Therapist empathy and client outcome: an updated meta-analysis

Elliott, Robert, Bohart, Arthur C., Watson, Jeanne C. and Murphy, David (2018) Therapist empathy and client outcome: an updated meta-analysis. Psychotherapy, 55 (4). pp. 399-410. ISSN 1939-1536

PDF - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (267kB) | Preview
Official URL: doi:10.1037/pst0000175


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.

Item Type: Article
Additional Information: ©American Psychological Association, [2018]. This paper is not the copy of record and may not exactly replicate the authoritative document published in the APA journal. Please do not copy or cite without author's permission. The final article is available, upon publication, at:
Keywords: empathy, psychotherapy relationship, psychotherapy process-outcome research, therapist factors, meta-analysis
Schools/Departments: University of Nottingham, UK > Faculty of Social Sciences > School of Education
Identification Number:
Depositing User: Murphy, David
Date Deposited: 16 Apr 2018 08:40
Last Modified: 23 Oct 2018 11:12

Actions (Archive Staff Only)

Edit View Edit View