Therapist Empathy and Client Outcome: An Updated Meta-Analysis

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. Clinical Impact Statement Question: Does therapist empathy predict success in psychotherapy? Findings: In general, clients have moderately better outcomes in psychotherapy when clients, therapists, and observers perceive therapists as understanding them. Meaning: Empathy is an important element of any therapeutic relationship, and worth the investment of time and effort required to do it well and consistently. Next Steps: Careful research using diverse methods is needed to firmly establish and explain the causal role of therapist empathy in bringing about client outcome; clinicians can contribute by identifying situations in which empathy may be particularly valuable or conversely contraindicated.