Journal of Counseling Psychology Copyright 19% by the American Psychological Association, Inc.

1996, Vol. 43, No. 3, 261-274 0022-0167/96/$3.00

The Current State of Empathy Research

Changming Duan Clara E. Hill

University of Missouri—Columbia University of Maryland—College Park

The literature on empathy, primarily from counseling and psychotherapy and secondarily
from social and developmental psychology, is reviewed. Obstacles that may account for
theoretical confusions and empirical difficulties in studying empathy are highlighted. The
decrease in empathy research in recent years appears attributable to the lack of clear focus and
effective research tools as well as the shift in interest from empathy to other concepts such
as the working alliance. It is argued that there is a need to return to studying empathy.
Researchers should distinguish between dispositional and experiential empathy and between
intellectual empathy and empathic emotions and indicate whether they are examining ther-
apist or client experience of empathy. Suggestions for future research are offered.

The concept of empathy, long cherished by psychothera-
pists and counseling psychologists (cf. Barrett-Lennard,
1962, 1981; Gladstein, 1977, 1987; Rogers, 1957), gener-
ated much research after Rogers's writings of its role in
psychotherapy. Unfortunately, reviewers have noticed that
the "definition and mechanism of empathy seem unclear"
(Sexton & Whiston, 1994, p. 26), and research has gener-
ated "little agreement among investigators" (Moore, 1990)
and offered few conclusive research findings (Gladstein,
1983). In his review, Gladstein (1983) delineated some of
the theoretical obstacles that made it difficult to do empathy
research and presented suggestions for further understand-
ing and research on the concept. Despite Gladstein's effort,
the number of published studies on the topic has decreased.
One cannot help but wonder about the reasons that have
contributed to the decrease of attention to empathy.
Whereas Gladstein's (1983) review a decade ago aimed at
obtaining "a better understanding of the confusing findings"
(p. 470), our review focuses on understanding why and how
the confusion exists. We believe that the confusion reflects
the diversity of the ways in which empathy is conceptual-
ized and suggest that such diversity needs to be understood
but not discouraged. Only a good understanding of this
diversity can lead to elimination of the confusion. In addi-
Editor's Note. Charles A. Claiborn served as the action editor for
this article.—CEH
Changming Duan, Department of Educational and Counseling
Psychology, University of Missouri—Columbia; Clara E. Hill,
Department of Psychology, University of Maryland—College
Park.
We would like to thank Annie Judge, Dennis M. Kivlighan, Jr.,
Michael J. Patton, Peter Shaughnessy, and Russell Thye for com-
menting on earlier versions of this article.
Correspondence concerning this article should be addressed to
Changming Duan, Department of Educational and Counseling
Psychology, 16 Hill Hall, University of Missouri, Columbia, Mis-
souri 65211. Electronic mail may be sent via the Internet to
edcoduan@mizzoul .missouri.edu.
261
tion, stimulating and facilitating future empirical research,
which was not a priority for Gladstein (1983), is a major
goal of our review. In this article, we present our critical
observations of the empathy literature, revisit some of the
issues discussed by Gladstein (1983), and discuss in more
detail some of the theoretical confusions and methodologi-
cal weaknesses in existing empathy research. We also iden-
tify future research areas. Our review and discussion are
mainly focused on counseling psychology and psychother-
apy research, but we also include related research in devel-
opmental and social psychology that aids in understanding
the empathy construct in therapy.
History and Definitions of Empathy
Although empathy has been a concept of interest for
writers outside of psychology for a long time, the psycho-
logical nature of empathy has been obvious since the incep-
tion of the concept. Late in the 19th century, as German
aesthetics moved from the objective world to the working of
the mind as accounting for the essential feature of human
aesthetic contemplation of the world, Robert Vischer (1873;
cited in Listowel, 1934) suggested the term Einfiihlung, the
predecessor of empathy, to mean humans' spontaneous pro-
jection of real psychic feeling into the people and things
they perceive. At the turn of the century, Lipps (1903, cited
in Wispe, 1987) organized and developed the theory of
Einfiihlung for psychology "from a psychological, nonmeta-
physical perspective" and through "a phenomenological
method" (Wispe, 1987, p. 39). He believed that people
knew and responded to each other through Einfiihlung,
which was preceded by projection and imitation, and that as
imitation of affect increases, Einfiihlung increases.
Titchener (1909) coined the term empathy as a rendering
of Einfiihlung, which he defined as a "process of humaniz-
ing objects, of reading or feeling ourselves into them"
(Titchener, 1924, p. 417). A reactive-projective perspective
and an emphasis on perceptive awareness of another per-
son's affect of sharing of feelings were apparent in this
262 DUAN AND HILL
view. Theories of empathy in psychology were largely
influenced by this view (e.g., Downey, 1929; Kohler, 1929)
until Mead (1934), who recognized the self-other differen-
tiation in empathy and added a cognitive component, an
ability to understand, to empathy (Deutsch & Madle, 1975).
It is not a historical accident that empathy became a very
important concept for psychotherapists and counseling psy-
chologists. From psychoanalytic theorists who view empa-
thy as a part of psychoanalytic cure (e.g., Kohut, 1977) to
humanistic theorists who perceive empathy as a necessary
and sufficient condition for psychological change (e.g.,
Rogers, 1959), empathy has been a key concept in under-
standing why and how therapy works. As in aesthetics,
empathy has been seen as a way of knowing and under-
standing another person or an object. Influenced by "their
own practical, clinical experience" (Gladstein, 1984, p. 49),
these theorists have described empathy as a process of
feeling "as if one were the other person" (Rogers, 1959, p.
210); "feeling in" (Downey, 1929, p. 176); "vicarious in-
trospection" (Kohut, 1971, 1977); assuming the internal
frame of another (Truax & Carkhuff, 1967); "transposing
oneself into the thinking, feeling and acting of another"
(Dymond, 1950, p. 344); and so forth. However, unlike in
aesthetics, empathy as a psychological concept has evolved
as an area of scientific inquiry. Particularly under the influ-
ence of Carl Rogers (1949, 1951, 1957, 1959), empathy has
been approached by researchers with scientific methods.
Empathy also quickly found new life in various subdis-
ciplines of psychology and has been studied as a determi-
nant of altruism (e.g., Batson, 1987), attribution (e.g., Regan
& Totten, 1975), and social judgment (e.g., Krulewitz,
1982); an indicator of child cognitive development (e.g.,
Hoffman, 1977); and so forth. Such a broad interest in
empathy from various disciplines supports the claim that
empathy is the very basis of all human interaction and "an
essential constituent" (Kohut, 1959, p. 462) of all psycho-
logical phenomena. However, such a diversity of interest
may have also contributed to the fact that empathy study has
been characterized by a multitude of theoretical positions
and inconsistent, even confusing, results, although promi-
nent theorists such as Rogers (1949, 1951, 1957, 1959,
1975), Barrett-Lennard (1962, 1981, 1993), and Kohut
(1971, 1977, 1984) have given detailed descriptions of
empathy. The unclearly communicated implicit structures
that underlie the various theories of empathy may have
allowed confusion to occur. In this section, we present both
explicit and implicit theoretical differences in the literature
about the construct of empathy and the nature of empathy,
the two dimensions along which empathy has been defined.
The Construct of Empathy
The term empathy has been used to refer to three different
constructs that may or may not overlap with each other.
Some theorists refer to empathy as a personality trait or
general ability (e.g., Book, 1988; Buie, 1981; Danish &
Kagan, 1971; Easser, 1974; Feshbach, 1975; Hoffman,
1982, 1984b; Hogan, 1969; Kerr, 1947; Mead, 1934). In this
view, empathy is conceptualized as a trait or as an ability to
"know another person's inner experience" (Buie, 1981, p.
282) or to "feel (perceive) the feelings (emotions) of other
people" (Sawyer, 1975, p. 37). These authors have defined
empathy by using terms such as "empathic disposition"
(Hogan, 1969, p. 309), "interpersonal orientation" (Rogers,
1957), "responsiveness . . . to the feelings of another per-
son" (Ianotti, 1975, p. 22), and "dispositional empathy"
(Davis, 1983, p. 113).
Those who believe that empathy is a trait or stable ability
include psychoanalytic theorists (e.g., Buie, 1981; Easser,
1974; Sawyer, 1975), psychotherapy researchers (e.g., Dan-
ish & Kagan, 1971; Dymond, 1950; Hogan, 1969; Rogers,
1957), and social and developmental psychologists (e.g.,
Aronfreed, 1970; Davis, 1983; Feshbach, 1975; Kesten-
baum, Farber, & Sroufe, 1989; Mead, 1934). The implicit
assumption underlying this view is that some individuals are
more empathic than others, either by nature or through
development. This conceptualization provides potential re-
search opportunities to those who are interested in studying
interindividual differences or understanding empathy devel-
opment in children. It also supports the research effort in
exploring issues such as how to use the therapist's empathic
ability in understanding and analyzing the client's self (e.g.,
Kohut, 1959), how to recognize high or low facilitative
counselors (e.g., Rogers, 1957), identifying which individ-
uals are more likely to be altruistic (e.g., Eisenberg &
Miller, 1987), and exploring the influence of the develop-
mental process or other personality characteristics on em-
pathy (e.g., Feshbach, 1975).
Other writers are interested in empathy as a situation-
specific cognitive-affective state (e.g., Barrett-Lennard,
1962; Greenson, 1960, 1967; Hoffman, 1984a; Rogers,
1949, 1951, 1957, 1959). From this perspective, empathy is
commonly defined as responding "vicariously" to a stimu-
lus or a stimulus person (Batson & Coke, 1981; Katz, 1963;
Stotland, 1969) or as sensing another's private world as if it
were one's own (Rogers, 1959; Truax & Carkhuff, 1967).
Operationally, a match between the observer's and the stim-
ulus person's affect or cognition (e.g., Feshbach & Roe,
1968; Stotland, 1969) or the degree to which a therapist
understands and feels client experiences (e.g., Barrett-
Lennard, 1962; Carkhuff, 1969; Truax & Carkhuff, 1967)
has been used as a criterion to identify and assess empathy.
The underlying implicit theory for considering empathy
to be a situation-specific cognitive or affective state appears
to be that regardless of one's developmental level of empa-
thy, empathic experience varies by the situation. This per-
spective allows for studying the effects of situational factors
and intraindividual differences in empathy, as well as pro-
moting empathic training or learning. Obviously, such a
focus is of interest to psychotherapy researchers in exam-
ining the outcome effect of therapist empathy during ses-
sions. Social psychologists also are interested in this ap-
proach because it allows them to manipulate empathy to
understand its role in other social processes such as altruism
(e.g., Batson & Coke, 1981; Stotland, 1969; Toi & Batson,
1982) and attribution (e.g., Gould & Sigall, 1977; Jones &
Nisbett, 1972; Regan & Totten, 1975).
 EMPATHY REVIEW
Theorists who are concerned with how empathy is expe-
rienced by therapists and clients in given situations have
conceptualized empathy as a multiphased experiential pro-
cess (e.g., Barrett-Lennard, 1981; Basch, 1983; Emery,
1987; Hoffman, 1984b; Katz, 1963; Reik, 1948; Rogers,
1975). These theorists consider the moment-to-moment ex-
perience of empathy and examine the processes involved in
producing and communicating an empathic state. Various
"stage" models have been offered to show that the therapist,
in experiencing therapeutic empathy, goes through a pro-
cess involving multiple elements. Barrett-Lennard's (1981)
cyclical model (identifying three phases of empathy: em-
pathic resonation, expressed empathy, and received empa-
thy), Rogers's (1975) "temporarily living in" process (in-
volving sensing the client's inner world and communicating
that sensing), Kohut's (1984) two-step empathy in psycho-
analytic cure (understanding-explaining sequence), and
Gladstein's (1983) "multistage interpersonal process" (in-
cluding emotional contagion, identification, and role taking)
exemplify this effort. The focus on describing multiple
stages or elements embodies the complexity of empathy and
the need for incorporating clinical experience in studying
empathy in the context of counseling or psychotherapy.
Viewing empathy as a multistage interpersonal process
implies that empathy involves a sequence of experiences.
The clinical value of such a view is obvious (Barrett-
Lennard, 1981; Gladstein, 1983), yet empirical efforts in
operationalizing empathy as a multistage phenomenon have
been limited. Like many other stage theories, multiphased
empathy is difficult to assess. Thus, theories of empathy as
a multistage process have remained more descriptive than
explanatory.
In sum, empathy has been used to represent divergent
constructs that can all be justified by the content and context
in which they are studied. Unfortunately, when the same
term is used to reflect different constructs, it leads to con-
fusion in the literature. If there is to be a better understand-
ing, it is necessary to avoid using the general term of
empathy and use instead the specific terms of dispositional
empathy, empathic experience, and empathic process to
specify which construct is being referred to.
The Nature of Empathy
Empathy has been identified by some as primarily an
affective phenomenon (e.g., Allport, 1961; Langer, 1967;
Mehrabian & Epstein, 1972; Stotland, 1969) referring to the
immediate experience of the emotions of another person.
Others, however, view empathy as primarily a cognitive
construct (e.g., Barrett-Lennard, 1962, 1981; Borke, 1971;
Deutsch & Madle, 1975; Kalliopuska, 1986; Katz, 1963;
Kohut, 1971; Rogers, 1986; Woodall & Kogler-Hill, 1982)
referring to the intellectual understanding of another's ex-
perience. A third view holds that empathy contains both
cognitive and affective components (e.g., Brems, 1989;
Hoffman, 1977; Shantz, 1975; Strayer, 1987) or that it can
be either cognitive or affective depending on the situation
(e.g., Gladstein, 1983).
263
To minimize the confusion in understanding the litera-
ture, Gladstein (1983) used cognitive empathy to mean
"intellectually taking the role or perspective of another
person" (p. 468) and affective empathy to denote "respond-
ing with the same emotion to another person's emotion" (p.
468). He stated that these two separate and distinct types of
empathy were identifiable in the social, developmental, and
counseling psychology literature, although the terms had
not been used. Smither's (1977) observation of "empathy
via contagion" and "empathy via role-taking" and Bache-
lor's (1988) identification of cognitive and affective styles
of therapist empathy (although Bachelor also found evi-
dence for sharing and nurturant styles of empathy) also
supported Gladstein's classification of the two types of
empathy.
Although Gladstein's (1983) distinction of the two types
of empathy is helpful in providing a useful framework for
studying empathy and reducing confusion, the argument
about the inseparability of cognitive and affective elements
of empathy has been made repetitively (e.g., Feshbach,
1975; Greenberg, Rice, & Elliott, 1993; Greenson, 1960;
Katz, 1963; Schafer, 1959; Strayer, 1987). It seems that the
terms cognitive empathy and affective empathy are not pre-
cise or descriptive and can be confusing because they may
represent a false dichotomy. In fact, research evidence
shows that cognitive and affective processes unavoidably
influence each other (e.g., Bower, 1983; Isen, 1984).
In sum, there has been considerable debate on the nature
of empathy. Cognitive and affective empathic processes are
thought to be distinct phenomena on one hand, but the
coexistence of cognitive and affective processes in empathy
is acknowledged on the other hand. Such an unclear, and at
times confusing, picture calls for more systematic research
to understand empathy as a cognitive phenomenon or an
affective phenomenon and to understand the relationship
between the two conceptions. This effort will not only make
the understanding of empathy more communicable between
and among subdisciplines of psychology but also facilitate
the operationalization and research of therapeutic empathy
as a multistage process, as advocated by Barrett-Lennard
(1981) and Gladstein (1983). However, we believe that the
overlapping terms of cognitive and affective empathy
should be avoided. Instead, we propose that researchers use
intellectual empathy to refer to the cognitive process and
empathic emotions to refer to the affective aspect of em-
pathic experience. These new terms should allow research-
ers more freedom of investigating cognitive or affective
elements of empathy as distinct phenomena without being
caught in the endless debate about the nature of empathy.
Continuous effort is needed in understanding how these two
processes may exist separately, coexist, or influence each
other.
Empirical Research
Measurement of Empathy
The variety of empathy measures is striking yet under-
standable given the variety of ways in which empathy has
264 DUAN AND HILL
been defined. Instruments have been used to measure em-
pathy as a relatively stable human ability or personality trait
(e.g., Davis, 1979, 1980; Hogan, 1969; Mehrabian & Ep-
stein, 1972), a state (e.g., Barrett-Lennard, 1962; Batson,
1987; Dymond, 1949; Eisenberg, Fabes, Bustamante, &
Mathy, 1987; Feshbach & Roe, 1968), or a multicomponent
phenomenon (e.g., Cochrane, 1974; Elliott et al., 1982;
Hargrove, 1974). In some of these measures, empathy is
viewed as cognitive (e.g., Hogan, 1969; Truax & Carkhuff,
1967); in others, it is viewed as affective (e.g., Eisenberg et
al., 1987; Feshbach & Roe, 1968; Mehrabian & Epstein,
1972); and, in still others, it is viewed as containing both
cognitive and affective elements or subscales (e.g., Davis,
1979, 1980). Empathy has been measured through self-
reports (e.g., Barrett-Lennard, 1962; Batson, 1987; Hogan,
1969), reports of others (clients; e.g., Barrett-Lennard,
1962; Truax & Carkhuff, 1967), observer ratings (e.g.,
Carkhuff, 1969), and physiological measures (e.g., Berger,
1962; Eisenberg et al., 1987; Krebs, 1975; Stotland, 1969).
As observed by Hill, Nutt, and Jackson (1994), the most
commonly used self-report or other-report instrument of
counselor-therapist empathy in counseling and psychother-
apy is the Barrett-Lennard Relationship Inventory (Barrett-
Lennard, 1962), a subjective and cognitive focused measure
that conceptualizes empathy as a state experienced by the
therapist for his or her client. Therapists rate themselves in
terms of how much they think they understood, or clients
rate therapists in terms of to what extent they felt under-
stood, in a given session. Commonly used observer-rated
counselor empathic state measures are Truax's Accurate
Empathy Scale (Truax & Carkhuff, 1967) and Carkhuff s
(1969) Empathic Understanding Scale (see Hill, Nutt, &
Jackson, 1994). These measures were designed to assess the
degree to which the therapist temporarily "lives" in the
client's world and takes the client's view (Rogers, 1957).
However, the validity of such self-report, client-report, or
observer-report methods is questionable. The accuracy of
self-report or client-report measures is limited by human
perception errors; that is, one may "think" that one under-
stands another person or is understood by another person
but the other person does not reciprocate. In addition, social
desirability may affect the therapist self-report, and client
reports may be influenced by other factors such as session
outcome and mood (e.g., Bruner & Taguiri, 1954; Gurman,
1977). Observer ratings, on the other hand, mainly capture
the outward expression of inward empathic experiences,
which may be confounded with therapist communication
skills (e.g., Alexander, Barton, Schiavo, & Parsons, 1976;
Rice, 1965). Because of such limitations, these measures
fail to tap whether the therapist has entered "the private
perceptual world" (Rogers, 1975, p. 4) of the client, "stood
in his shoes" (Katz, 1963, p. 5), or viewed and felt the world
from the client's "perceptual vantage point" (Truax &
Carkhuff, 1967, p. 285).
Several exploratory attempts have been made to assess
empathy as a multi-component phenomenon. Lister's scale
(Hargrove, 1974) divided empathy into eight aspects: inter-
nal frame of reference, perceptual inference, accurate per-
ceptual inference, immediacy, emphasis on personal percep-
tions, use of fresh words, appropriate voice, and pointing to
exploration. Cochrane (1974) scored six aspects of empa-
thy: internal frame, emotional separation, accuracy, con-
creteness, energy, and caring manner. Elliott et al. (1982)
refined Cochrane's components and added several other
aspects into the Response Empathy Rating Scale, which
contained nine components: intention to enter client's frame
of reference, perceptual inference and clarification,
accuracy-plausibility, here and now, topic centrality, choice
of words, voice equality, exploratory manner and impact
facilitation versus blocking, and distraction. These efforts at
rating therapist empathy in multiple dimensions mainly
focused on "client-received" empathy and relied on client
report (Bachelor, 1988), observer ratings (Elliott et al.,
1982), and session verbal interaction analysis (Hargrove,
1974). Such measures moved a step closer to therapeutic
empathy, as described by Barrett-Lennard's (1981) stage
model, but did not generate much empirical research, per-
haps because of a lack of tight theoretical connections
among the components or because the measures focused on
counselors' overt behavior rather than the empathic experi-
ence. These measures are also not successful as a means of
operationalizing empathy as a multiphased process because
they fail to show the presence of stages (e.g., empathic set,
empathy, and feedback; Barrett-Lennard, 1981), although a
vague time sequence is often implied by the elements.
In the context of psychotherapy, empathy as an affective
phenomenon has not been given much research attention.
Various attempts to assess empathy as "vicarious emotion"
have been reported in social and developmental psychology
research, primarily using self-report (e.g., Batson, 1987)
and physiological (e.g., Stotland, 1969) measures. Although
physiological methods are often believed to be superior to
self-reports in controlling for social desirability effects
(Eisenberg et al., 1987; Krebs, 1975), both methods are
problematic because they fail to differentiate empathy from
other emotions such as sympathy and personal distress.
In sum, although a considerable amount of effort has been
devoted to assessing empathy, valid measures are still lack-
ing. Gaps between how empathy is defined and measured
often exist, particularly in assessments of empathy in ther-
apy. Problems appear to exist at both a theoretical and
methodological level. Specifying exactly what is to be mea-
sured—trait or experience, state or stage, cognitive or af-
fective aspects—is necessary to develop a valid measure.
Moreover, because of the limitations of human perceptions,
the traditional scale approach seems inadequate in tapping
into empathy when it is defined as an inner experience
(cognitive or affective) or a sequence of experiences (inner
and outward). Alternative approaches need to be developed.
Relationships Between Intellectual Empathy and
Empathic Emotions
Little has been written about the role of empathic emo-
tions or the relationship between intellectual empathy and
empathic emotions in the therapy literature. Evidence in
other areas of psychology indicates that both intellectual
 EMPATHY REVIEW
empathy and empathic emotions may independently affect
interpersonal behavior. For instance, an affective empathic
state has been found to mediate helping behavior (e.g.,
Batson, Fultz, & Schoenrade, 1987; Eisenberg & Miller,
1987; Krebs, 1975; Toi & Batson, 1982), and a cognitive
empathic state has been found to alter the pattern of attri-
bution of others' behavior (e.g., Gould & Sigall, 1977;
Regan & Totten, 1975). However, the relationship between
these two types of empathy is not yet clear.
Some research findings suggest that intellectual empathy
and empathic emotions are independent phenomena. Mill
(1984) discovered that high self-monitoring individuals
were more able to take the perspective of another (in this
case, high ability to decode vocal cues), but they did not
express more affective empathy. When empathy was de-
fined as a cognitive or affective trait, Smither (1977) failed
to find a significant correlation between the two types.
Gladstein (1983) summarized the research evidence in the
literature and concluded that role-taking ability (intellectual
empathy) was not closely related to affective empathy (em-
pathic emotions).
Other evidence, however, seems to allow for a hypothesis
of a mutual influence of cognitive and affective empathic
processes. Hoffman (1984a), for instance, believed that the
empathizer's perception of the victim's innocence may in-
crease the emotional empathic response in the observer.
Krulewitz (1982) found that participants reacted to a rape
victim more empathically when the rape was committed by
a stranger rather than by a date. Social psychology research
also suggests that affect can influence cognitive activities
(e.g., Bower, 1983; Forgas & Bower, 1987; Snyder &
White, 1982), or vice versa (e.g., Davis, Hull, Young, &
Warren, 1987; Stotland, 1969). People in a happy mood
tend to be charitable, loving, and positive in interpreting
information about others (Bower, 1981) and tend to make
lenient judgments and situational attributions of a transgres-
sion (Duan, 1988). Recently, Hill, O'Grady, et al. (1994)
showed that positive presession mood was positively related
to client judgments of therapist helpfulness and session
depth.
The exclusion of empathic emotions in psychotherapy
research prevents the understanding of the relationship be-
tween therapist intellectual empathy and empathic emo-
tions. The indirect evidence seems to suggest that the way in
which counselor-therapist intellectual empathy and em-
pathic emotions interact or relate can be complicated or
conditional and is worth investigation. Knowledge of how
therapeutic empathy is experienced or affects the therapeu-
tic relationship and outcome will not be complete without
an understanding of how therapists use both intellectual
empathy and empathic emotions.
Role of Empathy in Psychotherapy
Although the primary function of empathy in psychother-
apy is perceived differently from various theoretical per-
spectives (see Bohart, 1991), the research that has generated
the most empirical findings has followed Rogers's (1957)
265
discussion of empathy as one of the "necessary and suffi-
cient conditions of therapeutic personality change" (p. 95).
The often-used paradigm measures and correlates
counselor-therapist intellectual empathy (assessed by either
participant or observer measures) and client outcome (as-
sessed by self-report, therapist, observer, or objective test
methods) after the speaking turn, interview, or treatment.
Truax and Carkhuff s (1967) work and that of others (e.g.,
Altman, 1973; Banks, 1972; Cabush & Edwards, 1976;
Jones, Wynne, & Watson, 1986; Kolb, Beutler, Davis,
Crago, & Shanfield, 1985; Lafferty, Beutler, & Crago,
1989; Luborsky, Chandler, Auerbach, Cohen, & Bachrach,
1971; Miller, Taylor, & West, 1980) provided empirical
evidence of the relationship of empathy to client change.
Other research has shown that only client perceptions of
empathy are related to client-rated counseling outcome
(Gurman, 1977; Orlinsky & Howard, 1986).
The conclusions about the efficacy of empathy, however,
have been challenged. Inconsistent research results have
been reported (e.g., Parloff, Waskow, & Wolfe, 1978), and
different conclusions regarding the function of empathy in
psychotherapy have been made (e.g., Gladstein, 1987;
Goldstein & Michaels, 1985). Bergin and Suinn (1975)
concluded that empathy (and other facilitative conditions)
was probably not sufficient "except in highly specific,
client-centered type conditions" (p. 462). Similarly, Lam-
bert and Bergin (1992) believed that empathy was more
relevant for milder disorders than for more severe distur-
bances.
Several methodological problems have also been re-
ported. Chinsky and Rappaport (1970) and Gormally and
Hill (1974) particularly criticized the research for unreliable
and inaccurate measures of empathy. Lambert, Dejulio, and
Stein (1978) pointed out the lack of cause-effect evidence
between empathy and outcome as a result of the correla-
tional research paradigms used. In addition, we believe that
the lack of attention to the role of therapist empathic emo-
tions and to the dynamic relationship between intellectual
empathy and empathic emotions can also account for the
inconsistent and inconclusive findings. Furthermore, the
way in which empathy traits influence intellectual empathy
and empathic emotions in therapy has not been studied, nor
has the relationship between empathy trait and therapy
outcome. Until these relationships are examined, an under-
standing of how empathy operates in therapy will not be
possible.
Predictors of Therapeutic Empathy
The literature on predictors of empathy is much smaller
than that on the role of empathy and has been concerned
mainly with individual differences in empathic ability. Al-
though intellectual empathy experienced or expressed by
therapists has usually been the focus of research, the as-
sumption that some individuals are more empathic than
others has clearly guided most of the research in this area.
Therefore, effort has been directed toward finding correla-
tions between therapist demographic (e.g., gender and age)
266 DUAN AND HILL
or relatively stable variables (e.g., cognitive style and per-
sonality) and therapist-experienced empathy, most often
measured, in various empathy scales, as the degree of the
therapist's understanding of the client.
Studies have examined the level of empathy in relation to
counselor gender (e.g., Carlozzi & Hurlburt, 1982; Kimber-
lin & Friesen, 1977; Petro & Hansen, 1977), sex role
orientation (e.g., Carlozzi & Hurlburt, 1982; Fong & Bor-
ders, 1985), personality type (e.g., Gillam & McGinley,
1983; Jenkins, Stephens, & Chew, 1992; Kulberg & Franco,
1975; Watson, Little, Sawrie, & Biderman, 1992), and cog-
nitive complexity (e.g., Alcorn & Torney, 1982; Blaas &
Heck, 1978; Heck & Davis, 1973; Kimberlin & Friesen,
1977; Lutwak & Hennessy, 1982). Although research find-
ings are often conflicting, there is some evidence that a
feminine sex role orientation is more strongly related to
empathic emotions than a masculine sex role orientation
(e.g., Carlozzi & Hurlburt, 1982; Fong & Borders, 1985)
and that higher cognitive complexity is positively related to
intellectual empathy (e.g., Heck & Davis, 1973; Lutwak &
Hennessy, 1982).
In addition, therapist overt verbal and nonverbal commu-
nication variables have been examined in relation to client-
perceived therapist empathy, most often defined as cogni-
tive in nature. The use of more sophisticated polysyllabic
language (Barrington, 1961), more concreteness of wording
(Schauble & Pierce, 1974), more narrative analogy (Suit &
Paradise, 1985), more postural shifts (Hermansson, Web-
ster, & McFarland, 1988), fewer general advisements
(Barkham & Shapiro, 1986), and less self-disclosure (Peca-
Baker & Friedlander, 1987) has been found to be associated
with higher levels of empathy being perceived by the client.
In addition to measurement problems, research in this
area is limited by the seemingly fixed assumption of indi-
vidual differences and lack of attention to intraindividual
differences. Situational factors such as counselor mood,
knowledge of the client, and awareness of the client's cul-
ture; the nature of clients' emotions; and client-counselor
values and value differences may influence therapists' feel-
ings and expression of empathy. The exclusive focus on
individual differences would limit understanding of cause-
effect relationships between empathic experience and its
predictors. Furthermore, the research is limited by not in-
cluding important variables such as counselor motivation
and attitudes toward empathy and counselor affective emo-
tions toward clients. Such knowledge will be helpful in
understanding how and why some therapeutic approaches
may suit certain counselors more than others and how
counselors may be trained to be more or less empathic.
Summary and Speculations About the Decrease in
Empathy Research
Although the volume of the research on empathy is siz-
able, the product appears weak. The research is character-
ized by conflicting constructs, problems with measurement,
and lack of systematic replications of various promising
research evidence. In addition, only limited content areas
have been covered, and many important factors that may
affect empathy have not been examined.
Furthermore, the amount of empathy research has de-
creased in recent years. Sexton and Whiston (1994) found
that only 11 empathy-related studies had been published in
major counseling psychology journals since 1985. We spec-
ulate that there may be several reasons for this puzzling
decrease of attention. One explanation for the decline is that
Gladstein's (1983) review discouraged diverse research in-
terest in empathy. His interest in empathy research seemed
to focus narrowly on the therapeutic functions of empathy
as a multiphase and multicomponent process, and he did not
advocate research beyond this focus, such as looking at
factors that predict empathy, examining cultural contexts
that influence empathy experience and expression, and as-
sessing empathy as just cognitive or affective. Although
clinical relevance justifies his position, the argument can be
made that knowledge of alternative empathy models, pre-
dictors of various types of empathy, and cultural differences
in empathic experiences is imperative in understanding the
role of empathy in therapy. To understand Gladstein's ob-
servation that empathy can be helpful or interfering, for
instance, the knowledge of the circumstances in which
empathy is elicited may be very useful.
Moreover, Gladstein's (1983) review also failed to offer
specific or heuristic directions for future research. After
presenting a "confused picture" (Gladstein, 1983, p. 480)
and expressing the vision that "we may not be able to
resolve the existing confused picture concerning empathy
and counseling/psychotherapy outcomes" (p. 480), Glad-
stein gave no specific directions and communicated a lack
of enthusiasm. Without strong encouragement and enthusi-
asm, the difficulty of understanding empathy as a complex
interpersonal process, particularly when each of the phases
or components is not yet understood and when there are not
even adequate assessment tools, may have been daunting for
researchers.
Another major reason for the decline may be that interest
seems to have shifted from therapist empathy to the working
alliance (see Hill & Corbett, 1993). The focus has shifted
from Carl Rogers's theory to more of an emphasis on the
psychoanalytic construct of the therapeutic or working al-
liance, which is construed as a more interactional process
(Bordin, 1979; Horvath & Symonds, 1991). Therapist em-
pathy is sometimes considered to be one component of the
working alliance. Some would say that an optimal under-
standing of the working alliance is not possible without
further knowledge of empathy (Beres & Arlow, 1974;
Meissner, 1993; Patton & Meara, 1992).
Future Research
We argue that there is a need to return to investigating
empathy. Understanding of empathy, at this time, is far from
sufficient in testing or demonstrating the role of empathy
described by major theorists, such as Rogers (1951, 1957,
1975) and Kohut (1959, 1971, 1984), who view empathy as
a necessary experience in therapeutic cure. The lack of
 EMPATHY REVIEW
coherence between the theoretical importance of empathy
and empirical evidence necessitates the return to empathy
research.
If practitioners are to be provided with useful informa-
tion, an understanding of how empathy operates in psycho-
therapy is necessary. Moreover, empathy should be consid-
ered in researching many other concepts such as the
working alliance. It makes logical sense to study empathy as
the therapist's contribution, along with the client's involve-
ment and the interaction between the therapist and client
(bonds and agreement on tasks and goals), to the working
alliance. The diverse empathy theories need to be tested,
and confusion caused by miscommunication among the
theories needs to be clarified. More empirically derived,
explanatory theories of empathy are necessary if there is to
be a better understanding and the use of concept of empathy
in counseling and psychotherapy training and practice. If
theory building is to be facilitated, it is necessary to under-
stand the predictors as well as functions of empathy as a
trait, an experience, or a process and as a cognitive, affec-
tive, or multistage and multicomponent phenomenon.
In this section, we discuss some possible research direc-
tions exemplifying these areas. We also try to discuss the
topics that may potentially lead to contributions to theory
building and to the understanding of empathy in general and
counseling and psychotherapy in particular.
Measuring Empathy as Experienced and
Communicated by Therapists
Measures that tap into clearly defined and distinct con-
structs of intellectual empathy and empathic emotion as
situation-specific experiences are particularly needed. Such
measures are crucial in operationalizing empathy as a mul-
tiphased process. Many past efforts relied on scales based
on self-perceptions or perceptions of others and produced
various biases or flaws. We propose that research methods
be integrated from other areas of psychology and that use of
empathy scales be avoided. To minimize social desirability
effects and self-perception flaws, we recommend indirect
methods that do not appear to be measuring empathy.
In assessment of intellectual empathy (defined as taking
the perspective of another), an attributional approach (cf.
Houston, 1990) appears promising. The literature in social
psychology has established that taking an actor's perspec-
tive will lead to more "self (actor) serving bias" or more
typical actor attribution (e.g., Aderman, Archer, & Harris,
1975; Brehm & Aderman, 1977; Deitz & Byrnes, 1981;
Gould & Sigall, 1977; Regan & Totten, 1975; Weiner,
Frieze, Kukla, Reed, Rest, & Rosenbaum, 1971). Thus, the
pattern of observers' attribution may potentially be used to
infer observers' perspective taking (Jones & Nisbett, 1972).
Houston (1990) found that individuals made relatively more
situational attributions when more cognitive awareness of
the other's inner state was expected than when such cogni-
tive awareness was not expected. Similarly, Davis (1979)
reported that individuals scoring high on perspective taking
offered causal attributions for another's behavior that were
267
less like those of a typical observer and more like those
offered by actors themselves. This linkage between perspec-
tive taking and attribution style supports the idea of using
the counselor's attribution of the client's situation to assess
the degree to which the counselor takes the client's perspec-
tive. If the counselor makes the same attribution of the
client's behavior or emotion as the client does, intellectual
empathy experienced by the counselor may be assumed.
Another approach to estimate perspective taking is using
the match between the counselor's perception of the client's
feelings or thoughts and the client's reported feelings or
thoughts. This method is similar to the "metaperception"
approach recommended by Barrett-Lennard (1981), who
believed that use of person A's view of person B's view of
the relationship between them was a "new plane of inquiry"
(p. 99) and a "powerful indirect or second-order way of
assessing empathy" (p. 99). The validity of the method can
be theoretically inferred, because the accuracy of the match
should reflect the degree to which one person is taking
another's perspective. Harman (1986) provided evidence
that the accuracy of therapist perception of client responses
to empathy measures is moderately correlated with client-
received empathy. Hill and her colleagues (Hill, Thompson,
Cogar, & Denman, 1993; Hill, Thompson, & Corbett, 1992;
Thompson & Hill, 1991) found that therapists differed in
their abilities to perceive client reactions accurately. When
the therapist perception matched the client-reported reaction
of being supported, Hill and her colleagues found that
clients reported feeling more helped.
To measure empathic emotions (defined as the experience
of vicarious emotions), we recommend using the match
between the counselor's emotion and the client's emotion as
the criterion. The usefulness of this matching variable was
demonstrated by Hill, Siegelman, Gronsky, Sturniolo, and
Fretz (1981), who used a match of emotions to measure
"congruence" and found that counselor congruence was
positively related to counselor facilitativeness. Using the
match between specific emotions experienced by the coun-
selor and client may be a way to tap into emotional em-
pathic experience without involving flawed self-perception
or influence of other personal reactions such as personal
distress (Batson et al., 1987) or sympathy (Wispe, 1986).
Developing sound systems to assess empathy as a mul-
tiphase or multicomponent interpersonal process with se-
quential stages is a more challenging task. The limited past
effort seemed attentive to multiple components only (e.g.,
Bachelor, 1988; Elliott et al., 1982; Hargrove, 1974), ne-
glecting the sequential nature of the empathy process. Hill
and O'Grady's (1985) system of counselor intentions and
Hill et al.'s (1992; Hill, Helms, Spiegel, & Tichenor, 1988)
system of client reactions and counselor perceptions of
client reactions could be useful to assess the moment-by-
moment process. These systems can assess the counselor's
experience of taking the client perspective (accurately per-
ceived client reaction) and intended communication of the
empathy (intention of intervention), as well as the client's
perception of counselor intention (perceived counselor in-
tention) and received empathy (reaction to counselor inten-
tion). Using the match between counselor-perceived client
268 DUAN AND HILL
reaction and client-reported reaction, for example, may not
only indicate therapist-experienced empathy but also make
the test of the "temporal sequence" (Gladstein, 1983, p. 475)
of empathic process possible.
In assessments of communicated empathy, one important
and promising direction is to consider the client's feeling of
being understood, moment to moment, as a criterion of
empathy because what really matters is the client's experi-
ence (cf., Barrett-Lennard, 1981; Rogers, 1951, 1957). Ac-
cording to Kohut (1984), experience and communication of
empathy will lead to the client experiencing a healthy self
and self-object relationship; thus, how the client experi-
ences the relationship in therapy can be a logical indicator
of empathy. The indirect systems, such as those of Hill and
O'Grady (1985) and Hill et al. (1988, 1992) mentioned
earlier or other outcome measures, may be used to infer
communicated empathy, but what these measures can do is
still limited. It appears that qualitative methods might be
more powerful than quantitative methods in this area. For
instance, maybe the client's description of his or her expe-
rience with the therapist can be used to estimate communi-
cated empathy.
Interaction Patterns of Intellectual Empathy and
Empathic Emotion
To understand empathy as a complex process, one needs
to know how intellectual empathy and empathic emotions
interact in therapists' observation and understanding of the
client. On the basis of the limited, indirect evidence, we
speculate that intellectual empathy and empathic emotion in
counseling and psychotherapy are separate processes that
may be independent from or related to each other under
different conditions. Research in discovering the patterns
and the conditions of the relationship has not drawn much
attention yet is worthwhile. It is necessary to know whether,
how, when, and under what circumstances empathic emo-
tions may affect intellectual empathy. Beyond contributing
to advancing the knowledge of empathy, such an under-
standing has significant clinical value as well. Awareness of
the conditions in which intellectually taking a client's per-
spective and feeling the client's emotions are, or are not,
related may allow the counselor a better use of empathy
cues in therapy. Moreover, the knowledge may also help
counselors in making effective conscious efforts to express
empathy to clients.
Roles of Counselor and Client Emotions in
Predicting Counselor Empathy
There is ample research evidence suggesting that affect
may influence individuals' thoughts, cognitive processes,
emotional experiences, and behavior (e.g., Bower, 1983;
Isen, 1975, 1984) and that "affect dominates social interac-
tion and is the major currency in which social intercourse is
transacted" (Zajonc, 1980, p. 155). However, the possible
role of counselors' affect in therapeutic empathy has not
drawn research attention. Considering that the counselor has
a role in all levels of the therapeutic relationship, it makes
logical and practical sense to examine counselor affect (e.g.,
presession mood) as one predictor of therapist empathy. In
fact, a recent preliminary effort revealed that counselor
presession anxiety was positively correlated with intellec-
tual empathy and that presession positive emotion level was
negatively correlated with affective emotions (Duan & Kiv-
lighan, 1995).
Emotions have been found to differ on various dimen-
sions such as pleasantness and arousal (Izard, 1977; Izard &
Beuchler, 1980; Tomkins, 1962), whether or not the emo-
tion is basic (Oatley & Johnson-Laird, 1987; Weiner &
Graham, 1984), level of control and effort (Smith & Ells-
worth, 1985), and so forth. Apparently, some emotions are
easier to access or are more common in human experience
than others (Ortony, Clore, & Collins, 1988; Strongman,
1978). Therefore, it is reasonable to speculate that counsel-
ors may have different levels of readiness or ability to
empathize with different emotions and that some client
emotions may be more likely to elicit counselor empathy
than others. However, minimal, if any, empirical effort has
been devoted to this area of inquiry.
Counselor empathy research has mostly dealt with non-
differentiated negative or unpleasant client emotions, be-
cause this is what counseling usually involves. Little is
known about the likelihood and function of empathy when
clients experience positive or pleasant emotions. Knowl-
edge is also lacking about the power of different negative
emotions in eliciting counselor empathy. It is plausible,
however, to assume that counselors, like other individuals,
may affectively empathize with clients experiencing either
pleasant or unpleasant emotions because empathizing with
someone with positive emotions can be emotionally reward-
ing and empathizing with someone with negative emotions
can be morally rewarding. What needs to be understood is
how the various positive and negative emotions differ in
eliciting empathic emotions in counselors. In comparison,
intellectual empathy is probably less affected by the pleas-
antness of the emotion. Because counselors are generally
trained to be intellectually empathic, understanding the pain
is probably not as aversive as feeling the pain of a suffering
individual.
Empathic Readiness and Cultural Differences
Few would question that the counselor's experience of
empathy toward the client is probably affected by the coun-
selor's empathic capacity, past experience, motivation to
empathize, and affective and cognitive state at the time of
the session. Yet, there is no empirical evidence about how
these factors affect empathic experiences in a session.
Research in other areas of psychology indicates that both
dispositional empathy and motivation to empathize may
affect the empathic experience. Affective empathic dispo-
sitions, for instance, have been shown to influence affective
reactions (Archer, Diaz-Loving, Gollwitzer, Davis, &
Foushee, 1981), feelings of sympathy (Davis, 1983), and
frequency of felt empathy (Ianotti, 1975). The influence of
 EMPATHY REVIEW
motivation in empathy has been implied by the success of
inducing empathy by giving empathy instructions (e.g.,
Macrae & Milne, 1992; Stotland, 1969) or through sensi-
tivity or role-taking training (Scott & Borodovsky, 1990;
Wade & Bernstein, 1991). However, it is not clear whether
empathic disposition and motivation are necessary condi-
tions of empathy or how important they are in producing
specific empathic experiences. Although the belief that em-
pathy is the "combination of introspection and putting one-
self in another's place" (Goldberg, 1983, p. 156) supports a
connection between empathic experience and one's dispo-
sitions and motivation, it is not known how strong this
connection is or whether the strength of the connection
varies with the situation. Empirical effort in this area may
help provide an understanding of whether, or when, human
empathy is spontaneous or induced and would have direct
implications for counselor training and selection.
Both the argument of the role of introspection in empathy
(Goldberg, 1983; Kohut, 1959, 1971, 1977) and that of
empathy involving situation appraisals (e.g., Hoffman,
1984a; Lazarus, 1991) call for considerations of the ever-
present cultural and individual differences in values, com-
mitment, appraisal standards, and so on in studying empa-
thy. There is a pressing need for knowledge concerning the
possible influence of culture on empathic experience, ex-
pression, and reception. Given that consumers of counseling
are becoming more culturally diverse, it is necessary to
understand whether, or how, the same client experience can
elicit different amounts of empathy from counselors with
varying cultural values and whether, or how, the same
counselor expression can be perceived as providing differ-
ent amounts of empathy by clients from different cultures.
The role of cultural values in empathic experiences is a
neglected area, although it makes sense to assume that
counselors with different values may be differentially ready
to empathize with clients holding different cultural values.
Values may affect one's situational appraisal and influence
one's ability to experience empathy in a given situation.
Preliminary efforts have shown that collectivistic values
tend to be related to a higher empathy disposition (measured
as perspective taking) and a higher likelihood of experienc-
ing another's negative emotions (Duan & Geen, 1995).
More questions may be asked along this line, such as
whether collectivistic values predict more empathy (partic-
ularly empathy cognitive in nature) if the client is struggling
with a highly individualistic issue. Does the similarity of
cultural values between counselor and client always lead to
more empathy? Knowledge in this area is extremely impor-
tant in making clinicians aware of their cultural biases and
differences between their and the client's cultural values
and helping them deal with value conflicts in working with
clients.
Role of Therapeutic Empathy: Helpful Versus
Unhelpful Empathy
It is intriguing that, on one hand, theorists (e.g., Kohut,
1984; Rogers, 1957, 1959) argue for the necessity of em-
269
pathy in helping clients change and that, on the other,
empathy has been perceived as not always helpful (e.g.,
Gladstein, 1983). Perhaps some kinds of empathy are help-
ful but others are not, or perhaps empathy is helpful at some
times but not at other times, or perhaps there is an optimal
level of empathy and too much or too less is unhelpful. The
clinical value of understanding the types of empathy that are
helpful and the situations in which empathy is helpful
appears obvious; surprisingly, however, not much empirical
attention has been devoted to such issues.
To understand the role of empathy, one needs to be aware
of clients' role in determining the effectiveness of any type
of empathy. Bachelor (1988) showed that different types of
helpful empathy exist for clients. Some clients in her study
perceived the therapist's accurate recognition of their ongo-
ing innermost experience, state, and motivation as empathy,
whereas some perceived the therapist's participation in their
ongoing feeling state as empathic. Moreover, some saw the
therapist's self-disclosure or supportiveness as being em-
pathic. Some clients in each of these groups expressed
desirable effects of the empathy, and some did not. These
findings allow one to infer that clients may need different
types of empathy from therapists.
The context and the timing of empathy are probably
important factors to consider in studying the usefulness of
therapeutic empathy. For instance, Hill and her colleagues
(Hill et al., 1992; Thompson & Hill, 1991) demonstrated
that when clients had negative in-session reactions, therapist
awareness of the reactions (intellectual empathy) led to
interventions that were perceived as less helpful than when
the awareness was absent. However, in the context of a
good therapeutic relationship, counselor misunderstanding
of clients was often found not to result in the intervention
being completely ineffective (Rhodes, Hill, Thompson, &
Elliott, 1994). It appears that client needs for empathy
change with time and context, and understanding such
changing needs is crucial for counselors in communicating
empathy to clients.
A proper understanding of the role of therapeutic empathy
also calls for research on the relationship of therapist em-
pathy to other conceptually similar phenomena that occur in
therapy. In addition to the working alliance, as previously
discussed, other similar phenomena are client attachment to
therapists (see Mallinckrodt, Gantt, & Noble, 1995), trans-
ference and countertransference (Gelso & Carter, 1994),
and empathic failures or misunderstandings (Rhodes et al.,
1994; Safran, Crocker, McMain, & Murray, 1990). It must
be determined whether empathy is the same as these other
phenomena or a component of these phenomena.
Conclusion
Although a considerable amount of research is available,
understanding of empathy is still limited. The lack of spec-
ification and organization of different views of empathy has
led to theoretical confusion, methodological difficulties,
inconsistent findings, and neglected areas of research in the
field. We hope that, in the future, researchers will distin-
270 DUAN AND HILL
guish between dispositional and state empathy and between
intellectual empathy and empathic emotion and will identify
whether they are examining the therapist's or client's expe-
rience of empathy. Various situational factors and cultural
differences need to be considered in understanding the
therapeutic empathic experience, and the role of such em-
pathic experiences needs to be understood through research-
ing the conditions under which empathy is helpful. The fact
that empathy research is still plagued by various theoretical
and methodological insufficiencies clearly extends an invi-
tation for creative and persistent researchers to exert their
scientific effort and contributions. Indeed, therapist empa-
thy is particularly important to study because more knowl-
edge about therapists' contribution to the therapy relation-
ship is needed.
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Received September 12, 1994
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Accepted February 8, 1996 •

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