or interpret at that point. Fifth, the author discussed the findings with a non-biased professional colleague in order to interpret how the data were linked to the big picture, theoretical perspectives and previous literature.

Data Analysis

Following the qualitative guidelines proposed by Creswell (1998) and Moustakas (1994), phenomenological analysis proceeded through several stages. The first was horizonalization of the data, in which the researcher read through the data and identified statements that described how the participants experienced the phenomenon of crying. Moustakas (1994) called these meaning statements and Creswell (1998) called them significant statements. For instance, one participant contributed a significant statement by describing crying as a genuine and spontaneous response:

I see it [crying] as an expression of a deep emotion and a genuine or real thing that happens. The client can see how I’m experiencing what they’ve told me. If that involves crying, that means that’s how I experience their story.

The second stage was transcribing the statements into separate themes. Third, phenomenological reduction was used to group the meaning statements thematically by coding them with short descriptions for each theme. Lastly, imaginative variation was used to vividly capture the textures of the themes. Through intuitive thinking, imaginative variation enables the researcher to derive structural themes from the textural descriptions (Moustakas, 1994). An overall description of the themes that illustrated the essential meaning of the experience was concluded.

Audio-recorded interviews were transcribed verbatim for each participant and the transcripts were analyzed by the author and cross-analyzed for consistency by a professional colleague who was not a member of the counseling profession. All of the interviews were thematically and categorically analyzed for commonalities in the phenomenon of crying, and regular discussions were held to achieve consensus on emerging themes from the descriptive to the analytic stages.

Three main phases of data collection and analysis occurred over the course of 32 weeks. The first phase was an initial analysis that took place during data collection. The second was a content analysis conducted after the study was completed. The final analysis was thematic, in which categories were used to organize contributions.

Categorical analytic procedures described by Creswell (1998) and Merriam (1998) guided analysis of the interview data and narrative questionnaire data, which were combined for analysis. During the interviews, the author bracketed (epoche) experiences that may have contaminated collection, interpretation and analysis of the data. Bracketing is performed by examining possible researcher biases and then setting those biases aside (Moustakas, 1994). This challenge was addressed by the researcher maintaining a journal of thoughts and reactions in order to increase his awareness of and accountability to the process of epoche. Potential researcher biases consisted of the researcher’s personal experiences with crying, his own values and opinions concerning the phenomenon of crying, and his own professional ethics related to crying with a client.

During data collection, there was a continuous cycle in which the researcher read, reread, reflected on and interpreted the data. Constant comparison (Merriam, 1998) was practiced, in which multiple readings of the data set were examined and compared with the next piece of data. Unique responses and isolated situations also were identified and analyzed.

Ethical Considerations

As a professional counselor, the researcher has been conditioned by his training and abides by ethical codes of conduct from professional organizations, most of which do not address the issue of a counselor’s crying in session with a client. These measures were taken during data analysis so as not to interfere with the accurate telling of each participant’s personal experiences of the phenomenon of crying.

Ethical approval was granted by the Internal Review Board of the university where participants were solicited. Participants were asked to consent to a voluntary interview about the nature of their experience of crying in session with a client and notified of the estimated time of participation. The results of the interviews were confidential and no personal identification was requested of the participants.

Procedures to Ensure Trustworthiness

A variety of strategies were used to ensure the credibility, confirmability (validity) and trustworthiness (reliability) of this study. First, a purposeful sample was selected for this investigation to ensure that the participants had a wide range of experiences as counselors in a therapeutic milieu, and in order to increase the probability of participants having experienced the phenomenon of crying in a session.

An audit trail (Lincoln & Guba, 1985) was created to ensure that the participants felt confident that the research data showed a fully accurate description of their experiences of crying in session. Records were kept in the form of raw data (e.g., field notes), data reduction (e.g., summaries of theoretical notes), data reconstruction (e.g., structure of categories, themes, relationships, definitions, conclusions), and process notes (e.g., trustworthiness notes relating to credibility and dependability).

Data triangulation (Thurmond, 2001) was implemented by soliciting feedback from participants during the analysis stage of data collection. The participants’ diversity of experience, theoretical perspectives, demographic variability and length of experience as licensed professionals in their fields helped the researcher gain a clearer understanding of the phenomenon of crying and how it applies to counseling. Participants were allowed to see the interview questions prior to the interview, in order to provide more in-depth and thoughtful answers regarding the phenomenon being investigated.

Member checking was implemented to test the accuracy of the categories, interpretations and conclusions of the researcher with the participants from whom the data were originally obtained. This procedure was conducted informally during the normal course of observation and conversation with the participants at the time of their interviews. A more formal procedure was implemented after the researcher transcribed the interviews and sent them to participants for investigation. After the evaluation stage was complete and themes were established for the phenomenon of crying in session with clients, an email was sent to participants with a summary of the thematic conclusions, soliciting feedback, challenges or additional information from participants.

An external audit was conducted throughout the evaluation and analysis stages, in which the author discussed the data with a colleague who was not a part of the mental health profession. The purpose of choosing this colleague was to have an unbiased person who would not be swayed by training as a counselor and the ethics of the profession. The researcher’s assumption was that mental health professionals would be more prone to accept, tolerate and be nonjudgmental toward clients’ intense emotional experiences, even to the point of crying with them. Another external audit conducted to foster the accuracy and validity of the present study included advising from a faculty member in the applied statistics and research methods department of the university where the participants were sampled.

Results

Through analysis of the participants’ interviews, invariant horizons were identified and themes were extracted and clustered through the reduction process (Moustakas, 1994). Following are textual descriptions of the prominent identified themes that emerged, including awareness, empathy, modeling and authenticity. An examination of participants’ experiences also was extrapolated from the data.

Theme 1: Awareness

Each of the participants spoke about the skill of awareness as a decisive factor as to whether they would cry in session. Awareness was described as a skill that could be learned and used by the counselor, not only to determine whether to cry in session, but whether the voluntary nature of crying as an emotional response could be used to facilitate a therapeutic interaction. One male counselor-participant described crying as follows:

Crying means different things in different cultures. Some cultures and people may see crying as a sign of weakness, whereas others encourage its expression to practice being humble and exercise social kindness. As part of being culturally sensitive, a counselor needs to pay attention and try to explore with the client about this behavior. Crying is like a universal language that involves a list of vocabulary from different cultures and persons.

Awareness was an essential component of whether crying was considered therapeutic for the client. Even though all participants had cried to some degree or another in session, their respective levels of comfort and opinions of what could help counselors-in-training prepare for such emotionally charged issues varied. One participant spoke of not being able to turn her crying on or off, but said that if she felt it was not appropriate because it took the focus off the client, then she tried to block herself from crying or tearing up:

If I cry in session, I open it up and tell the client that this is how I’m experiencing your situation and I’m crying, how does that feel to you? If they say it’s not ok, then I’ll tell them that I’ll try to block it, but I’m not sure if I’ll always be able to.

One interview question asked whether counseling programs could do anything different in terms of preparing counselors-in-training to deal with emotionally intense situations in which crying might occur. There was consensus among more than half of the participants that they had had no formal training in dealing with such emotionally intense situations, largely because this training is not something that can be taught from a textbook. One can read about an issue, but experiencing it is something quite different. To know oneself was said to be more pertinent, in terms of knowing how one would react to a particular situation. All of the participants made this statement, though they had no formal training in dealing with emotionally intense situations in which crying might occur. A male marriage and family counselor stated:

You can read the kinds of things we’re talking about in a book, but I think the best way to teach people is in experiential situations. To have some knowledge that these things are going to happen and that it’s ok to deal with it, that’s the cognitive piece that you can teach people. The emotional piece, that you can’t teach people, is how to handle it.

Another participant, a licensed professional counselor, stated that she was in fact overprepared. She continued, “My master’s program was in the day [1970s] when there was a lot of therapy. It was about intensity and our own comfort with intensity.” She felt that the pendulum had swung too far the other way, stating, “I think we ought to do a lot more personal growth in our [training] programs than we do.”

Theme 2: Empathy

A predominant issue for the participants was that of crying linked with empathy. All participants felt that crying demonstrated a deeper form of empathy toward the client. Empathy is the experience of being in the client’s shoes and tapping into the present felt experience of the situation. One of the most effective ways a counselor can help a client change is to affirm his or her subjective experience. Empathy is an essential skill for helping clients feel that they are being validated and understood (Teyber, 2000). For a counselor, knowing the issues that touch his or her own personal soft spots (countertransference) is important in order to inform a counselor’s interaction with a client. One participant said, “I think it [crying] may be the ultimate empathy, if the tears are genuine. I’m sure Carl Rogers would have cried with clients.” The researcher challenged the participant by asking, “I wonder if he [Carl Rogers] ever did cry with a client?” Her response was as follows:

How could he not, because when we’re really in psychological contact we don’t absorb their stuff; we experience it with them for a short time. I don’t think we leave unscathed. I think clients change from our work with them and we change from our work with our clients.

Empathy points to an invisible element that leads to a deeper connection with an individual. Crying with a client in session, if genuine, was deemed a deeper kind of empathy, beyond words, that demonstrates a validating connection and recognition of the client’s subjective experience.

Theme 3: Modeling

As a result of specialized training, counselors may be regarded as more competent in human relation skills such as emotional expression, and thus bear a responsibility to model positive and appropriate expressions of intense emotions to clients. Modeling relates to how the client interprets and integrates the influence of the counselor’s actions into his or her daily activities of emotional expression. Because of training in interpersonal effectiveness, counselors may be more adept at emotional expression, and thus there may exist a higher expectation from others regarding trained mental health professionals’ reactions to such emotionally intense situations. A school counselor stated:

By acknowledging crying, you don’t have to pull back, because what I’ve seen with therapists is they pull back in an attempt to control it, so they lose contact with the client and the situation. They’re also modeling for the client that it [crying]’s not ok and whatever it is they’re experiencing is not okay to share with other people, because it makes people uncomfortable.

Counselors can have a significant influence on clients and model a corrective emotional experience. If counselors are not to be merely conduits for cultural values, in terms of what the socially acceptable response is for emotional expressions, then a counselor modeling authenticity is most effective when it is a genuine act of responding to an emotionally intense situation.

Theme 4: Authenticity

All participants came from a counseling perspective that was relationally based. One counselor came from a cognitive-behavioral theoretical approach, four came from a family systems perspective, one from an existential approach, one from an Adlerian approach, and the remainder from a person-centered perspective. What these theoretical perspectives have in common is that the relationship with the client forms the foundation of the theory. Being genuine was correlated with authenticity and therapeutic effectiveness. Crying might have an equalizing effect, confirming to clients that the counselor is human and understands their experience.

It was found that among participants the range of and comfort with emotional expression varied by age. Older participants (> 40 years old) with more experience had become more comfortable with the way in which they expressed their emotions. Younger participants (< 40 years old) felt that it was acceptable to cry as long as it was appropriate in their estimation, but were less likely to do so while in session with a client.

A technique called immediacy can have an equalizing effect on the relationship and induce a therapeutic moment by revealing the counselor’s immediate perspective on the situation at hand. One female participant clarified, “Usually when I cry I will say something regarding the tears and have a discussion whether they are helpful or disturbing to the client.” While authenticity is not the sole determining factor of whether or not a counselor cries, according to participants, crying is a strong indicator of the authenticity of a therapeutic interaction. For one counselor, her authenticity took the form of a countercultural response:

When I went to my dad’s funeral, I was thinking, if I don’t cry then they’re going to think something is wrong with me, so I hope I can cry. . . . Sometimes you’re in a situation where you feel it’s expected.

Despite cultural expectations, authenticity represents characteristics that are unique to every individual and is an internal experience of an outward expression. What is a genuine emotional expression to one counselor might look different to another.

Discussion

The outward expression of crying in a counseling session and whether tears flow as a result of a counselor’s unresolved issues versus an empathetic response to a client’s situation is critical for determining the effectiveness of the crying response. The studies reviewed and the participants interviewed varied in their conclusions about whether to cry with a client while in session and whether it is helpful to the client. Whether it is helpful to the client for the counselor to cry with him or her depends upon certain factors, including the degree and timing of the counselor’s tears, the cultural acceptableness of this type of emotional expression, and even gender. There are unforeseen factors that only a counselor can experience with a client based on the conditions of that exact moment. That being said, whether or not to cry with a client is a choice made based on the professional judgment of the counselor.

One way to measure the appropriateness of crying in session with a client is by the generally accepted practices of professionals in the mental health field. A counselor’s professional judgment has some link to the larger profession and the generally accepted practices of other professionals, as long as they adhere to the ethical standards of the prominent organizations of the field. However, this strategy may not always yield a conclusive answer. A counselor’s oath to do no harm should be a guiding factor, as well as obtaining supervision in order to work out these unique situations with clients.

The theme of authenticity and the desire to be oneself in the counseling session was consistent among the participants of this study. It has been suggested that hiding behind technical expertise and leaving one’s genuineness out of the relationship may not create the most therapeutic environment (Corey, 2001). Considerable research indicates that the counseling relationship is more important than technique in predicting client outcomes (Lambert & Cattani-Thompson, 1996; Nelson & Neufeldt, 1996). Thus, counseling by its very nature requires counselors to undertake the difficult task of managing countertransference while maintaining a genuine and open relationship with clients. To be authentic in session may mean to cry with a client or it may not, even if the emotional expression is intentionally held back. There may be no conclusively right or wrong way to be with a client, only a list of ethical guidelines to which to adhere.

Another important concept that is becoming more useful in the field of counseling is mindfulness. Mindfulness is much like this study’s theme of awareness, which the participants in this study recognized as an important aspect of determining whether to cry with a client. Self-awareness is considered not only a vital part of a counselor’s development, but also an important goal for the client who engages in counseling. Mindful attention helps distinguish between distorted thoughts and emotional patterns that entrap, in order to free the counselor (Bennett-Goleman, 2001). By practicing mindfulness, the counselor strengthens personal attention as a protection against being hijacked by a schema or distortion of thoughts. A mindful counselor can be more aware of thought patterns and catch him or herself from reacting to certain stimuli, such as a client’s tears. By not reacting, a counselor can make a wise choice as to the most appropriate response for a given situation. Because a goal of mindfulness is to be more fully present in the moment, a counselor who is mindful may be more aware of the subtleties between the counselor and client and be less judgmental. The mindful counselor may be slightly detached and more objective in an assessment of the situation and therefore less triggered by rogue feelings and judgments, while allowing for clarity of the situation and an authentic emotional response that may include crying.

Conclusion

A lack of clarity remains around the issue of intense emotional experiences in the counseling situation, which often includes crying or tearing up to some degree, as well as a lack of training in counselor education programs to deal with such situations. This study employed methods adopted from the phenomenological research tradition to generate data with which to interpret the crying event. The phenomenological method served as a starting point for exploration, and through this investigation, a rich description of the textural and structural aspects of each counselor’s experience was developed, as well as a final synthesized description of each participant’s unique set of circumstances. The findings of this investigation may prove useful for counseling faculty, supervisors, counselors and other mental health professionals.

Conflict of Interest and Funding Disclosure

The author reported no conflict of interest or funding contributions for the development of this manuscript.

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Appendix

A qualitative interview on personal experiences and effects of counselors’ crying in session.

Tell me why you decided to be a counselor.

Have you ever cried in session with a client? If no, have you ever felt like crying while in session with a client?

What do you think of clients crying in session?

What issues would make you cry in session with a client?

What do you think of other therapists who cry in session?

What is your response to a client who starts crying in session?

What do you do if you feel like crying in session with a client?

What strategies do you use to deal with yourself crying in session?

How would your crying be beneficial to the therapeutic relationship?

How would your crying hinder the therapeutic relationship?

What fears do you have of allowing yourself to cry in session with a client?

How do you keep yourself from crying in session with a client?

How would your controlling your desire to cry affect your relationship with a client?

What else would you like to add?

Miles Matise, NCC, is an Assistant Professor at Troy University. Correspondence should be addressed to 81 Beal Pkwy SE, Fort Walton Beach, Florida, 32548, mmatise@troy.edu.

A Comparison of Empathy and Sympathy Between Counselors-in-Training and Their Non-Counseling Academic Peers

An Exploration of the Personal Experiences and Effects of Counselors’ Crying in Session

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