Help for the Helper

1. Empathy is a Double-Edged Sword for Helpers

It is my hypothesis that many therapists suffer in their work as a result of unconscious empathy—that is, empathy processes that are outside of the therapist’s awareness and therefore also outside of his control.

Empathy's Central Role. Empathy, the ability to experience what others experience, is the cornerstone of effective psychotherapy. It allows therapists to relate to clients, understand their feelings, and gain insight into their experiences. However, this very tool can become a source of suffering if not consciously managed.

The Pitfalls of Unconscious Empathy. When empathy operates outside of a therapist's awareness, it can lead to various pitfalls, including unmanageable countertransference, projective identification, compassion fatigue, vicarious traumatization, and burnout. Therapists may unconsciously take on their clients' emotions, leading to agitation, sleep disturbances, and strained relationships.

The Need for Professional Separation. To be truly empathetic and useful, therapists must prioritize self-care and maintain a professional separation from their clients. This involves recognizing the risks of the profession and taking proactive steps to mitigate them.

2. Neuropsychological Systems are Key to Therapist Well-being

For a therapist to minimize risks to her emotional and physical well-being, she needs to be able to find ways to balance her empathetic engagement, regulate her ANS arousal, and maintain her ability to think clearly.

Three Essential Systems. Therapist self-care hinges on the proper functioning of three neuropsychological systems: interpersonal empathy, autonomic nervous system (ANS) and arousal regulation, and clear thinking. These systems must work in harmony to ensure a therapist's emotional and physical well-being.

Balancing Empathy. Therapists must find a balance between empathetic engagement and maintaining a professional distance. Unconscious empathy can lead to emotional contagion, where the therapist becomes overwhelmed by the client's feelings.

Regulating Arousal. The autonomic nervous system (ANS) plays a crucial role in managing stress and arousal. Therapists need to be aware of their own ANS arousal levels and develop strategies to regulate them.

Maintaining Clear Thinking. Clear thinking relies on the balanced functioning of all brain structures. Therapists must be able to maintain their ability to think rationally, even in the most distressing situations.

3. Somatic Empathy: The Body-to-Body Connection

Empathy is deeply grounded in the experience of my lived-body, and it is this experience that enables us to directly recognize others, not as bodies endowed with a mind, but as persons like us.

Beyond Cognitive Understanding. Somatic empathy recognizes that empathy is not just a cognitive process but also a physical one. It involves the body's ability to resonate with and mirror the physical states of others.

Mirror Neurons and Emotional Contagion. Mirror neurons, brain cells that reflect the activity of another's brain cells, may play a role in somatic empathy. Emotional contagion, the tendency to "catch" the emotions of others, is another key aspect of this phenomenon.

The Body's Role in Empathy. The body is a central vehicle for emotional contagion, with facial, vocal, and postural mimicry playing a significant role. By unconsciously mirroring another person's physical expressions, we can come to experience their emotions.

4. Mirroring and Mimicry: Walking in Another's Moccasins

[Actively] imitating these movements, we ‘sense’ and understand the expression in ourselves and, consequently, in the patient.

The Chameleon Effect. Humans have a natural tendency to copy facial expressions, postures, and mannerisms, often unconsciously. This "chameleon effect" can facilitate understanding and rapport.

Postural Mirroring. Postural mirroring, the mimicry of another's physical posture, can be a powerful tool for gaining insight into their emotional state. By consciously adopting a client's posture, therapists can get a literal feel for what it's like to be in their skin.

The Risks of Unconscious Mirroring. Unconscious postural mirroring can lead to emotional contagion, where the therapist becomes overwhelmed by the client's feelings. It's crucial to be aware of this process and to consciously choose when to mirror and when not to mirror.

5. The Autonomic Nervous System and Arousal Regulation

[Empathy is] an autonomic nervous system state which tends to simulate that of another person.

The ANS and Stress Response. The autonomic nervous system (ANS) is at the center of the body's response to stress. It prepares the body for fight, flight, or freeze when faced with a threat.

Sympathetic vs. Parasympathetic. The ANS has two branches: the sympathetic nervous system (SNS), which activates under stress, and the parasympathetic nervous system (PNS), which is active during rest and relaxation. Maintaining a balance between these two branches is crucial for well-being.

The Importance of Arousal Awareness. Therapists need to be able to identify the internal cues that differentiate stress from relaxation. This awareness allows them to regulate their arousal levels and prevent compassion fatigue, vicarious traumatization, and burnout.

6. Clear Thinking Requires a Balanced Brain

Our difficulty here is to get one word [countertransference] not to mean as many different things as there are people using it.

The Triune Brain. Paul MacLean's triune brain model describes three brain regions: the reptilian brain (basic life support), the limbic system (emotions), and the neocortex (rational thought). A balance between the neocortex and the limbic system is necessary for clear thinking.

The Amygdala and the Hippocampus. The amygdala acts as an early warning system, while the hippocampus helps to process information and lend context to memories. Stress hormones can suppress the activity of the hippocampus, impairing rational thought.

Somatic Markers and Decision Making. Antonio Damasio's theory of somatic markers suggests that emotions are necessary for rational thought. Body sensations provide cues that guide decision-making.

7. Projective Identification Reconsidered: Taking Charge of Shared Feelings

Our difficulty here is to get one word [countertransference] not to mean as many different things as there are people using it.

Challenging the Traditional View. The theory of projective identification, which suggests that clients can induce specific feelings and behaviors in therapists, can lead to client blame and a sense of helplessness. A more empowering perspective focuses on the therapist's own empathetic responses.

Somatic Empathy as an Explanation. Somatic empathy, including facial and postural mirroring, can account for shared feelings without attributing causation to the client. This puts the therapist in charge of her own emotional experience.

The Importance of Self-Awareness. By becoming aware of their own mirroring tendencies and emotional responses, therapists can control the contagion and maintain a professional distance. This involves recognizing that shared feelings do not necessarily mean that one person caused the feelings in the other.

8. Maintaining Boundaries: The Therapist's Own Chair

Our difficulty here is to get one word [countertransference] not to mean as many different things as there are people using it.

The Image of the Two Chairs. The image of the therapist and client each in their own chair serves as a reminder of the importance of maintaining professional boundaries. When therapists lose themselves in their clients, they are essentially sitting in the client's chair.

The Continuum of Contact. It's important to navigate the continuum of contact, balancing symbiosis and separation. The goal is to be aware of the level of contact you choose, and to adjust it as needed for the benefit of both yourself and your client.

Strategies for Staying in Your Own Chair. This involves a combination of self-awareness, arousal regulation, imagery control, and boundary setting. By mastering these skills, therapists can protect themselves from compassion fatigue, vicarious traumatization, and burnout.

Last updated: March 11, 2025