Empathy, Challenge, and Psychophysiological Activation in Therapist–Client Interaction

Abstract

Two central dimensions in psychotherapeutic work are a therapist’s empathy with clients and challenging their judgments. We investigated how they influence psychophysiological responses in the participants. Data were from psychodynamic therapy sessions, 24 sessions from 5 dyads, from which 694 therapist’s interventions were coded. Heart rate and electrodermal activity (EDA) of the participants were used to index emotional arousal. Facial muscle activity (electromyography) was used to index positive and negative emotional facial expressions. Electrophysiological data were analyzed in two time frames: (a) during the therapists’ interventions and (b) across the whole psychotherapy session. Both empathy and challenge had an effect on psychophysiological responses in the participants. Therapists’ empathy decreased clients’ and increased their own EDA across the session. Therapists’ challenge increased their own EDA in response to the interventions, but not across the sessions. Clients, on the other hand, did not respond to challenges during interventions, but challenges tended to increase EDA across a session. Furthermore, there was an interaction effect between empathy and challenge. Heart rate decreased and positive facial expressions increased in sessions where empathy and challenge were coupled, i.e., the amount of both empathy and challenge was either high or low. This suggests that these two variables work together. The results highlight the therapeutic functions and interrelation of empathy and challenge, and in line with the dyadic system theory by Beebe and Lachmann (2002), the systemic linkage between interactional expression and individual regulation of emotion.

Commentary on Robin Wooffitt’s Paper “Poetic Confluence: A Sociological Analysis of an Enigmatic Moment”

“…Peräkylä et al 2008;Madill 2015), covering such practices as delivery and reception of reformulations of the patient's talk (Antaki 2008), interpretations (Bercelli et al 2008;Peräkylä 2010 and, mirroring of voice between the therapist and the patient (Weiste & Peräkylä 2014), affiliation ruptures (Muntigl et al 2013;Muntigl & Horvath 2014) and even dream interpretation (Peräkylä & Bergmann in review). Quite recently, the conversation analytical account of psychotherapy has been linked to the measurement of the physiological responses in the participants of therapeutic sessions (Voutilainen et al 2018). I fully agree with Wooffitt that this line of study could be very informative for the intersubjective psychoanalysis.…”

Seeing the Situational Gestalt - Movement in Therapeutic Spaces

“…Cl: It feels a l(hoh)ot unc(huh)omfortable actually (Rae, 2008, p. 64) Rae speaks of 'lexical substitutions' that have the effect that a patient can admit to have downgraded his feelings in his utterances. Such lexical substitutions show that not only therapists do 'understand' (Madill, 2015) that therapists are not simply 'empathic', but they 'challenge' their clients' self-descriptions (Voutilainen et al, 2018). Challenging is the other pole of the continuum.…”

Psychotherapist’s empathic responses to client’s troubles telling/feelings talk in psychotherapy: A conversation analysis

“…Research in CA has begun to shed light on how empathy is practiced by psychotherapists in the context of psychotherapeutic interactions (Hutchby 2005;Voutilainen et al 2018;Peräkylä 2011;Weiste & Peräkylä 2013;Wynn and Wynn 2006). Researchers who examined empathy in psychotherapy under CA framework in past studies reported mostly on a threepart sequence (Muntigl et al 2014;Wynn and Bergvik 2010), examined psychotherapists' practices to express display (Muntigl et al 2014) and tested the effect of empathy on psychophysiological responses in participants (Voutilainen et al 2018). To the best of my knowledge, little work has been done to examine organizational features and turn design of empathy in psychotherapy, and no studies have touched on turn constructions of empathic talk by which psychotherapists convey empathy towards their clients' troubles/feelings talk.…”