79relationship), and a strong working alliance leads to desired therapy outcomes
(Elliott et al. 2011 ; Norcross and Wampold 2011 ). Rubin ( 2002 ) notes that empathy
“...is essential because it fosters a safe, trusting environment and opens up the pos-
sibility of deeper levels of understanding and compassion between patient and thera-
pist” (p. 31). Empathy also builds a “deep emotional connection” between the patient
and therapist (Rubin 2002 , p. 33). Within medicine, clinical empathy plays a key role
in the quality of care received as it allows clinicians “...to fulfill key medical tasks
more accurately, thereby achieving enhanced patient health outcomes” (Neumann
et al. 2009 , p. 339). Gladstein ( 2012 ) speculates that empathy is essential in part
because it encompasses multiple strategies such as actively attending, interpretation,
working in a mutual relationship with patients, and placing patient needs first.
Stone ( 1994 ) asserts that “In counseling relationships we earn the right to say
certain things or use certain interventions. Most troubled individuals do not take
helpers seriously unless they respect them. Respect is not a gift that comes auto-
matically with one’s vocation; it is earned primarily through skillfully establishing
relationships with counselees” (p. 36). Empathy is a critical component of establish-
ing a relationship characterized by mutual respect.
A growing body of literature demonstrates that genetic counselors regard empa-
thy as central to genetic counseling (e.g., Abrams and Kessler 2002 ; Kao 2010 ;
McCarthy Veach et al. 2002a, b; McCarthy Veach and LeRoy 2012 ; Miranda et al.
2016 ; Runyon et al. 2010 ; Wells et al. 2016 ; Zahm et al. 2016 ). Similar to psycho-
logical and medical health fields, within genetic counseling empathy is viewed as
critical to serving patients (Kao 2010 ; McCarthy Veach et al. 2007). For instance, in
Runyon et al.’s ( 2010 ) survey of practicing genetic counselors, one counselor
expressed, “I have learned that I can be an important source of support to others in
devastating emotional states, just by providing a calm and compassionate ‘pres-
ence’” (p. 377).
Duric et al. ( 2003 ) analyzed empathic expression in 111 cancer genetic counsel-
ing sessions and found patients who received more empathic responses to initial
cues about their feelings were more likely to give more feeling cues over the course
of the session. Moreover, patients who received more empathy responses showed a
greater decrease in depression post-session than did patients who received fewer
empathy responses. Importantly, the researchers noted “Patients who may be in
most need of psychological support are not likely to emotionally disclose more than
nondistressed patients during sessions. Therefore, the responsibility should rest
with the clinician for actively eliciting emotional needs” (p. 261). These findings
suggest that when you initiate discussion of patients’ emotions and respond to their
affective cues, patients may more fully express their feelings.
Pieterse et al. ( 2005 ) administered pre- and post-genetic counseling surveys to
cancer genetic counseling patients regarding their needs and preferences, their per-
ceptions of the counseling they received, and genetic counseling outcomes. They
found that 20% of the patients who rated as important “receiving explanations about
(emotional) aspects of counseling and about their own risk of cancer” (p. 31) were
not satisfied with the extent to which these needs were addressed during counseling.
Moreover, they found “addressing counselees’ major needs results in higher percep-
tions of control and, to some extent, in lower levels of anxiety” (p. 33). These find-
4.2 Importance and Functions of Primary Empathy