95the emotional pressure builds up until we are ready to explode. In this state, our
thought processes are blocked and we are unable to cope. We feel out of control of
ourselves. To regain control, we must first release some of the emotional pres-
sure...” (Geldard and Anderson 1989 , p. 39).
Your own background, abilities, and present situation will affect the ease with
which you can empathize (cf. Miranda et al. 2016 ). Your empathy toward a patient is
impacted by your “empathic capacity, past experience, motivation to empathize, and
affective and cognitive state at the time of the session” (Duan and Hill 1996 , p. 268).
Additional reasons (addressed earlier in this chapter) that empathy is difficult
include:
- Worry that you won’t be able to think of what to say/will lose your train of
thought. - Your own issues get in the way (over-identifying).
- You lack personal experience with a patient’s concern and therefore think you’re
unable to understand. - Fearing you will be overwhelmed by a patient’s emotion.
- Fearing your patient will be overwhelmed.
- Believing you somehow “gave” patients their feelings because you named them.
- Thinking you are responsible for making their feelings stop, for fixing the
reason(s) they feel as they do, etc. - Feeling caught up in the threat—Their story could be your story (see counter-
transference in Chap. 12 ). - Feeling helpless—that your empathy is not enough.
- Thinking you may never be able to stop worrying about/crying about/ruminating
about a particular patient.
Strategies to help you engage empathically with patients include: - Stay as physically relaxed as possible in sessions (deep breathing, relaxed body
posture). - Discuss difficult cases in detail with supervisors.
- Recognize empathy is always necessary and often it is enough.
- Take breaks from your work, when feasible, after a particularly intense case
(even 1 day away can help) (Figley 2002 ). - Do other professional activities in addition to direct clinical practice (e.g., teach-
ing, public education, research). - Maintain your physical health.
4.9.2 Is Empathy Different from Sympathy?
Empathy is not the same thing as sympathy (Clark 2010). Vincent ( 2005 ) differenti-
ates sympathy and empathy. Sympathy involves “feeling toward another,” while
empathy involves “insight into the feelings of another” by “projecting your own
4.9 Typical Concerns About Primary Empathy