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Cited by 495Psychotherapy Techniques and ApplicationsEmpathy and Medical EducationCounseling Practices and Supervision

The DOI matches its Crossref record; 117 of the 118 references it cites were found in a registry or an index; none of the 7 sources its claims cite is checked for support yet.

Therapist empathy and client outcome: An updated meta-analysis.

Open access
Elliott, Robert, Bohart, Arthur C., Watson, Jeanne C., Murphy, David·2018·Psychotherapy
DOI 10.1037/pst0000175
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Abstract

Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .28 (p < .001; 95% confidence interval [.23, .33]; equivalent of d = .58) for 82 independent samples and 6,138 clients. In general, the empathy-outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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Crossref · 10.1037/pst0000175

Cites

117 of 117 references verified0 citation errors · 0 not checkable

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Claims the paper makes

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  • Probably not a substantial claim. 12
  • It may state two separate claims as one. 18
  • The quote only partly states this claim. 1
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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Effect-level fail-safe number differs between text and table

    Minor

    The text gives the effect-level fail-safe number as 12, but Table 2 gives it as 13.

  • Table 3 does not contain the cited measure comparison

    Minor

    The text directs readers to Table 3 for differences among empathy-measurement perspectives. The table labeled Table 3 instead presents causal-inference conditions.

  • The count of studies is conflated with the count of samples

    Minor

    The methods distinguish 82 client samples from 80 separate studies, but Table 1 labels its total of 82 as studies included.

  • Study-level heterogeneity has two reported values

    Minor

    The text reports a study-level I2 of 72%, whereas Table 2 reports 76.8%. The 72.2% value in the table belongs to the effect-level analysis.

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Research works printed but not linked: 26

  1. Barrington, B. L. (1967). The differential effectiveness of therapy as measured by the Thematic Apperception Test. In C. R. Rogers et al. (Eds.), The therapeutic relationship and its impact (pp. 337-352). Madison: University of Wisconsin Press. . [combined with Kiesler, Mathieu, Klein & Schoeninger, 1967, and Van der Veen, 1967]
  2. Beutler, L. E., Crago, M., & Arizmendi, T. G. (1986). Research on therapist variables in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (3 rd ed., pp. 257-310). New York: Wiley.
  3. Beutler, L. E., Johnson, D. T., Neville, C. W., & Workman, S. N. (1972). "Accurate empathy" and the AB dichotomy. Journal of Consulting and Clinical Psychology, 38, 372-375.
  4. Gurman, A.S. (1977). The patient's perception of the therapeutic relationship. In A.S.Gurman & A.M. Razin (Eds.), Effective Psychotherapy: A handbook of research (pp. 503-543). New York: Pergamon.
  5. Hamilton, J. C. (2000). Construct validity of the core conditions and factor structure of the Client Evaluation of Counselor Scale. The Person-Centered Journal, 7, 40-51.
  6. Hansen, J. C., Moore, G. D., & Carkhuff, R. R. (1968). The differential relationships of objective and client perceptions of counseling. Journal of Clinical Psychology, 24, 244-246.
  7. Ickes, W. (Ed.). (1997). Empathic accuracy. New York: Guilford.
  8. Johnson, S.M., Bradley, B., Furrow, J., Lee, A., Palmer, G., Tilley, D.G., & Woolley, S.R. (2005). Emotionally Focused Marital Therapy Workbook. New York: Brunner Routledge.
  9. Kiesler, D. J., Klein, M. H., Mathieu, P. L., & Schoeninger, D. (1967). Constructive personality change for therapy and control patients. In C. R. Rogers et al. (Eds.), The therapeutic relationship and its impact (pp. 251-294), Madison: University of Wisconsin Press. (Combined with Barrington, 1967, and Van Der Veen, 1967) *
  10. Lerner, B. (1972). Therapy in the ghetto. Baltimore: Johns Hopkins University Press.
  11. Martin, D. G. (2000). Counseling and therapy skills (2 nd ed.). Prospect Heights, Illinois: Waveland Press.
  12. Melnick, B., & Pierce, R. M. (1971). Client evaluation of therapist strength and positive- negative evaluation as related to client dynamics, objective ratings of competence and outcome. Journal of Clinical Psychology, 27, 408-410.
  13. Muller, J., & Abeles, N. (1971). Relationship of liking, empathy and therapists' experience to outcome in psychotherapy. Journal of Counseling Psychology, 18, 39-43.
  14. Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy-noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4 th ed., pp. 270-378). New York: Wiley.
  15. Orlinsky, D.E., Rønnestad, M.H., & Willutzki, U. (2003). Process and Outcome in Psychotherapy. In M.J. Lambert (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (5th ed) (pp. 307-389). New York: Wiley.
  16. Parloff, M. B., Waskow, I. E., & Wolfe, B. E. (1978). Research on therapist variables in relation to process and outcome. In Garfield, S. L., & Bergin, A. E. (Eds.), Handbook of psychotherapy and behavior change (2 nd ed., pp. 233-282). New York: Wiley.
  17. Peake, T. H. (1979). Therapist-patient agreement and outcome in group therapy. Journal of Clinical Psychology, 35U, 637-646.
  18. Sachse, R. (1990b). The influence of therapist processing proposals on the explication process of the client. Person-Centered Review, 5, 321-344.
  19. Shlien, J. (1997). Empathy in psychotherapy: A vital mechanism? Yes. Therapist's conceit? All too often. In A. C. Bohart & L. S. Greenberg (Eds.), Empathy reconsidered: New directions in psychotherapy (pp. 63-80). Washington, DC: American Psychological Association.
  20. Strupp, H. H., Fox, R. E., & Lessler, K. (1969). Patients view their psychotherapy. Baltimore: Johns Hopkins Press.
  21. Truax, C.B. (1966). Therapist empathy, warmth, and genuineness and patient personality change in group psychotherapy: A comparison between interaction unit measures, time sample measures, and patient perception measures. Journal of Clinical Psychology, 22, 225-229.
  22. Truax, C.B., Carkhuff, R. R., & Kodman, F., Jr. (1965). Relationships between therapist- offered conditions and patient change in group psychotherapy. Journal of Clinical Psychology, 21, 327-329.
  23. Truax, C. B., & Mitchell, K. M. (1971). Research on certain therapist interpersonal skills in relation to process and outcome. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (1 st ed., pp. 299-344). New York: Wiley.
  24. Truax, C. B., & Wittmer, J. (1971). The effects of therapist focus on patient anxiety source and the interaction with therapist level of accurate empathy. Journal of Clinical Psychology, 27, 297-299.
  25. Truax, C. B., Wittmer, J., & Wargo, D. G. (1971). Effects of the therapeutic conditions of accurate empathy, nonpossessive warmth, and genuineness on hospitalized mental patients during group therapy. Journal of Clinical Psychology, 27, 137-142.
  26. Watson, J.C., & Prosser, M. (2002). Development of an observer rated measure of therapist empathy. In J. C. Watson, R. Goldman, & M Warner (Eds.), Client-centered and experiential psychotherapy in the 21st century: Advances in theory, research and practice (pp.303-314). Ross on Wye: PCCS Books.

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Metadata

Authors
Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D.
Affiliations
University of Nottingham (GB)
Corresponding author
Elliott, Robert
ORCID
Venue
Psychotherapy
Publisher
American Psychological Association (APA)
Published
2018-12
Volume
55
Issue
4
Pages
399-410
ISSN
  • 0033-3204 (ISSN-L)
  • 1939-1536
DOI
10.1037/pst0000175
OpenAlex
W2897362601
Semantic Scholar
f8cb722ce1760eb9a601849b1586d8f6fccac372
Cited by
495
References
118
Citations by year
2026: 97 · 2025: 86 · 2024: 58 · 2023: 85 · 2022: 65 · 2021: 53 · 2020: 31 · 2019: 17 · 2018: 2
FWCI
30.26
Type
journal article
Language
en
Open access
Locations
  • Psychotherapy (publishedVersion)
  • PubMed (publishedVersion)
  • Nottingham ePrints (University of Nottingham) (acceptedVersion)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
  • Social Sciences › Psychology › Clinical Psychology › Counseling Practices and Supervision
Keywords
therapist empathy, client outcomes, psychotherapy outcome, empathic accuracy, consumer perception, viewer perception, therapist perspectives, theoretical orientation
MeSH terms
Attitude of Health Personnel, Mental Disorders, Empathy, Humans, Professional-Patient Relations, Psychotherapy, Treatment Outcome

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