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The Schema Therapy Bulletin

The Official Publication of the 

International Society of Schema Therapy

HARNESSING A STURDY AND EFFECTIVE EMPATHICALLY ATTUNED CAREGIVER MODE IN THE TREATMENT ROOM BY WENDY BEHARY 

REVIEW BY ROBIN SPIRO (USA)

A self-proclaimed empathy junkie,” Wendy Behary  highlighted the differences between  empathy”  “sympathy” and compassion”: When experiencing empathy,  one feels the other person’s experience as they express it and resonates with their emotions, thoughts, attitudes and sensations.  Sympathy is a feeling of sorrow for someone’s pain and suffering, while compassion is feeling compelled to do something to take away someone’s pain and suffering

Wendy provided literary references which brought empathy to life. In To Kill a Mockingbird, Atticus Finch spoke about understanding someone when you climb into their skin and walk around in them.”  John Steinbeck said, you can only understand people if you feel them in yourself.” These fictional characters are echoed by psychiatrist/interpersonal-neurobiologist Dan Siegel, who  has described the client’s experience of feeling felt.”  Empathic attunement allows the therapist to connect the dots” and understand nonverbal and unstated communication.

Wendy suggested  nuanced language which helps the patient feel our empathy.  Instead of a reflective listening approach in which a therapist may say, it seems like” or as I understand it you feel,” an empathic response shows a sense of KNOWING as in must be difficult, given that…”, of course you feel,” or I understand… especially since I know that you…” 

Wendy cited neurobiological research showing that in addition to the activation of mirror neurons, empathy is looked at as a kind of mindreading” of another.  It is a predictor of clinical outcome both within psychological and in the medical field.  A study at Harvard’s Mass General Hospital using the E.M.P.A.T.H.Y. education program resulted in a correlation between improved physician empathy and increased patient satisfaction scores.

Wendy described empathic confrontation as a balance between expressing understanding for the patient’s makeup and constructed coping modes (protecting the therapeutic alliance and preventing distractions like defensiveness), while holding the patient responsible for their behavior.  With this empathic stance, the patient can be accountable for change without the burden of schema-based shame or unlovability.

Finally, Wendy described a process of decentering” which can help to bolster therapists when confronted with challenging, critical and angry patients.  When therapist’s schemas and modes are triggered, we can become preoccupied with attempts to regain a sense of emotional safety or to combat feelings of incompetenceThe process for decentering ourselves – from the personal affront and schema-driven effects of confrontation – involves taking a moment to connect with our own internal vulnerability and imagine our little child self” in a safe and appropriate space in our mind, i.e., tucking them into bed, or picturing them in a playful and secure environment where they are not responsible for taking on an angry/bullying patient, or an entitled and demanding narcissist.

Decentering allows therapists to consciously protect their own vulnerable sides, so they can maintain a sturdy and empathic caregiver mode with their patients, and can provide the resonant understanding and realness which is so essential for healing.

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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