Empathy is something mental health professionals are assumed to have in abundance. We normally take for granted that anyone wishing to be a therapist would have that fundamental quality as it is the cornerstone of proper mental health assessment and treatment. But, while many therapists have sympathy, empathy is not quite so common, particularly in treating individuals with DID.
It is important to understand the differences between sympathy and empathy. Both are necessary to engender and cultivate a therapeutic alliance but they have separate functions and impacts on both therapists and patients. Sympathy is a feeling that engenders warmth in a connection while empathy is something far more active that provokes a much more personal and deeper understanding.
Sympathy is feeling compassion for the hardships that another person has encountered or is currently experiencing. It doesn’t require that you actually understand or can share in some way that person’s experience. It is more like you feel bad that they have had to experience something distressing.
Empathy is actually imagining yourself in the shoes of another person, getting a sense of what their pain might really be by imagining yourself in their circumstances. It is a deeper understanding because, to a greater or lesser extent, you are touching the feelings of another person – not just witnessing them. Sympathy is like seeing the other person’s experience from the outside whereas empathy is like touching the person’s experience from the inside.
While a therapist cannot truly experience the early childhood abuse of their patient, the therapist can seek to truly imagine themselves in the circumstances of their patient at the time of the original traumas. One has to consider as deeply as possible what the terror and pain was for the patient. To do this, you cannot imagine yourself now, as an adult, but rather imagine being a small child under attack by an abuser who is 10 times your size and controls every aspect of your being. Imagine that attacker threatening you or your siblings if you were to say anything about the abuse. Imagine that the attacker is the person who is supposed to be caring for you, the person everyone in the outside world assumes is protecting you. Imagining yourself like that, having only a small child’s limited verbal and physical development, and in that set of circumstances, is one way to generate empathy, to appreciate the intensity of the traumatic experience of a patient.
Doing this on an ongoing basis is a way to cultivate direct empathy for the patient. It is critical to being able to develop the capacity to communicate safety and understanding to the patient in the present. It is this capacity that enables the patient to begin to trust the therapeutic alliance that is so necessary for effective treatment.
In practice, empathy involves sympathy and compassion. So, it is important to enhance those qualities as well. It is not possible to have true empathy for someone injured in a car accident without feeling sympathetic towards their pain as well as feeling the desire to lend a helping hand. Many people, therapists and otherwise, can relate to car accidents and injuries that result from them.
Not so many people, therapists and otherwise, can relate to the circumstances that result in DID – which are much more terrifying. It is the terrifying nature of the abuse experience, happening in early childhood, that sometimes keeps therapists from being willing to fully empathize with their patients. For therapists, one has to be careful with these kinds of empathy exercises because there is a risk of vicarious trauma. I have discussed this further in Volume 2 of Engaging Multiple Personalities as I believe it is a real issue therapists must deal with in their own lives.
Remember that while empathy is the ability to understand another individual’s experience by putting oneself into the other’s place, the therapist must retain their own objectivity. Therapists must be introspective and assess their own reactions to what their patient may have survived. This includes being aware of the therapist’s own fears of vicarious trauma and perhaps fears as to how they themselves might have reacted had they been subjected to that abuse.
As therapists, empathy is perhaps the most crucial quality needed in the establishment of rapport, of a therapeutic alliance. Deep empathy helps our patients to be open to experiencing the therapeutic milieu as safe, as trust-worthy and as having integrity. This is the prerequisite for effective helping relationships, enabling the patients to share their innermost concerns with their therapist to begin and continue in the process of healing.
