The Importance of Therapeutic Empathy
Often when cognitive-behavioral counseling or psychotherapy is described, the techniques and theory are emphasized while the importance of the relationship between the client and the counselor or therapist is underemphasized. This is unfortunate. The use of therapy manuals, which is increasing both in psychotherapy research and in clinical practice, exacerbates this concern about an overemphasis on techniques (Connolly Gibbons, Crits- Christoph, Levinson, & Barber, 2003). The use of therapy manuals may be seen as restricting the counselor's ability to respond to the client's needs in the moment; however, detailed analyses of transcriptions of CBT sessions show that therapists do vary in their responses to clients (Connolly Gibbons et al., 2003). Counselors and therapists cannot become so reliant on techniques that they forget that clients require a warm and supportive environment in the therapeutic process. Thus, it is important to be clear that although CBT manuals focus on the specific treatment techniques, the helping relationship is also addressed.
A study of clients with depression seeking treatment from a counselor or therapist using either a CBT approach or an emotionally focused approach based on client-centered and Gestalt techniques showed that there were no significant differences between the ratings of the different types of therapists on variables such as empathy, unconditional acceptance, and congruence (J. C. Watson & Geller, 2005). This shows that as therapists treat clients, they are able to do so within a therapeutic relationship, regardless of the use of the theory underlying their approach. Beck et al. (1979) described the importance of the relationship and included strategies for developing a therapeutic relationship in manuals. Bums and Auerbach (1996) highlighted the necessity for a warm, empathic therapeutic relationship in cognitive therapy. They provided an empathy scale that clients can use to rate how warm, genuine, and empathic their counselors or therapists were during a recent session. The necessary and sufficient conditions for personality change developed by Carl Rogers are included in Beck's cognitive therapy as "necessary, but not sufficient." In other words, these factors form the basis for the relationship, but the techniques of cognitive therapy are viewed as necessary to produce therapeutic change. The efficacy of the intervention is dependent on a relationship that is characterized by counselor or therapist warmth, accurate empathy, and genuineness (Beck, Wright, Newman, & Liese, 1993).