The Science of Empathy by Sahar Dorani, M.A.

         

Who would have thought that the saying “I feel your pain” actually has scientific validation? As a mental health clinician, I was fascinated to learn that a therapist’s ability to empathize with his or her clients was backed by sound research. In the early 1990’s, an Italian neurophysiologist, Dr. Giacomo Rizzolatti, was investigating the planning of movement in the brains of mammals by studying the activities of individual nerve cells in the brain of macaque monkeys. This was done by placing electrodes on the premotor cortex of monkeys’ brains to see how activities (such as reaching for fruit or toys) were planned and initiated. Every time a monkey reached for food, the monkey’s neurons in a specific brain region would fire. Before resuming his experiment one day, one of the researchers reached for a raisin while the monkey being studied sat still. The researcher noticed that the measuring device hooked up to the monkey’s brain was firing even though the monkey was merely sitting still watching him grab the raisin. One of the premotor neurons was firing, just the way it had when the monkey itself had been reaching for food! This was the moment that marked the accidental discovery of what we now call “mirror neurons.” 

            Researchers found that the same activity was present in human brains, which means the brain activity of someone doing something was replicated in the brain of someone who was observing the action. Since this discovery, social scientists have been interested in how this finding extrapolates to a therapist’s ability to feel empathy when their clients share emotionally-charged information in session. As it turns out, when electrodes have been placed on both therapist and client, the brain activity in the client is mimicked by the therapist’s brain, illustrating that a therapist has the same neuronal activity as his/her client when empathizing in therapy sessions.

            Dr. Terry Lesh conducted one of the earliest studies on empathy between therapists and clients in 1970. Specifically, the link between Zen meditation and the development of empathy in therapists was examined. It was found that therapists who took part in Zen-Buddhist meditative practices regularly were able to develop a higher degree of empathy (illustrated by accurately detecting and describing the affective state of others) than therapists who did not meditate. This was thought to be because meditation and mindfulness facilitate empathy through reducing stress, and thus, increasing self-compassion.

            Taking this research a step further, a 2013 study at the University of Chicago found neurobiological roots of psychopathic behavior. In the field of psychology, someone with antisocial personality disorder lacks remorse and empathy and often manipulates others for personal gain. We’re talking about con artists and serial killers, and the range of sociopaths and psychopaths in between. In the aforementioned study, functional magnetic resonance imaging (fMRI) was used to measure brain activity in 121 prison inmates believed to have had antisocial personality traits. These individuals were shown visual scenarios illustrating pain (e.g., a finger slammed in a door, toes caught under heavy objects, etc.) and told to imagine that the accidents happened to themselves, or somebody else. Researchers found that, when imagining they were experiencing the pain themselves, the inmates showed a typical neural response within the brain regions involved in empathy for pain. However, when participants imagined pain to others, these brain regions failed to become activated. Actually, when imagining others’ experience of pain, the participants showed increased levels of arousal in their ventral striatum, which is a brain region involved in experiencing pleasure. The results of this study convey that, not only do psychopathic individuals lack the capacity for empathy, but also some of them actually derive pleasure from watching others in pain. While this may seem obvious to some of us familiar with this clinical population, the neuroscience of a sadistic psychopath proves to be fascinating. From Zen meditation fostering empathy in counselors to discovering the neuronal basis of psychopathy, the human brain never ceases to amaze.    

References:

Decety, J., Chen, C., Harenski, C., & Kiehl, K.A. (2013). An fMRI study of affective perspective taking in individuals with psychopathy: Imagining another in pain does not evoke empathy. Frontiers in Human Neuroscience, 7, 489. doi: 10.3389/fnhum.2013.00489

Lesh, T.V. (1970). Zen meditation and the development of empathy in counselors. Journal of Humanistic Psychology, 10 (1), 39-74. doi: 10.1177/002216787001000105 

Staemmler, F. M. (2011). Empathy in psychotherapy: How therapists and clients understand each other. J New York, NY: Springer Publishing Company.  

The Recovering Therapist, by Sahar Dorani M.A.

There seems to often be a misconception that therapists in mental health are always composed, and impervious to psychological angst. As in many careers, for a psychologist the role of professional may be seen as trumping the therapist’s own human emotions. Yet with all of the training that a clinician receives, the emotional difficulty of certain situations will prevail and conquer the conceptual ways that we are taught to deal with such scenarios. Understandably, conflict may arise when one is having difficulty with the exact life issue that he or she is working to help others through. This can create cognitive dissonance for an individual, such as in the example of a marriage and family therapist who is going through a divorce, or a person of the clergy who preaches while challenging and second-guessing their faith. Equal is the struggle of a grief counselor who is mourning the loss of a loved one. This was my reality during my second year of graduate school while working with adults in an outpatient therapy clinic.

Social Media in Therapy, by Sahar Dorani, M.A.

In today’s world of explosive social media- where your family learns about your life via Facebook before you have an opportunity for disclosure- there are clearly less options for people to maintain their privacy. We may want to be present and feel connected- but perhaps not to some people who remain outside our social circles. In graduate school psychology courses, supervisors and professors may discuss the myriad of issues that can arise when running into a therapy client in a public place. Some ideas could be to act as though you don’t notice a client (unless the client acknowledges you), keeping discussion to a minimum and avoid talking about therapy content, and not disclosing your relationship to the client if interacting with individuals in your clients’ company. However, as a new clinician practicing psychotherapy in 2013, a true concern exists in considering how to be present on the internet for personal use without being fully accessible to your clients. If a client finds you on either of the numerous social media outlets or online professional networks, is there a way to avoid exposing your client to information about yourself (which likely blurs therapeutic boundaries) without leaving your client feeling rejected?

Multiculturalism, by Sahar Dorani, M.A.

Multiculturalism does not solely refer to differences in skin color or to different religious symbols worn around one's neck. Rather, multiculturalism encompasses many facets of one's identity- including age, sexual orientation, presence or absence of disability, ethnicity, gender, socioeconomic status, religion, and any characteristic (potentially unique to the majority) that is shared by a group of people.  

Different Culture, Same Goals, by Sahar Dorani, M.A.

There are many incidences in daily life in which cultural differences between people may create tension or affect the working relationship they may have with one another. This tension can be incredibly heightened in the therapeutic alliance, being that it is an intimate (and in a sense fragile) relationship. In working with clients of various cultural backgrounds, I have witnessed how differences in age, gender, and ethnicity between client and therapist can contribute to intense moments in session.

Hysteria in Diagnosis, by Sahar Dorani, M.A.

In a day and age where diagnosing clients remains key to our work as therapists, and to our training as diagnosticians, many clinicians may have mixed feelings about assigning a diagnosis to clients in treatment. As my knowledge about (and experience in) the field continues to develop, I am quickly learning that the manual we use to diagnose our clients is simultaneously hated, yet needed, by many mental health providers in the field. The practical purpose of the DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders- Fourth edition/Text Revision) is to be able to clearly identify and categorize symptoms. Originally created by the American Psychiatric Association in 1952, the DSM enables mental health providers to utilize the manual to better understand a client's potential needs, in addition to being a tool for assessment and diagnosis.

Silenced By Privilege, by Sahar Dorani, M.A.

In the field in psychology, I find that we are constantly being trained to be culturally aware and sensitive to the needs of underserved members within our communities. I have found that many times, our multicultural training focuses heavily on issues affecting non-American or nonwhite individuals and groups. While I clearly understand the importance in this, I did not realize until recently that there are many clients in need whom may get overlooked perhaps due to the assumed privilege that may accompany the lighter-skinned Caucasian individual. When working as a therapist in an outpatient drug treatment center for recently incarcerated males, my Caucasian clients tended to be the minority in our treatment program. One of my American clients approached me after group therapy and brought to my attention his feeling of invisibility in our group sessions and in the treatment center milieu. I noticed that this particular client tended to stay silent when uncomfortable; voicing his grievances was incredibly unlike him. Hence, when he spoke, I listened a bit more intently.

Once a ‘Disorder’, Always a Disorder, by Sahar Dorani, M.A.

The most recently used edition of the DSM, the Diagnostic and Statistical Manual of Mental  Disorders- fourth edition- text revision, has gone through quite an evolution since the publication of its first edition in 1952. As a student learning how to utilize this diagnostic tool (while attempting to avoid ‘over-diagnosing’), I find myself captivated when discovering previous diagnoses that were actually viewed as legitimate "disorders", but then later were revised and no longer considered a disorder. The definition of ‘Disorder’ in the mental health field is explained as: 1. A lack of order or regular arrangement; confusion.; 2. An ailment that affects the function of mind or body. Given this definition and its use by us diagnosticians, it feels unnatural that the term ‘ailment’ seems to have a time-limited implication.  It makes sense logistically that some ailments may become alleviated over time, but it seems that I have been repeatedly dumbfounded that a group of professionals in the American Psychiatric Association decide what characteristics of “the human condition and development” are to be considered ailments or irregular to the ‘normal’ development of an individual. At the same time, I must respect that this is the best devised systematic way yet to assign mental health diagnoses to be treated.

Lifelong Relationships, by Sahar Dorani, M.A.

The most difficult factor faced in clinical work is creating deep connections with individuals over time, only to carefully terminate those relationships, and hope that the therapeutic work has a positive influence on the individual client (and hopefully the therapist as well). I have become all too familiar with the various forms of ‘boundaries’ in therapy, and the flexibility of such boundaries, depending on the therapist and his or her clinical judgment. Most therapists would admit that they have worked with an individual (whether formally as a client or informally) who made a significant emotional impact on them. Personally, these emotional connections are gifts to me; a reward from the work that I do, the essence of my motivation to practice psychotherapy.

Multiculturalism in Clinical Psychology: a Lifetime of Consultation, by Sahar Dorani, M.A.

Teaching student therapists to be culturally-sensitive and multiculturally aware clinicians seems to be a demanding and controversial task. I recall the incredibly awkward memories of my Multicultural Awareness class in my first year of graduate school. This is a course designed to enlighten therapists-in-training about the powerful influence that (a client’s) culture can have on the therapeutic relationship and on the client’s values, beliefs, and behaviors. Although self-disclosure was not mandatory for us in this class, it was inevitable that some of us were going to become emotional when discussing ‘hot topics’ such as hate crimes, politics, discrimination due to religious affiliation, socioeconomic status, disability, sexual orientation, ethnicity, and gender. At this time a few years ago, I was petrified of the unknown demands of graduate school, yet was also excited, wide-eyed, and actually quite vulnerable in retrospect.

Lost in Translation, by Sahar Dorani, M.A.

In a field as diverse and evolving as Psychology, being culturally aware has become as much of a clinician’s skill set as formulating cases and planning interventions. Clients immigrating to America often experience hardship during their move and acculturation process. Working with these clients in therapy proves even more challenging when English is not their first language, and the therapist is less than fluent in the client’s native tongue. Moving to a foreign country to relocate one’s life can be difficult and emotionally taxing for anyone; culture shock and trauma are not uncommon to this adjustment process, especially for women coming from Middle Eastern countries without much social support here in the States.