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Empathy in Group Therapy: Facilitating Resonant Chords, by Alexis D. Abernethy, Ph.D., Joseph T. Tadie, Ph.D., and Bikat Sahle Tilahun, Ph.D. Estimated Time to Complete this Activity: 90 minutes Learning Objectives:  The reader will be able to: 1. Describe differing theoretical approaches to empathy. 2. Discuss the specific challenges of providing empathy in group therapy. 3. Name the unique opportunities that group therapists may use in providing empathy in therapy groups. Author Disclosures: Alexis D. Abernethy, Nothing to Disclose Joseph T. Tadie, Nothing to Disclose Bikat Sahle Tilahun, Nothing to Disclose

INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 64 (4) 2014 ABERNETHY ET AL. EMPATHY IN GROUP THERAPY

Empathy in Group Therapy: Facilitating Resonant Chords ALEXIS D. ABERNETHY, PH.D. JOSEPH T. TADIE, PH.D. BIKAT SAHLE TILAHUN, PH.D.

ABSTRACT Empathy has consistently been identified as an important quality of psychotherapists. Understanding unique ways that empathy emerges in group therapy may assist group therapists in fostering empathy. Rogerian and selected psychodynamic and interpersonal perspectives on empathy are discussed. Group psychotherapy poses a challenge for empathic responding, but also a rich opportunity for utilizing a more varied embodied approach to empathy.

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n addition to warmth, acceptance, and affirmation, empathy has consistently been identified as an important therapist characteristic (Jørgensen, 2004). While the more complicated process of group therapy poses more challenges and potential for misattunement compared to individual therapy, it also offers more opportunities for empathic resonance. In group therapy, two dimensions of therapeutic relationships, relationship and strucAlexis D. Abernethy is Professor of Psychology in the Graduate School of Psychology at Fuller Theological Seminary in Pasadena, California. Joseph T. Tadie is Postdoctoral Fellow at the Aurora Mental Health Center in Aurora, Colorado. Bikat Sahle Tilahun is Psychology Postdoctoral Fellow, Chronic Pain Medicine, at the Cleveland Clinic, Cleveland, Ohio. The authors would like to thank Sean Love and Cari Yardley for their contributions to an earlier phase of this work. We would also like to thank Scott Rutan for his helpful comments.

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tural constructs, have received attention (Johnson, Burlingame, Olsen, Davies & Gleave, 2005). Several relationship constructs have been associated with mixed or positive outcomes in group therapy: group climate, group cohesion, alliance, and empathy (Johnson et al., 2005). Given the added complexity of group structurally and the additional relationship dimensions (i.e., leader-member, member-member, and member-group), does the group therapist need to conceptualize, experience, and facilitate empathy differently than an individual therapist? This is a common question that students raise. Their first impression is that empathy in groups appears different than in individual work. Technically, what they often see is a group therapist responding to one patient’s communication empathically, but not to another member’s communication, at least not immediately. Their initial impression is that this member has not been responded to empathically. This concern regarding reduced individual attention is not uncommon for referring individual therapists. They may fear that their patient may get lost in group therapy and not be attended to fully. Patients may also have a similar concern as to whether they will get sufficient help from a group therapist who is working with other patients simultaneously. Clearly, therapists’ theoretical orientation and personality influence their empathic responses. In cases where most observers might agree that the same empathic responses are not generated in group therapy as they would be in individual therapy, is this because empathy is understood, experienced, and/or communicated differently in groups? Empathy is not conceptualized differently in its core meanings, but the presence of group members complicates but also enriches the opportunity for empathic responding. Instead of a bidirectional process, the group therapist has the additional task of responding to multiple members as well as the group-as-a-whole and facilitating their empathic responding to one another. Reflecting on different perspectives on empathy and considering specific technical challenges and opportunities for group therapists may equip therapists to be more empathic with their group members and assist in preparing patients, referring therapists, and training students for group therapy. In addition, the nonverbal dimensions of empathy are an important focus; they may be



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underutilized and particularly valuable for group work. If empathy can be understood as finding resonance for a single note in individual therapy, then this resonance needs to be extended to a complex chord in group therapy. ROGERIAN PERSPECTIVE ON EMPATHY

Carl Rogers (1975) defined empathy as: entering the private perceptual world of the other and becoming thoroughly at home in it. It involves being sensitive, moment to moment, to the changing felt meanings which flow in this other person, to the fear or rage or tenderness or confusion or whatever, that he/she is experiencing. It means temporarily living in his/her life, moving about in it delicately without making judgments, sensing meanings of which he/she is scarcely aware, but not trying to uncover feelings of which the person is totally unaware, since this would be too threatening. It includes communicating your sensings of his/her world as you look with fresh and unfrightened eyes at elements of which the individual is frightened. (p. 4)

This perspective highlights several key dimensions of empathy: joining by entering the world of the other, becoming very familiar with the other, developing sensitivity to moment-to-moment changes in affect and meaning, moving in a nonjudgmental manner, anticipating the reaction of the other, sharing one’s perspectives unbound by the fears that possess the other, and looking into the patient’s world. Elliot, Bohart, Watson, and Greenberg (2011) emphasize this dimension of anticipating a patient’s communication as comments that focus on what is implicit in a patient’s communication, even if not verbalized. Another important aspect of this description is that it includes cognitive and affective dimensions of empathy, but it also underscores other aspects of perception, including movement and sight. Rogers’s definition immediately surfaces a challenge for the group therapist. How is a group leader able to attend and respond at one time to multiple patients in a group? How does the group leader engage in this process for all group members simultaneously? How does the leader then respond on multiple sensory levels? The leader also faces the additional demand of member-member relationships as well as the group-as-a-whole. In

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an effort to obtain perspectives on empathy that assist in conceptualizing commonalities and distinctions in individual and group therapy, selected definitions will be presented that highlight either the interactional process of empathy, the interpersonal process of empathy, or the nonverbal dimensions of empathy. PSYCHODYNAMIC PERSPECTIVES ON EMPATHY

Tansey and Burke (1985) note two commonly agreed-upon features of empathy: empathy has two components, and it unfolds with deepening levels of awareness over time. Burke and Tansey (1985) argue that a therapist may identify either in a concordant manner with a patient’s projected self-representation or in a complementary manner with a patient’s object representation. This initial component refers to Fliess’s (1942) “trial identification” with the patient. This empathic trial identification matches and is concordant with the patient’s self-representation (Racker, 1957). Tansey and Burke note that concordant identifications that usually involve feelings of warmth and closeness have typically been considered signs of empathy. They argue that a complementary identification, which Racker defines as occurring when the therapist’s self-representation matches the patient’s internalized object representation, may also result in empathy. They caution that concordant identifications do not always result in empathy. In group therapy, not only the leader, but also the members may be responding in concordant or complementary fashion to other members’ communications. These multiple identifications provide more opportunities for empathic responding, but also for misattunement. The therapist needs to attend to his/her concordant identifications, but also the group members’. The definition of empathy is consistent in individual and group therapy, but the experience of empathy may vary with multiple people. Given this common experience, it is helpful to prepare members for the likelihood that they may experience resonance with members but that there also may be a complementary identification. This “as if” experience may be an important opportunity for self-learning and assisting other group members. It is useful to remember that empathy is an unfolding process and instead of providing an immediate response, the therapist’s



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efforts may be directed toward creating a group dynamic that will deepen the member’s self-understanding. Nava (2007) contrasts two clinical objectives that are associated with empathy: comprehension and explanation. Comprehension refers to understanding and conveying the patient’s immediate experience, whereas explanation refers to an accumulated understanding over time that more fully connects with the patient’s past experiences and dynamics. It is not unusual for members to be able to suggest a comprehension type of empathy as they convey understanding of another member’s experience. This expressed sense of understanding from member B, which Member A might not have expected, can be powerful. In a mature working group, members also may offer a limited degree of explanatory empathy, particularly based on their past experiences of this member, even in the context of the group. In individual therapy, there are no others beyond the therapist and patient for empathic reflection. In addition to providing their own empathic responses, group therapists may draw on a dyadic interaction of two members to provide the group member with a potential concordant and complementary response. This is a way that the group can offer an invaluable social microcosm for members. It underscores how the group therapist can orchestrate group dynamics to enhance members’ ability to receive and offer empathic responses. Nava (2007) contrasts classical psychoanalysis, where the analyst does not fully see the patient, with the richness of the face-toface interaction of group therapy, which facilitates the therapists’ ability to sense the emotions of their patients. Work on mentalization reveals that even children have the capacity to sense the feelings and intentions of others (Fonagy & Target, 1998). Research on mirroring helps deepen our understanding of this process. Gallese (2011) describes the “we-centric space” as infants imitate the affective and bodily experiences of caregivers even before there is cognitive understanding of these behaviors. He describes an embodied simulation that is mandatory, pre-rational, and nonintrospective. He summarizes this in the following way: Every time we relate to other people, we automatically inhabit a we-centric space, within which we exploit a series of implicit certainties about the other…this enables us to directly understand

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what the other person is doing, why he or she is doing it, and how he or she feels about a specific situation. (p. 100)

He adds that this understanding occurs on a neural level. Gallese (2011) notes that facial expressions are “directly understood by means of embodied simulation producing an ‘as if’ experience engendered by a shared body state. It is the body state shared by the observer and the observed that enables direct understanding” (p. 95). In highlighting the importance of implicit communication and in her apt description of Anne Alonso’s ability to be fully present in groups, Ulman (2011) underscores Alonso’s attentiveness to the unconscious, but also the importance of an affective attunement that includes the body. Gallese (2009) uses the term “resonance” and describes empathy as the ability to experience interpersonal relationships “at the implicit level of intercorporeity, that is, the mutual resonance of intentionally meaningful sensory-motor behaviors” (p. 523). He highlights the bodily resonance mechanisms that make interpersonal relationships possible. Anne Alonso described an empathic response to a group member that included a vocal and an artistic response as she sang a song to a group member. Sometimes resonance may move beyond metaphorical to literal dimensions. While the song was sung to a member for whom it was particularly salient, this type of intervention likely created strong “resonance” in the group and may have increased the collective attunement of the group to this member. This kind of empathic response has a potentially exponential effect that would not be possible in a dyadic relationship. Nonverbal language of group members sometimes forecasts a forthcoming communication before it is conveyed and allows the therapist to track articulated and unarticulated responses of members and the group-as-a-whole. This nonverbal dimension and embodied attunement is underutilized and should be more fully activated by all, but particularly by group therapists. Tansey and Burke (1985) summarize past work on the sequences associated with therapist empathy and identify three triangular phases associated with processing interactional communications. First is reception, in which the therapist receives communication. Second, the therapist experiences and analyzes this communica-



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tion. Third is communication, in which the therapist contributes what has been internally processed. They purposely use the term “interactional” to refer to verbal and nonverbal communication, as well as a process of mutual and ongoing influence. In their description of the final phase of communication, they specifically describe the role of nonverbal communication in therapists’ empathic communication. For example, empathy can be powerfully conveyed by taking in another’s emotion within one’s body. The nonverbal reflection of this can be more powerful than words. While their discussion focuses on the process of projective identification, emphasizing self-representation and affects, we would add the importance of receiving not only the verbal but nonverbal communications of patients and experiencing and analyzing these communications from an embodied position. Livingston and Livingston (2006) define empathy in the context of groups from a self-psychological perspective. They note that, “when we speak of sustained empathic focus, we are emphasizing the therapist’s active focus on each group member’s underlying feelings and subjective experience” (p. 72). Livingston and Livingston highlight the multiple lenses and diverse choice points that group leaders adopt as they attempt to sustain an empathic focus in groups. The personal and subjective meanings of group events are what we prioritize in a steady and active manner.... It is essential for the therapist to be responsive to and legitimize each person’s subjective experience of events, but often these subjective views clash…. The challenge is to balance sustaining a focus on one person’s experience with an awareness of the other group members and their reactions to this process. Sometimes the deepest work is done… by sustaining a focus on one person’s affective experience in the here-and-now. Other times the focus meaningfully shifts to feelings from the there-and-then (i.e., on genetic material). At still other times, the focus flexibly shifts from one person’s subjective experience to another’s. In all these instances, what is sustained is the emphasis on amplifying and elucidating inner, affective experience. (p. 72)

Livingston and Livingston underscore the challenge of maintaining a focus on the individual member as the leader monitors other members’ reactions. The empathic challenge for group lead-

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ers is complicated by the added dimensions of member-member and member-group connections. Alonso and Rutan (1984) describe how the group provides a healing environment for members. One critical dimension is that members are confronted empathically by equals in an accepting and contained environment. The group therapist focuses on building empathic bridges between members. The therapist is focused on increasing empathy for patients, patients’ empathy for themselves, but also on members’ empathy for one another. Shapiro (1991) refers to this as the process of helping and even teaching members to understand their subjective worlds. He adds that, “The individual therapist is primarily responsible for studying the interplay between the patient and therapist, while the group therapist has the additional responsibility of explaining the respective world views of one patient to another” (p. 220). He notes that the power of group is that patients have the opportunity to internalize the experience of not only being understood but of understanding others. INTERPERSONAL PERSPECTIVES ON EMPATHY IN INDIVIDUAL THERAPY

Empathy is considered to be inherently “interpersonal” and is an important component of individual interpersonal therapy (Goodman, 1992) and interpersonally oriented group therapy (Yalom & Leszcz, 2005). Despite this, empathic expression necessarily appears differently in group therapy than in individual therapy. In order to make this distinction, it is important to understand how empathy functions in individual therapy from an interpersonal perspective. In the interpersonal theoretical model, analyzing the experiences and bi-directional interactions between two individuals is considered a primary mechanism in individual therapy. These interactions refer to mutually exploring the relational/interactional factors that impact both the patient and the therapist in the course of therapy. An example of this is found in Sullivan’s (1953) concept of consensual validation, which refers to the therapist and patient mutually investigating the meaning of particular verbal or nonverbal behaviors in therapy. In seeking to



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establish a common understanding of such behaviors, each party must empathically seek to discern the perspective of the other. Therapeutic rapport rests on the strength of the relationship and the ability of the therapist to identify authentically the individual as well as the mutually shared experience of the process. Thus, in order to make accurate appraisals, the therapist must be sensitive to the perceptions of the patient as well as to how such perceptions impact the patient’s emotional experience. Working to understand these perceptions allows the therapist to recognize the patient’s experience as valid within the interpersonal relationship, and then to communicate such understanding through verbal or nonverbal means. In the therapeutic process, there are points where the patient and therapist experience convergence in their perceptions, and other points where they encounter divergence, or empathic failure (Mordecai, 1991). Empathic failure refers to emotional or affective misattunement to the patient’s experience in the context of the interpersonal interaction. Such misattunement is inevitable in the course of therapeutic interaction and can represent a disruption in the therapeutic relationship. For some patients and situations, such failures can be tolerated more easily and be repaired through basic clarifying inquiries that restore empathic resonance. In other cases, the misattunement may create a rupture in the relationship that requires more intensive interpersonal reparation that might focus on exploring the implications the misattunement has for the patient’s self-perception. Thus, the therapist must be prepared for empathic failure and conscious of the meaning it has for the patient as well as the relationship as a whole. Empathy has clear relevance for management of the therapeutic relationship in an interpersonal model. Moreover, when therapeutically engaging interpersonal issues such as parataxic distortions of self based primarily on internal fantasy (Sullivan, 1953), empathy can be a connective “thread” as these perceptions are modified through comparing the patient’s self-perception with that of the therapist. Utilizing this empathic thread allows the patient to be heard, understood, and engaged with in a way that deepens self-awareness and relationship functioning. These notions are based primarily on interactions in an individual therapy

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context, yet they serve as a foundation for empathy in interpersonally oriented groups. EMPATHY IN INTERPERSONALLY ORIENTED GROUPS

Yalom and Leszcz (2005) asserted that for group therapy to be successful, empathy (as expressed by the therapist as well as group members) is a necessary component. They argue that, Both the underlying meaning of the individual’s behavior and the impact of that behavior on others need to be revealed and processed if [group] members are to arrive at an empathetic understanding of one another. Empathetic capacity is a key component to emotional intelligence and facilitates transfer of learning from the therapy group to the patient’s larger world. (p. 43)

Yalom & Leszcz view empathy as foundational to constructing a culture of understanding within the group context. Moreover, the implication is that learning how to relate empathically to others within the group will generalize to a patient’s larger context in a way that fosters interpersonal competency. As empathy is a crucial part of this therapeutic process, the question remains as to how it manifests itself in group, given the added complexities of this setting. The group therapist plays a key role by modeling empathy for the group, although it will necessarily appear differently given that group therapy is not bi-directional but, rather, multi-directional. In bi-directional interactions, verbal expressions of empathy are common, as they are clear and direct ways of communicating attunement. Nonverbal expressions of empathy (e.g., facial expressions, head nodding) are also useful but are not necessarily the sole means of empathic expression. Settings that foster multi-directional interactions such as group therapy are vastly more complicated because the therapist is required to manage many different relationships, experiences, and interactions. Allen (1982) highlighted the importance of nonverbal attending for group counselors. He drew on Berne’s work (1966) that emphasized the importance of not only sight, but of all senses, including smell, taste, touch, and hearing for increasing therapists’ ability to attend to their patients. He argued that “multiple attending” is



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a critical skill for the group therapist where the group is scanned regularly and partial brief impressions are collected to form a sense of the whole. Through “multiple-attending,” the therapist makes a deliberate attempt at maintaining a simultaneous awareness of the process and experience of all group members. Allen (1982) has stated that multiple attending is a necessary element in all group theoretical modalities and is the most effective way to develop rapport, establish trust, and communicate empathy. Because of the increased complexity of multi-directional interactions, a group therapist must be adept at utilizing empathic expression in a way that is conducive to multiple attending. Nonverbal empathy becomes increasingly important because it is a recognizable, but less direct, form of empathic expression. This allows it to be a more efficient way to communicate attunement because it requires less verbal interruption. Overusing verbal empathy in group can have a number of undesirable outcomes. One possibility is that excessive verbal empathy can inadvertently limit the potential for engaging group dynamics because the verbal exchange between one group member and the leader can create a dyadic subgroup as the interaction becomes bi-directional without leaving space for other members. The following illustration highlights how this potential dynamic can emerge. Case Example 1

A therapist was co-leading a process group on an acute inpatient psychiatric unit at a local hospital. The group consisted of approximately seven individuals of varying ages and diagnoses. The group began in typical fashion with an open sharing time when group members could discuss any desired topic or experience they wished to disclose. Various members shared information associated with how each of them were feeling that day as compared to the previous day, but there was little deep or emotional content. About ten minutes into group, one patient began to share his reason for admission (suicide attempt) and began to describe the feelings of guilt he was experiencing as a result. The therapist offered a number of verbal empathic reflections as the patient spoke. This continued for perhaps ten minutes when

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the therapist noticed that the rest of the group appeared to be disengaged. Case Discussion. Although there could have been several explanations for this, the therapist observed that because he had continued offering verbal empathic responses, he had created a dyadic subgroup where he and the patient were interacting but without space for group involvement. The other members were observers of this therapeutic work and unable to participate as a group. The therapist began to transition his empathic expressions from primarily verbal to nonverbal responses. This increased contemplative silence in the group that translated into more opportunities for group interaction. Members themselves began to empathize with the patient while also incorporating their own reflections and experiences. Nonverbal empathy preserved the benefits of communicating attunement, but also invited the entire group to engage in the interpersonal process generated by the suicidal member’s sharing. Scanning the group to sense their degree of connection and identification with the member’s communication and noting bodily position and facial expressions provided the group therapist with rich information for empathic resonance in the group and increased opportunities for others to enter the group process and actively contribute. As members actively participate in the group-generated culture of empathic understanding, they are able to attune to others while also reflecting on their own needs and reactions. Lack of group cohesion limits an empathic atmosphere in group. Thus, it is essential that group members be invited not only to share their own material, but also to participate in communicating empathy to others. Leaders can encourage this through modeling verbal and nonverbal empathy. They may also make group-oriented process comments that allow group members to align with a common experience/emotion and encourage empathic resonance. This can be beneficial from an interpersonal theory standpoint, as there are now numerous relational avenues for the expression of empathy, disruption of parataxic distortions, repairing of empathic failures, and exploration of interpersonal patterns of interaction. One way of accomplishing this might be to invite a group member to reflect on a personal experience while listening to other group members share. This acti-



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vates self-reflection for an individual that can increase awareness of internal experience and understanding of another member. This approach is likely to generate both empathic attunement and failure, but the group setting allows each of these potentialities to be contained and explored. In case of empathic failure in group, there are opportunities to collectively contribute to the process of reattunement. This can occur as members explore reactions to misattunement with others through feedback or observations from the rest of the group. The next case example offers a practical look at how this can occur. Case Example 2

In the same setting as the previous case example, a group was coled on a different day. This group had a generally depressed tone as patients shared a variety of past painful experiences. During a silence approximately halfway into group, a patient who had not yet spoken that day shared that he had broken up with his girlfriend before admitting himself to the hospital. The therapist, operating on cues from the earlier group process, offered an empathic reflection that the patient seemed to be feeling sad about the break-up. A few of the other members used nonverbal expressions (nodding, sad/concerned facial expressions) to echo their agreement. The patient, however, stated that he was not sad but was relieved to have the burden of this relationship off his shoulders so he could discontinue a pattern of the dysfunctional relationship that contributed to his depression. He also said he felt upset because the therapist and the group did not “get” him. The therapist acknowledged his experience and then attempted to repair/reattune by asking the patient to clarify his feelings. The patient did so, and as he explored his recent break-up more deeply, other group members were able to empathize with his experience of feeling trapped within negative situations and relationships. Case Discussion. This reattunement allowed the patient to more openly share and self-reflect in the re-established culture of understanding. Moreover, the therapist and other patients were able to empathically join with him in his experience. Individual members will be the focus in group sessions, but the members

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also function as a collective entity. Thus, it is important to ensure that individual members do not become the sole focus, at the expense of the group as a whole. The same is true for empathic expression, as the therapist seeks to be aware of the interpersonal dynamics in group to ensure smooth transitions from focus on an individual to the group. Exploration of an individual’s perception of self can be usefully engaged through interactions with other group members and when members can also integrate expressed empathy into the process. The result is that a foundation of trust and attunement solidifies. Vignette

Therapist: Where shall we start? Carl: Well, I’m glad I’m here right now because I’ve had a difficult day today. The vice president of my company really got on my case this morning and he said he didn’t know why we didn’t have our presentation ready. I was so angry that I had to leave the office and go to a coffee shop so I wouldn’t lose control and really tell him how I felt. (leans forward and clinches his fists) Therapist: (adopts a facial expression that conveys some of the intensity of his affect and visually scans other group members to assess their responses) Susan: You’re not the only one angry, Carl. (raises her voice) I think a lot of us have had some stuff to be angry about. Only my problems are at home. I left the office stuff behind when I sold the business. Maily: I don’t usually get angry at work like Carl says he does. But I don’t know what you’d call it. I get an upset stomach and I have to find a secluded spot to sit down and relax. I feel like my heart is beating too fast. Just yesterday, in the ER, they brought in a little girl, about five years old, who had been in a really bad accident. She was in really bad shape and I thought I was going to have a heart attack. I couldn’t take it. I think it was a panic attack. (starts to blush) Alex: (sitting quietly with his hand over his eyes) Therapist: (with sensitive tone) I can sense a lot of anger, anxiety, and frustration right now. Carl, as you describe your ordeal with



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your boss, you are clenching your fists and leaning in more and more. Susan, you raised your voice when you discussed your day. Maily, you seemed to have a little bit different response to what is being discussed. I wonder if anyone has feelings about what is happening in group right now.

Commentary. The therapist could have made each of the above comments following each individual communication. By bundling these affects together, something may be lost from the opportunity for individual attunement, but the group members seem to respond in kind to negative affect. Some member-tomember empathy was occurring. Here the therapist attunes to this collective process, highlighting the nonverbal dimensions, but still notes the individual contributions. Later in the session: Jenna: For once my office assistants got everything done on time today. Usually they seem to forget things and I had another one quit last week. But today, they actually did their job (leans forward a little and fidgets with a tissue in her hand). Today was fine. Therapist: You know, Jenna, as you are saying that today was fine, I can see that you were fidgeting with a tissue and starting to lean in. Also, Alex, you haven’t said anything yet and I noticed that your eyes have been covered the whole time. Alex: You know I don’t like to start the conversation. I didn’t feel like I had anything to say just now. Therapist: (with thoughtful nod) You have let me know how you feel about starting things. Alex: Well, yeah. I want to stay out of the conversation because it doesn’t pertain to me. Why would I want to talk about my day? Nothing happened today. (raises his voice a little)

Commentary. The therapist also practiced “multiple attending” (Allen, 1982) in which he observed each member’s expressions, body language, and mode of speaking. One view of the therapist’s comments could be that they are confronting resistance in these interactions. Another way of understanding this process might be that Jenna’s verbal content reveals some dimensions of her experience, but it is unclear what “fine” means. Her nonver-

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bal communication may be viewed as contradicting her words and inconsistent with her affect. The therapist might use his/her own body to assess whether there is resonance with increased tension or guarded relief as he listens to and looks at this patient. He then might bring this experience into the room as an empathic reflection. IMPLICATIONS

Burke and Tansey (1985) highlight some of the issues in the debate about the teachability of empathy. Greenson’s (1960) position is that you cannot teach the capacity for empathy, but misuses of empathy could be addressed. Greenson has identified two categories of disturbance of empathy for therapists: inhibition and lack of control. A therapist may not be able to feel with the patient and may not have the personal flexibility to entertain trial identifications. Another challenge would be if the therapist’s emotional reaction does not result in greater empathy but in an unanalyzed countertransference reaction. For example, the therapist may not have sufficient regulatory mechanisms to contain the affects and impulses that such identifications evoke. Insightoriented psychotherapy is one approach for addressing this. Burke and Tansey offer another perspective on empathic disruptions with implications for teaching empathy. They argue that delineating interactional communication helps to clarify where empathic failures occur. For example, some therapists may have difficulty with being silent, especially in group where pressure is heightened. Psychotherapy training typically provides modeling for how to craft verbally empathic interventions, but it provides less modeling for how to respond with empathic silence and associated nonverbals. Burke and Tansey suggest that while empathic disruption may be due to countertransferential issues that need to be addressed in therapy, these disruptions may also be related to the therapist’s inadequate knowledge and experience in processing interactional communications. What is gained by highlighting similarities and differences in empathy between individual and group therapy? Therapists, students, supervisors/consultants, and our group members might benefit from attending to this difference. Psychotherapists will



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be more attuned to ways of fostering empathy in groups beyond individual attunement. This may include an intentional focus on facilitating empathy among members and weighing the benefits of therapist-expressed, as distinct from member-elicited, empathy. Students will benefit from increased understanding of how to observe and facilitate empathy. For consultants and supervisors, this provides a way of discussing the levels of attending and intervention that consultees/supervisees are engaged in. For group members, as is common in interpersonal approaches, group might be explained as a place not only for their growth and self-understanding, but also for a deepened understanding of others. Patients should also be encouraged to explore the nonverbal dimensions of this experience. Brown (2009) notes that the leader and members share responsibility in this. Burke and Tansey (1985) caution that empathy does not end with what a therapist understands internally. It also entails the process of “giving back” to the patient. The empathic task for group therapists is not only searching for notes, but also chords that resonate. The group therapist has his or her own, as well as the group’s, words, affect, and bodies as important resonating chambers.

REFERENCES Allen, E. (1982). Multiple attending in therapy groups. Personnel and Guidance Journal, 60(5), 318-320. Alonso, A., & Rutan, J. (1984). The impact of object relations theory on psychodynamic group therapy. American Journal of Psychiatry, 141(11), 1376-1380. Berne, E. (1966). Principles of group treatment. New York: Oxford University Press. Brown, N. W. (2009). Becoming a group leader. Upper Saddle River, NJ: Pearson Education. Burke, W. F., & Tansey, M. J. (1985). Projective identification and countertransference turmoil: Disruptions in the empathic process. Contemporary Psychoanalysis, 21(3), 372-402. Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. In J. C. Norcross (Ed.), Psychotherapy relationships that work (2nd ed., pp. 132-152). New York: Oxford University Press.

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