The Power of Empathy in Therapy: Lessons from Carl Rogers

How Understanding and Validation Can Transform Lives

Last week, I dedicated my section to the teachings of American psychologist Carl Rogers, who advocated that an unconditional, empathetic attitude from the therapist towards the patient is the cornerstone of change in psychotherapy. Rogers believed that our difficulty in expressing empathy stems from the fact that true empathy can lead us to change, an action that frightens us all. While this is partly true, from my experience working with couples who struggle to express empathy towards each other, I believe there is another central reason: we confuse expressing empathy towards the emotional state of our interlocutor, based on a willingness to understand their perspective, with validating their worldview and coping mechanisms.

Two cases come to mind as I try to hone in on this point. Rani (a pseudonym) suffered from obsessive jealousy towards his partner. During one of his jealous fits, he stole her phone while she was showering and rummaged through her correspondence. It was one of the first times that I could not empathize with a patient. Emotionally Focused Couples Therapy (EFT) is largely based on Rogers' principle of empathy, but I sat there in silence, wanting to scold Rani and confront him. He was a large man and his girlfriend was tiny; he was wealthy, and she had no socioeconomic resources. What was he thinking? In my mind, it starts with snooping on the phone and ends with a family tragedy. I couldn't be empathetic, but I knew that was my role, so I stammered something.

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I eagerly awaited my tutorial with Rita Ventura, a legendary Greek therapist and a Rogerian instructor for 17 years before she learned about EFT. Rita explained to me the difference between empathy for the person's situation from their point of view and validating their worldview and coping mechanisms. At the next session, I addressed Rani: "I hear that you were overwhelmed by enormous anxiety, thinking she didn't love you and that her behavior hinted she was hiding things from you. You felt so weak and ashamed to admit it that you thought you had no choice but to stop the torture and steal her phone, even though it hurt both of you."

From that moment, I understood the liberation in empathy. I realized that standing in Rani's shoes and understanding the logic behind his actions from his perspective did not mean validating his feelings of fear as a true indicator of danger in his relationship. This empathic expression allowed me to maintain my external perspective on his behavior, which was dangerous and inappropriate.

This meeting was a turning point. Rani cried, connected with his vulnerability, and revealed to me and his partner (now his wife) that his jealousy stemmed from his fear of karma, believing he deserved punishment for a violent act he committed as a child. His behavior did not repeat, and I am convinced this happened much faster than if I had reprimanded him. Making him feel guilty might have suppressed his domineering behavior temporarily, but it would not have addressed the underlying issue. Rani's macho behavior was an unproductive coping mechanism, and the key was to understand what he was trying to cope with through this behavior—something that could only be discovered through empathy.

I learned an equally important lesson with Dana (a pseudonym), the first patient I met who expressed a desire to die and felt her life lacked meaning. Dana sat in faded, worn clothes, bent over and pale. Her partner sat silent and still, and I sat in front of them terrified. I used every tool I had: checking for self-danger, agreements about making contact, reminders about going to the emergency room in case of distress, and more. But none of it felt right. Dana seemed to drift further away with every word I spoke.

I sought advice from Rita again. "Do you understand why she wants to die?" Rita asked. "Yes," I replied. "She is a girl with many abilities, personal charm, intelligence, and good taste, but if I saw the world and myself as she does, I would also want to die." "Good," Rita said. "Then tell her exactly that next time."

Before the next meeting, I was nervous, but I went for it. "You know, Dana," I told her, "I thought about what you said last time, and I can understand you. If I put aside my view of you with all your skills, charm, kindness, intelligence, and your support for the weak, and look at things from your point of view, I understand why you want to die. If I thought my whole world was bad, I was bad, no one wanted to be with me, I was important to no one, and I was sure nothing in the world could change, I would also want to die."

My heart pounded as I spoke, but the transformation was immediate. Dana came to the next session in a white fabric shirt with a wide neckline, her hair washed and styled neatly. She explained, "The last meeting changed something for me. When you said you could understand why I wanted to die, I stopped criticizing myself for feeling this way. That self-attack stopped, releasing energy that had been locked up, and I began to breathe. It was okay to feel that way, and I could understand myself."

These experiences underline the power of empathy in therapy. By understanding and validating the emotional state of patients without endorsing their harmful behaviors, therapists can foster genuine change. Empathy enables patients to confront their vulnerabilities and underlying issues, leading to healthier coping mechanisms and improved mental health.