Therapist Experience, Personal Therapy, and Distressing States of Mind: Regulation and Resonance as Dialectics of Therapeutic Empathy

  • Shannon L. McIntyreEmail author
  • Lisa Wallner Samstag
  • Sara C. Haden
  • Joan W. Duncan
Original Paper


The current study is based on the notion of an empathic dialectic, marked by states of emotional resonance and regulation, which has been described by contemporary theories of therapeutic empathy and empirically supported by research on non-therapists. We operationalized emotional resonance as personal distress empathy, and we sought to examine how activities promoting self-regulation impact the association between personal distress empathy, and other facets of poor self-regulation. This was accomplished through an online study, which administered several self-report instruments to a sample of 158 non-therapists and 139 therapists of various levels of experience, collecting participants’ demographic information, attachment status, level of shame-proneness, the fear of invalidity, and personal distress empathy. We examined the impact of several moderators on the paths from attachment anxiety, shame-proneness, and the fear of invalidity to personal distress empathy; and, thus, on the indirect effect between attachment anxiety and personal distress empathy. For our first hypothesis, we expected therapist status to significantly moderate the paths in this proposed meditation. For our second hypothesis, we anticipated personal therapy sessions would significantly moderate this meditation. For our third hypothesis, we expected that both personal therapy and therapist experience level would moderate this mediation. Most notably, our results indicated that the fear of invalidity explained the association between attachment anxiety and personal distress empathy, and this mediation was stronger among non-therapists when compared to therapists. Yet, personal therapy did not similarly impact the relationships among these variables. Implications for future research are discussed.


Attachment Empathic process Personal distress empathy Therapist effects Therapist training Therapist supervision 



Statistical support was provided by data science specialist Dr. Steven Worthington, at the Institute for Quantitative Social Science, Harvard University.


The authors did not receive funding for the research or publication of this article.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project has been approved by the Institutional Review Board at Long Island University, New York.

Informed Consent

Informed consent was obtained from all individual participants involved in the study.


  1. Badenoch, B. (2018). Safety is the treatment. In S. W. Porges & D. Dana (Eds.), Clinical applications of polyvagal theory. New York: W.W. Norton Company Inc.Google Scholar
  2. Batson, D. C., Fultz, P., & Schoenrade, P. A. (1987). Distress and empathy: two qualitatively distinct vicarious emotions with different motivational consequences. Journal of Personality, 55(1), 19–39.Google Scholar
  3. Britton, P. C., & Fuendeling, J. M. (2005). The relation among varieties of adult attachment and the components of empathy. Journal of Social Psychology, 145(5), 519–530.Google Scholar
  4. Buechler, S. (2008). Making a difference in patients’ lives. New York: Routledge.Google Scholar
  5. Davis, M. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44(1), 113–126.Google Scholar
  6. Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy, 48(2), 198–208.Google Scholar
  7. Decety, J., & Lamm, C. (2009). Empathy versus personal distress: Recent evidence from social neuroscience. In J. Decety & W. Ickes (Eds.), The social neuroscience of empathy (pp. 199–213). Cambridge, MA: MIT Press.Google Scholar
  8. Dozier, M., Cue, K., & Barnett, L. (1994). Clinicians as caregivers: Role of attachment organization in treatment. Journal of Consulting and Clinical Psychology, 62(4), 793–800.Google Scholar
  9. Ehrenberg, D. B. (1992). The intimate edge: Extending the reach of psychoanalytic interaction. New York: W.W. Norton & Company.Google Scholar
  10. Elliot, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410.Google Scholar
  11. Fülöp, E., Devecsery, A., Hausz, K., Kovács, Z., & Csabai, M. (2011). Relationship between empathy and burnout among psychiatric residents. New Medicine, 4(1), 143–147.Google Scholar
  12. Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A comparative analysis of six pre-conceptions about internet questionnaires. American Psychologist, 59(2), 93–104.Google Scholar
  13. Goubert, L., Craig, K. D., & Buysse, A. (2009). Perceiving others in pain: Experimental and clinical; evidence on the role of empathy. In J. Decety & W. Ickes (Eds.), The social neuroscience of empathy (pp. 153–165). Cambridge, MA: MIT Press.Google Scholar
  14. Griffin, D. W., & Bartholomew, K. (1994). Metaphysics of measurement: The case of adult attachment. In K. Bartholomew & D. Perlman (Eds.), Advances in personal relationships (Vol. 5, pp. 17–52)., Attachment processes in adulthood London: Jessica Kingsley Publishers.Google Scholar
  15. Hall, J. A., Davis, M. H., & Connelly, M. (2012). Dispositional empathy in scientist and practitioner psychologists: Group differences and relationship to self-reported effectiveness. Psychotherapy, 37(1), 45–56.Google Scholar
  16. Hassenstab, J., Dziobek, K., Rogers, K., Wolf, O. T., & Convit, A. (2007). Knowing what others know, feeling what others feel: A controlled study of empathy in psychotherapists. Journal of Nervous and Mental Disease, 195(4), 277–281.Google Scholar
  17. Hatcher, S. L., Favorite, T. K., Hardy, E. A., Goode, R. L., Deshetler, L. A., & Thomas, R. M. (2005). An analogue study of therapist empathic process: Working with difference. Psychotherapy: Theory, Research, Practice, Training, 42(1), 198–201.Google Scholar
  18. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
  19. Holmes, J., & Slade, A. (2018). Attachment in therapeutic practice. Thousand Oaks, CA: Sage Publications Inc.Google Scholar
  20. Joireman, J. A., Needham, T. L., & Cummings, A.-L. (2002). Relationships between dimensions of attachment and empathy. North American Journal of Psychology, 4(1), 63–80.Google Scholar
  21. Karyagina, T. D., Kukhtova, N. V., Olifirovich, N. I., & Shermazanyan, L. G. (2017). Professionalization of empathy and predictors of helping professionals burnout. Konsul’tativnaia Psikhologiia i Psikhoterapiia, 25(2), 39–58.Google Scholar
  22. Kline, R. B. (1998). Principles and practice of structural equation modeling. New York: Guilford Press.Google Scholar
  23. Kohut, H. (1959). Introspection, empathy, and psychoanalysis: An examination of the relationship between mode of observation and theory. Journal of the American Psychoanalytic Association, 7(1), 459–483.Google Scholar
  24. Kurdek, L. A. (2002). On being insecure about the assessment of attachment styles. Journal of Social and Personal Relationships, 19(6), 811–834.Google Scholar
  25. Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., et al. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74(6), 1027–1040.Google Scholar
  26. Lopez, F. G. (2001). Adult attachment orientations, self-other boundary regulation, and splitting tendencies in a college sample. Journal of Counseling Psychology, 48(4), 440–446.Google Scholar
  27. Lopez, F. G., Gover, M. R., Leskela, J., Sauer, E. M., Schirmer, L., & Wyssmann, J. (1997). Attachment styles, shame, guilt, and collaborative problem-solving orientations. Personal Relationships, 4(2), 187–199.Google Scholar
  28. Lynch, J. S., Hill, E. D., Nagoshi, J. L., & Nagoshi, C. T. (2012). Mediators of the shame-guilt- psychological adjustment relationship. Scandinavian Journal of Psychology, 53(5), 437–443.Google Scholar
  29. Main, M., Hesse, E., & Kaplan, N. (2005). Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age: The Berkeley longitudinal study. In K. E. Grossmann, K. Grossmann, & E. Waters (Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 245–304). New York: Guilford Press.Google Scholar
  30. Marmarosh, C. L., Schmidt, E., Pembleton, J., Rotbart, E., Muzyk, N., Liner, A., et al. (2015). Novice therapist attachment and perceived ruptures and repairs: A pilot study. Psychotherapy, 52(1), 140–144.Google Scholar
  31. Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44.Google Scholar
  32. McClintock, A. S., Anderson, T., Patterson, C. L., & Wing, E. H. (2018). Early psychotherapeutic empathy, alliance, and client outcome: Preliminary evidence of indirect effects. Journal of Clinical Psychology, 74(6), 839–848.Google Scholar
  33. Mehrabian, A., & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40(4), 525–543.Google Scholar
  34. Mikulincer, M., Gillath, O., Halevy, V., Avihou, N., Avidan, S., & Eshkoli, N. (2001). Attachment theory and reactions to others’ needs: Evidence that activation of the sense of attachment security promotes empathic responses. Journal of Personality and Social Psychology, 81(6), 1205–1224.Google Scholar
  35. Mikulincer, M., Shaver, P. R., Bar-On, N., & Ein-Dor, T. (2010). The pushes and pulls of close relationships: Attachment insecurities and relational ambivalence. Journal of Personality and Social Psychology, 98(3), 450–468.Google Scholar
  36. Norcross, J. C. (2005). The psychotherapist’s own psychotherapy: Educating and developing psychologists. American Psychologist, 60(8), 840–850.Google Scholar
  37. Obegi, J. H., & Berant, E. (2009). Attachment-informed psychotherapy research with adults. In J. H. Obegi & E. Berant (Eds.), Attachment theory and research in clinical work with adults (pp. 461–489). New York: Guilford Press.Google Scholar
  38. Pletzer, J. L., Sanchez, X., & Scheibe, S. (2015). Practicing psychotherapists are more skilled at downregulating negative emotions than other professionals. Psychotherapy, 52(3), 346–350.Google Scholar
  39. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: W.W. Norton & Co.Google Scholar
  40. Rangganadhan, A. R., & Todorov, N. (2010). Personality and self-forgiveness: The roles of shame, guilt, empathy and conciliatory behavior. Journal of Social and Clinical Psychology, 29(1), 1–22.Google Scholar
  41. Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationships: As developed in the patient-centered framework. In J. S. Koch (Ed.), Psychology: A study of a science (Vol. 3, pp. 184–526)., Formulations of the person in the social context New York: McGraw-Hill.Google Scholar
  42. Rogers, C. R. (1975). Empathic: An unappreciated way of being. The Counseling Psychologist, 5(2), 2–10.Google Scholar
  43. Roisman, G. I., Padrón, E., Sroufe, L., & Egeland, B. (2002). Earned-secure attachment status in retrospect and prospect. Child Development, 73(4), 1204–1219.Google Scholar
  44. Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30(1), 5–44.Google Scholar
  45. Rubino, G., Barker, C., Roth, T., & Fearon, P. (2000). Therapist empathy and depth of interpretation in response to alliance ruptures: The role of therapist and patient attachment styles. Psychotherapy Research, 10(4), 408–420.Google Scholar
  46. Safran, J. D. (1993). Breaches in the therapeutic alliance: An arena for negotiating authentic relatedness. Psychotherapy, 30(1), 11–24.Google Scholar
  47. Simpson, J. A., Rholes, W. S., & Nelligan, J. S. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62(3), 434–446.Google Scholar
  48. Sze, J. A., Gyurak, A., Goodkind, M. S., & Levenson, R. A. (2012). Greater emotional empathy and prosocial behavior in late life. Emotion, 12(5), 1129–1140.Google Scholar
  49. Tangney, J. P., Dearing, R. L., Wagner, P. E., & Gramzow, R. (2000). Test of self-conscious affect-3 (TOSCA-3). Fairfax, VA: George Mason University.Google Scholar
  50. Thompson, M. M., & Zanna, M. P. (1995). The conflicted individual: Personality-based and domain-specific antecedents of ambivalent social attitudes. Journal of Personality, 63(2), 259–288.Google Scholar
  51. Trusty, J., Ng, K.-M., & Watts, R. E. (2005). Model of effects of adult attachment on emotional empathy of counseling students. Journal of Counseling & Development, 83(1), 66–77.Google Scholar
  52. Tucker, D. M., Luu, P., & Derryberry, D. (2005). Love hurts: The evolution of empathic concern through the encephalization of nociceptive capacity. Development and Psychopathology, 17(3), 699–713.Google Scholar
  53. Van de Mortel, T. F. (2008). Faking it: Social desirability response bias in self-report research. Australian Journal of Advanced Nursing, 25(4), 40–48.Google Scholar
  54. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. New York: Routledge.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyLong Island UniversityBrooklynUSA
  2. 2.Program for PsychotherapyCambridge Health Alliance/Harvard Medical SchoolCambridgeUSA
  3. 3.Doctoral Program in Clinical PsychologyLong Island UniversityBrooklynUSA

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