Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources

doi:10.1016/j.pragma.2005.09.008

Journal of Pragmatics

Volume 38, Issue 9, September 2006, Pages 1385-1397

https://doi.org/10.1016/j.pragma.2005.09.008 Get rights and content

Abstract

Empathy is a central notion in psychotherapy and has been the attention of much research, focusing on its importance for the provider–patient alliance and for the success of psychotherapy. Despite its importance, little effort has previously been made in order to study the details of actual sequences through which empathy is achieved. In this study drawing on the method of conversation analysis, actual interactions between therapists and their patients have been video taped and analysed in detail. The present study describes and analyses three types of empathy that can be identified in actual sequences of talk; cognitive empathy, affective empathy, and sharing empathy. These types of empathy are higher level conversational resources that build on the more basic resources, such as questions, assertions, and other types of utterances and non-verbal behaviour. When empathy is expressed, the patient should receive by responding appropriately to the therapist's prior utterance. This receipt may involve answering questions, agreeing with assertions, demonstrating understanding, and appropriate showing of feelings. A lack of proper receipt by the patient is oriented to by the interactants and may result in signs of conversational failure, such as reformulations, pausing, and an abrupt change of topic.

Section snippets

Rolf Wynn (born 1968) received an MA in English linguistics in 1993 (University of Tromsø), and became an MD in 1995 (Tromsø). He earned a PhD in English linguistics in 1998 (University of Bergen) and a PhD in medicine/psychiatry in 2004 (Tromsø). He has published on various topics, including on the analysis of provider–patient interaction and on the use of coercion in psychiatric care. He is a consultant psychiatrist and a researcher at the University of Tromsø, Norway.

References (43)

W.J. Evans et al.
The genomic revolution and the obstetrician/gynaecologist: from societal trends to patient sessions. Best practice and research
Clinical Obstetrics and Gynaecology
(2002)
N. Mead et al.
The impact of general practitioners’ patient-centredness on patient's post-consultation satisfaction and enablement
Social Science and Medicine
(2002)
Deborah Tannen
The machine-gun question. An example of conversational style
Journal of Pragmatics
(1981)
Yrjö O. Alanen et al.
The Finnish integrated model for early treatment of schizophrenia and related psychoses
A. Bachelor
How clients perceive empathy: a content analysis of ‘received’ empathy
Psychotherapy
(1988)
G.T. Barrett-Lennard
The empathy cycle: refinement of a nuclear concept
Journal of Counselling Psychology
(1981)
Wayne A. Beach
Preserving and constraining options: ‘Okays’ and ‘official’ priorities in medical interviews
Howard B. Beckman et al.
The effect of physician behaviour on the collection of data
Annals of Internal Medicine
(1984)
Patrick S. Byrne et al.
Doctors Talking to Patients
(1976)
Paul Drew et al.
Analyzing talk at work: an introduction

P. Drew et al.

Conversation analysis: a method for research into interactions between patients and healthcare professionals

Health Expectations

(2001)

C. Duan et al.

The current state of empathy research

Journal of Counselling Psychology

(1996)

Encylopædia Britannica Online, 2005. Retrieved from http://www.brittanica.com on 5 June,...

Richard M. Frankel

Talking in interviews: a dispreference for patient-initiated questions in physician–patient encounters

Phillipa Garety et al.

Cognitive–behavioural therapy for people with psychosis

M. Haakana

Laughter as a patient's resource: dealing with delicate aspects of medical interaction

Text

(2001)

M.A.K. Haliday et al.

Cohesion in English

(1976)

John Heritage

Garfinkel and Ethnomethodology

(1984)

John Heritage

Explanations as accounts: a conversation analytic approach

A.O. Horvath et al.

Relationship between working alliance and outcome in psychotherapy: a meta-analysis

Journal of Consulting and Clinical Psychology

(1991)

Ian Hutchby et al.

Conversation analysis

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Michael Wynn (born 1973) has an MA in English literature from the University of Tromsø. He has published on topics relating to Victorian-age and contemporary culture and literature. He currently works as a research assistant at the University Hospital of Northern Norway.

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Empathy as an interactionally achieved phenomenon in psychotherapy: Characteristics of some conversational resources

Abstract

Section snippets

Clinical Obstetrics and Gynaecology

Social Science and Medicine

Journal of Pragmatics

The Finnish integrated model for early treatment of schizophrenia and related psychoses

How clients perceive empathy: a content analysis of ‘received’ empathy

Psychotherapy

The empathy cycle: refinement of a nuclear concept

Journal of Counselling Psychology

Preserving and constraining options: ‘Okays’ and ‘official’ priorities in medical interviews

The effect of physician behaviour on the collection of data

Annals of Internal Medicine

Doctors Talking to Patients

Analyzing talk at work: an introduction

Conversation analysis: a method for research into interactions between patients and healthcare professionals

Health Expectations

The current state of empathy research

Journal of Counselling Psychology

Talking in interviews: a dispreference for patient-initiated questions in physician–patient encounters

Cognitive–behavioural therapy for people with psychosis

Laughter as a patient's resource: dealing with delicate aspects of medical interaction

Text

Cohesion in English

Garfinkel and Ethnomethodology

Explanations as accounts: a conversation analytic approach

Relationship between working alliance and outcome in psychotherapy: a meta-analysis

Journal of Consulting and Clinical Psychology

Conversation analysis