How Good Are Your Empathy Skills… With Clients? And Loved Ones?

psychology blog

Author: David D. Burns, MD

Most mental health professionals believe they are reasonably good at empathy. However, this is not necessarily supported by some surprising research findings. 

Therapist accuracy

Research indicates that therapists’ views of the therapeutic alliance are barely correlated with clients’ views. What this means is that your beliefs about how empathic and caring you are may have little, if anything, to do with how your clients actually see you. In other words, you can strongly believe you did a great job in a session, but your client may have experienced you as cold and lacking in understanding. 

Therapist empathy skills

TEAM (T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods) therapists obtain client ratings of therapist empathy and helpfulness immediately after every therapy session using sensitive and highly reliable assessment tools. When mental health professionals use these rating scales for the first time, they typically

receive failing grades from 50% to 100% of their clients. This can be a severe shock to the system!

That’s the bad news. The good news is that with some empathy training, along with humility and an open heart, your empathy skills and ratings can increase dramatically in just a few weeks. This can lead to increased satisfaction in your clinical work and in your personal life as well. 

In the past, I have delegated empathy training to one portion of the summer intensive, typically about a half day at most. But I have discovered that this is not nearly enough, and that learning superb or even good empathy skills can be far more challenging than you think! In fact, it’s much like learning to play the piano. Dedication and ongoing practice are mandatory.

That’s why I’m excited to have this opportunity to focus on advanced empathy training in this year’s all-new summer intensive, and want to thank Praxis for giving me this opportunity. I am convinced that empathy training is one of the greatest needs for all therapists, from beginners to the most advanced.

We will focus on common problems we all encounter when dealing with clients, friends, or loved ones who:

  • complain constantly but ignore or “yes but” you when you try to help
  • are angry, violent, or threatening
  • are relentlessly critical
  • are argumentative and unreasonable
  • are stubborn and rigid
  • won’t express their feelings
  • refuse to listen
  • refuse to talk to you
  • are self-centered and narcissistic
  • falsely accuse you
  • are flirtatious
  • and more.

We will also focus on how to help clients who are in conflict with others, and how to avoid the common mistakes almost all therapists make when treating clients with relationship difficulties.

You will get the chance to learn and practice many powerful communication tools. You will receive individual mentoring and feedback from me as well as more than a dozen colleagues from the Feeling Good Institute in Mountain View, California as you hone your new skills throughout the workshop.

We will also focus on the spiritual side of relationship conflicts, such as the “great death” of the self. You will discover that we all create our own interpersonal reality at every moment of every day, even though we often see ourselves as victims of the other persons’ “badness.”

Tools include:

  • Five Secrets of Effective Communication
  • The Law of Opposites
  • Three Advanced Tools: Changing the Focus, Multiple Choice Empathy; Positive Reframing.
  • Forced Empathy
  • The Interpersonal Downward Arrow (psychoanalysis at warp speed)
  • The Relationship Journal
  • The Intimacy Exercise
  • Interpersonal Decision-Making
  • The Blame Cost-Benefit Analysis
  • The Paradoxical Invitation
  • Sitting with Open Hands
  • The “Great Death” of the “self”
  • How to deal with your Inner Chatter!

Is empathy important? Does it really make a difference?

Karl Rogers, an early psychotherapy pioneer, believed that therapist empathy is the necessary and sufficient condition for personality change. Beck did not agree. He argued that empathy is necessary but not sufficient, and that the cognitive therapy tools really trigger change. 

I asked Albert Ellis, the noted and controversial New York psychologist, what he thought about this controversy. He graciously wrote to me and argued that Rogers and Beck were both wrong. He said that therapeutic empathy is neither necessary, sufficient, nor desirable! In fact, he said that therapeutic empathy was bad, because “clients would just get dependent on their therapists and wouldn’t do their effing homework!”

Who was right? Join us this summer and find out. You’ll learn how to develop far more satisfying relationships with your patients and more loving relationships with the people you care about—as well as the ones you don’t!

Thanks so much for reading this blog! I hope to see you at the South SF Conference Center in August! 

David Burns, MD

Learn How to Develop More Meaningful Relationships with Challenging Clients!


Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients’ and therapists’ shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 – 643.

Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive – behavioral therapy: a structural equation model. Journal of Consulting and Clinical Psychology, 60(3): 441 – 449.