At various times in the treatment process, mental health counselors may inadvertently equate the concepts of empathy and sympathy. This confusion is understandable because there is ambiguity between the two terms that could contribute to miscommunication in counseling. This article clarifies the therapeutic distinctions between empathy and sympathy through the dimensions of aim, appraisal, apprehension, and agreement.

Expanding on a framework introduced by Carl Rogers, an integral model of empathy in counseling uses empathic understanding through 3 ways of knowing: Subjective empathy enables a counselor to momentarily experience what it is like to be a client, interpersonal empathy relates to understanding a client's phenomenological experiencing, and objective empathy uses reputable knowledge sources outside of a client's frame of reference. Across the counseling process, empathy is integral to treatment strategies and interventions.

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This article suggests considerations and strategies for identifying and modifying a client's defense mechanisms in counseling. A systematic approach to a client's mechanisms of defense contributes to therapeutic gain. Inappropriate counselor responses intensify an individual's defenses and undermine the counseling relationship. Definitions of individual defenses and indicators for identifying the mechanisms are provided. A literature review focuses on the counseling implications of the defenses. The process of defense mechanism modification is illustrated through a case example.

From a humanistic orientation, Carl Rogers (1964) described 3 ways of knowing with reference to empathic understanding: subjective, interpersonal, and objective. In the context of a threefold perspective of knowledge, the author expands on Rogers's conception of empathy. As a consequence of a conceptual change in the direction of empathy, implications for counseling are affected.