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Empathic Distress and Compassion, and some reflections on psychodynamic theory.

Empathic Distress
This morning I read Chapter 3 of McGonigal's "The Science of Compassion".  I almost wish I'd read it before I wrote yesterdays blog.  But on the other hand, it is useful for me to scaffold information in this way, using my own personal understanding, such as it is, to make sense of my reading, and then make modifications to this understanding as I read more and obtain more information to assimilate into the schemas that I am generating.

Chapter 3 speaks of empathic distress.  This to my reading, is what I was speaking about when I discussed the situation whereby a therapist, when faced with a clients distress, may become so overwhelmed by the distress that they feel in response, that their ability to be a helpful is affected.

McGonigal speaks of emotional contagion and empathic distress, although I am not sure that these are (or are intended to be) the same thing, they are both useful terms in this discussion.  Emotional contagion seems to be a behavioural phenomena, it occurs without need for a cognitive understanding or interpretation of what is happening.  Empathy, and empathic distress to me seem to require an understanding, emotionally or cognitively, about what the other person is experiencing.

McGonigal describes empathic distress as a necessary precursor to compassion, however it can make helping people in distress difficult if not impossible as the boundaries between self and other become blurred and the emotion overwhelming to the therapist.

Emotional Contagion and Transference
Whilst McGonigal speaks of emotions that are clearly shown through bodily processes (thus can be 'caught', there are times in a therapy situation when these process can occur away from conscious awareness.  I think that this is similar to a phenomena that some therapists call transference.

(although I'm not sure if I agree with the precise terminology, if one is to be faithful to Freuds own explanation about it, but there is apparently a lot of confusion in the psychodynamic field, about what transference precisely is so I may well be splitting hairs for no good reason)  

At any rate, transference could occur due to the non-conscious (or pre-conscious) contagion of emotions by the following means;  a client may be very dissociated and/or split, and have learned to separate themselves so completely from their emotions that they may not even recognise that they ever have a particular emotion.  An example may be anger.  In these cases, a therapist who has learned to be very attuned to their own responses, and is high in empathy, may experience feelings of anger, reflecting the very anger in the client that the client denies that they feel.  Presumably this could be through mirror neurons detecting small facial or bodily movements, or reflexions in the tone of voice of the client, away from consciousness. These minute movements are percieved and responded to by the therapists mirror neurons causing the therapist to produce similar physical movements.  This in turn results in the therapsit experiencing the feelings of the emotion.  Often neither the client or therapist are aware of the precise how's and why's of this emotional transference, but the effect can be exceedingly strong.

Reflections
The therapist can and does use these experiences to help them to form reflections on what sort of experience the client may be having that are not currently availble for discussion.  This in turn helps to guide how they may best work with the client.  However, these ways of forming hypotheses about clients experience need to be used with caution, and as I mentioned in the previous chapter any anger the therapist experiences in the therapy room  belongs to the therapist, and the therapist must take full responsibility for it.  If the therapist finds the anger to be at disturbing or overwhelming levels, then they need to take this to supervision, or their own therapy.  At the very least, the anger is very useful material for the therapists personal reflection, which should be made separately from any reflections they make regarding the client.

What about empathy felt through other means?  For instance, when one reads about an distressing event.  Although the physical signs of distress are not currently present in the other person, one might find themself imagining how it would be to experience the distressing event, and therefore might have an emotional response that they term 'empathy', although of course, whether their emotional response is similar to the person who actually experienced the distressing event or not, is not known at this point.  

The state of compassion
So, the my final question is now, how do therapists use their  empathic distress, to enter a state of compassion from which they can most effectively help a client.  According to McGonigal, "one must be able to know what it means to be with suffering, and not afraid to be with things as they are".  This means having the resilience and courage to feel the emotion without having a panic/freeze/flee response, and to respond to the experience with love and kindness. 

Again Mcgonigal reiterates that the idea that compassion is a state of peace, calm and happiness is misleading and can be unhelpful.  In several studies that she describes, it was found that it is necessary to be aware of ones own distress in order to understand the distress of another person. However this awareness needs to be tempered by the wisdom of knowing how to respond to the distress with loving kindness, and separating ones self from the distress, in order to be able to pay full attention to the client.

McGonigal speaks of a German study by Tanya Singer, in which people were trained in two styles of meditation - compassion meditation, in which the person focusses on the suffering and cultivates a response of love, care and concern, whilst another group where taught to be creative and tell comforting self stories such as "it isn't as bad as it seems" or "it will turn out ok".  Whilst viewing videos of people experiencing high levels of distress, both groups experienced reduced empathic distress, (that is "stress" activity in the amygdala was reduced),  however the first group alone (the compassion group) showed activity in brain areas associated with love and reward chemicals such as oxytocin and dompamine.

Thus if people just focuss on thinking positively, the result may be the shutting down of empathic distress, and prevention of the experience of compassion.


I have discussed McGonicals ideas around empathic distress alongside some of my own understanding of psychodynamic processes, as I think that they could both be results of similar brain processes.  These theories could be developed to explain some of the mechanisms through which therapists develop an attuned, trusting and holding relationship with their clients.  They also explain, part of the need for the therapist to be able to remain objective and boundaried, whilst allowing ones self to be open to experiencing all of the emotions in the room during a therapy session.




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