Is low therapist empathy toxic?

Starting in the 1950s Carl Rogers brought Pers... — Starting in the 1950s Carl Rogers brought Person-centered psychotherapy into mainstream focus. (Photo credit: Wikipedia)

Miller and Moyers make the case that low therapist empathy is toxic with a review of some research on the topic.

In one study, a single in-session therapist behavior predicted 42% of the variance in clients’ 12-month drinking outcomes: the more the therapist confronted, the more the client drank (Miller, Benefield, & Tonigan, 1993).

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Client resistance increased and decreased as a step function in response to counseling style. Teach/Direct (Information/Advice) increased client resistance by 70% in contrast to empathic listening. Resistance dropped back down with resumed listening and jumped backup with a return to Teach/Direct.

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In a randomized trial comparing therapist styles with problem drinkers receiving feedback regarding the severity of alcohol-related assessment results, client resistance responses were 70% higher with directive as compared to client-centered counseling (Miller et al., 1993).

And, that high therapist empathy should be treated as an evidence-based practice:

It appears that therapist empathy can predict meaningful proportions of variance in addiction treatment outcome (e.g., Miller et al., 1993; Valle, 1981) that are an order of magnitude larger than the between-treatment differences typically observed in clinical trials (Imel et al., 2008) and typically fall within the range of what addiction treatment providers regard to be a clinically meaningful effect (Miller & Manuel, 2008). In psychotherapy research more generally, therapist empathy may account for as much or more outcome variance than therapeutic alliance or specific intervention (Bohart, Elliot, Greenberg, & Watson, 2002; Imel, Wampold, & Miller, 2008). It could be argued that providing accurate empathy in addiction treatment is an evidence-based practice regardless of theoretical orientation and that its absence will reduce the likelihood that clients will change their substance use.