More than reflections: empathy in motivational interviewing includes language style synchrony between therapist and client.
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Empathy is a basic psychological process that involves the development of synchrony in dyads. It is also a foundational ingredient in specific, evidence-based behavioral treatments like motivational interviewing (MI). Ratings of therapist empathy typically rely on a gestalt, "felt sense" of therapist understanding and the presence of specific verbal behaviors like reflective listening. These ratings do not provide a direct test of psychological processes like behavioral synchrony that are theorized to be an important component of empathy in psychotherapy. To explore a new objective indicator of empathy, we hypothesized that synchrony in language style (i.e., matching how statements are phrased) between client and therapists would predict gestalt ratings of empathy over and above the contribution of reflections. We analyzed 122 MI transcripts with high and low empathy ratings based on the Motivational Interviewing Treatment Integrity global rating scale. Linguistic inquiry and word count was used to estimate language style synchrony (LSS) of adjacent client and therapist talk turns. High-empathy sessions showed greater LSS across 11 language style categories compared with low-empathy sessions (p<.01), and overall, average LSS was notably higher in high-empathy versus low-empathy sessions (d=0.62). Regression analyses showed that LSS was predictive of empathy ratings over and above reflection counts; a 1 SD increase in LSS is associated with a 2.4 times increase in the odds of a high-empathy rating, controlling for therapist reflections (odds ratio=2.4; 95% CI: 1.36; 4.24, p<.01). These findings suggest empathy ratings are related to synchrony in language style, over and above synchrony of content as measured by therapist reflections. Novel indicators of therapist empathy may have implications for the study of MI process as well as the training of therapists.
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Linguistic style synchrony was significantly correlated with empathy of the therapist, as rated by trained observers in a standardized test.
“Linguistic style synchrony was significantly correlated with empathy of the therapist, as rated by trained observers in a standardized test.”
From Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance (2016) · cites this paper as Lord et al., 2015
Age, gender and language matching are necessary to enhance clients' satisfaction.
“Other studies have also shown that age, gender [40] and language matching [41] necessary to enhance clients’ satisfaction.”
From Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study (2016) · cites this paper as [41]
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- Authors
- Lord, S. P., Sheng, E., Imel, Z. E., Baer, J., & Atkins, D. C.
- Affiliations
- University of Washington (US)
- University of Utah (US)
- Corresponding author
- Lord, Sarah Peregrine
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 46
- Issue
- 3
- Pages
- 296-303
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC5018199
- OpenAlex
- W1995814612
- Cited by
- 144
- References
- 59
- Citations by year
- 2026: 16 · 2025: 11 · 2024: 13 · 2023: 18 · 2022: 15 · 2021: 13 · 2020: 11 · 2019: 16 · 2018: 7 · 2017: 9 · 2016: 12 · 2015: 2 · 2014: 1
- FWCI
- 9.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01da016360-03)
- National Institute on Alcohol Abuse and Alcoholism (R01AA018673)
- National Institute on Drug Abuse (R01/DA016360, R34DA034860)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Social Sciences › Psychology › Social Psychology › Action Observation and Synchronization
- Keywords
- empathy, motivational interviewing, reflective listening, implementation fidelity, therapist reflection, therapeutic process
- MeSH terms
- Adult, Communication, Empathy, Female, Humans, Language, Male, Middle Aged, Professional-Patient Relations, Verbal Behavior, Motivational Interviewing
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