S5:E3 Empathy in Psychology

What does it truly mean to be empathetic in a clinical setting? In this episode, host Dr. Jonathan Douglas sits down with APA author Dr. Douglas Flemons, PhD, LMFT, Professor Emeritus of Family Therapy, to explore the nuance of empathy within psychotherapy.

Dr. Flemons discusses the concept of "feeling into" a client’s experience through curiosity and imagination. They dive into the practical application of these skills, the importance of clinical humility, and the powerful role of refraction over mirroring. This conversation offers a profound look at how we bridge the gap between two internal worlds, whether you are a seasoned clinician, a student in training, or simply interested in the mechanics of human connection.

Key Topics Covered:

• The etymological and practical differences between empathy, sympathy, and compassion.
• Why claiming to fully understand a client can actually hinder the therapeutic process.
• Using "clinical curiosity" to navigate difficult client histories.
• The role of the therapist’s own physical and emotional responses in informing treatment.
• Insights into Dr. Flemons’ latest book, Empathic Engagement in Clinical Practice – an APA published work.

About Dr. Douglas Flemons, PhD, LMFT

Douglas Flemons, PhD, is Professor Emeritus of Family Therapy at Nova Southeastern University, where he taught and supervised clinical graduate students for 30 years. During his academic career, Dr. Flemons directed his program’s training clinic, created and directed the university’s Student Counseling Center, and was co-director of the university’s Office of Suicide and Violence Prevention. He is the author of six books and sixty articles and book chapters that illuminate a relational approach to psychotherapy, clinical hypnosis, suicide assessment, and empathy. His most recent book, Empathic Engagement in Clinical Practice, and its companion video, Empathy in Therapy, were published in 2026 by the American Psychological Association. Douglas and his wife, with whom he co-edited three editions of Quickies: The Handbook of Brief Sex Therapy, currently co-direct their private practice and training institute, Context Consultants, from their home in North Carolina.

Transcript

Dr Jonathan Douglas (00:04.889)
Hi, this is On Psych, the podcast of the Ontario Psychological Association. I'm the host, Dr. Jonathan Douglas, and I am here today with Dr. Douglas Flemmons. I immediately managed to forget the disclaimer. I promised I wouldn't forget, but here it is. OPA is not responsible for the content here. I take full responsibility for anything that spills out of my mouth. Not that I'm specifically worried about that.

I'm just catching myself because I keep promising I need to mention that. But so back to Dr. Douglas Flemons, who has been very patient through a process of setting up a podcast. And very much appreciate that patience. And you have written a book recently. Can you tell us a little bit about yourself and about this book?

Douglas (00:58.05)
The book is about empathy, empathic engagement in clinical practice. I come to that after teaching for 30 years, graduate students, clinical graduate students, and then private practice through all of that and post-teaching and a bunch of writing.

Dr Jonathan Douglas (01:18.017)
And it's, it's really like I so enjoyed, you know, exploring this book. It brought me back to, you know, the the roots of my own training. And, you know, it leaves me feeling like we've forgotten something in psychotherapy lately, you know,

Douglas (01:24.367)
great.

Douglas (01:41.998)
It's possible to get caught up in theories and research and lose connection somewhere in the midst of that.

Dr Jonathan Douglas (01:52.065)
Exactly, exactly. It feels like in our practice these days, there's a lot of pressure. We're often dealing with third party payers. And I'm talking about Canada, I'm sure it's even worse in the United States. And there's this feeling that it's our job to change the client. I'm wondering what your thoughts on that are.

Douglas (02:10.008)
Yes.

Douglas (02:21.922)
Well, definitely, clients don't come with the idea of let's just hang out and eat ice cream. They are coming hoping that we can be helpful. So I do think of myself as a, overarchingly, I guess, as a change agent. But to rush forward into that thinking, hey, I have a good idea, just do this, makes it possible for us to deliver sensible but not.

Dr Jonathan Douglas (02:27.555)
Mm-hmm.

Douglas (02:50.494)
sensitive advice that people then feel rushed into or not amenable to and they're holding themselves away from us with all of our efforts to make a difference. So as you're alluding to, the first step is getting connected and for clients not to have to experience us as other. And empathy is very effective in doing that.

Dr Jonathan Douglas (03:13.464)
Yeah.

Yeah, yeah. And obviously a lot of what you do is clinical training. know, tell me about the process of bringing, you know, students to that awareness and that level of sensitivity of practicing empathy.

Douglas (03:35.64)
Well, I had this marvelous opportunity for my whole graduate teaching career. We had a clinic. I was director for five years of that with One Way Mirrors. so team of six students, we spent six hours together once a week. The ideal for the clinic was every student would have one hour sessions. And so we'd have six sessions over the course of six hours. My ideal was three sessions.

because it would give us time before and after to be able to process what was going on. And so then I'm watching live along with the other team members as one student is in the room with an individual couple of family. We have a telephone contact so I can call in and suggest they take a break or make a suggestion or something. Sometimes I would wander in and contribute, participate. And so it was just, it was always...

Dr Jonathan Douglas (04:07.939)
Yes.

Douglas (04:32.896)
always happening. Just and being able to see in real time the students being able to make a difference and connect with the clients and the clients being moved, the clinician being moved, and also see where failures happened and then be able to somehow through a feedback process correct and reconnect and so on. So it's just, it's fabulous.

Dr Jonathan Douglas (04:58.061)
It reminds me a lot of my own clinical training. I feel like it's a model that perhaps isn't used nearly often enough. The one-way mirror, the review of the session in great detail afterwards to pick up those moments of lost opportunity and to...

Douglas (05:13.454)
Yeah.

Dr Jonathan Douglas (05:25.571)
to explore the way in which things might have gone slightly differently.

Douglas (05:29.614)
Being able to reflect on it, you're right, not only in the moment, we would also video the session so we could go back over them and look for turning points, pivot points, failed opportunities, missed opportunities, and then look at what can you shift, get ready for to do differently the next time. It creates, I think, a very steep learning curve.

Dr Jonathan Douglas (05:37.944)
Mm-hmm.

Dr Jonathan Douglas (05:50.551)
Mm-hmm. Mm-hmm.

It really is because, you we should probably go back to sort of like the basics, you know, and some of the points that you raise in your book. The first of which I think is like, what's the difference between empathy, sympathy and compassion?

Douglas (06:10.934)
Yes.

Douglas (06:14.668)
It's interesting, empathy came into the language in the early 1900s. It was coined. The other two terms emerged into the language. So we look around 14, 1500s and they're arriving in English, least according to the Oxford English Dictionary, tracking their first appearances in written form. But empathy was coined by Edward Tichner, psychologist in the States.

who was actually translating an English term, Einfulung, which was originally the concept out of German philosophical aesthetics, trying to make sense of if we stand in front of a work of art, how is it that we are moved? And Einfulung was developed, coined in German to try to capture that. Sympathy and compassion.

Sympathies from Greek, compassion from Latin, but they're basically doppelgangers. They have the same basic roots. The sim of sympathy and the calm of compassion both have to do with being together with. And the passion part is to feel or to suffer. So both of them, their etymological roots mean to suffer with, to feel with. Empathy.

Titchner was an etymology expert. He knew Greek and Latin quite well. And he coined the term purposefully because the root of the word einfulung comes from Greek, which means to feel or to suffer into. And so same with empathy. It means to feel or sense into. So the difference in the prepositions means everything. Instead of to be suffering along with,

it's suffering into and it makes a world of difference as far as your position as a clinician. What is your orientation to the relationship with the client and with their suffering? What is your job and then what are you doing to try to get to know what's going on with them?

Dr Jonathan Douglas (08:28.693)
Yes. Yeah, exactly. know, it's, I think, you know, you raised such a great point, which is that it's really, it's about imagination and curiosity, right? As opposed to that experience of, you know, being overwhelmed by what the client is feeling.

Douglas (08:42.882)
Yeah.

Douglas (08:52.898)
Yeah, so yes, if our client comes in and they are in dire straits, they're suffering tremendously, we will have, most humans will have a sympathetic response to that. Somebody is in pain in front of us and our brain lights up the pain centers in a similar place that their pain centers are lighting up that's, or creation of their, or least illumination of their pain.

to suffer with, to feel with someone is just, it means just to be human, but it arrives to us. We don't do anything to make it happen except care about the person. Empathy requires, as you said, imagination. It's a purposeful thing. You're making the choice to try to make sense of their experience. So you experience their suffering and then to make sense of it means to feel into it.

Dr Jonathan Douglas (09:36.28)
Yeah.

Douglas (09:52.14)
not just observe it alongside, but to investigate, to explore. And that is an act of imagination that's fueled by clinical curiosity.

Dr Jonathan Douglas (10:03.233)
Mm-hmm. Mm-hmm.

Dr Jonathan Douglas (10:08.609)
Yeah, and I, you know, one of the things I really love about, you know, what you're describing.

Dr Jonathan Douglas (10:16.985)
you know, positioning that curiosity about what is happening inside the other person. You know, it's not necessarily our job to always fully understand it and say, I fully understand. In fact, that's rarely very helpful.

Douglas (10:35.694)
I would say it's never helpful and it's always wrong. You can never fully understand somebody. There's always a gap of necessity. And to claim that you fully understand or even to claim, not quite so bombastically, I understand what you're going through, that too can be a problem. It helps to approach the whole thing with humility. I don't have a clue.

Dr Jonathan Douglas (10:39.671)
Yeah. Yeah.

Dr Jonathan Douglas (10:58.839)
Yes.

Douglas (11:04.684)
what you're going through. But I am committed to developing as best I can an appreciation for what it's like. And I'm going to ask you questions so that I can explore with you and then articulate what's coming to me, what I'm inferring from what we're saying. And by giving it voice, you get to be able to tell me

Yes, you're there. That's a great description of what I'm going through or no, not quite. I wouldn't say it that way. Okay, so let me clarify. Let me alter. Use your feedback to help correct. And what we're working towards is getting closer and closer appreciation or representation of what it is that you're describing. At which point,

You, as Carl Rogers would say, feeling understood, don't feel alone.

Dr Jonathan Douglas (12:05.529)
Yeah, yeah, that experience of, you know, feeling seen, feeling profoundly heard, right? And having that understanding demonstrated, right, as opposed to told.

Douglas (12:16.663)
Yours.

Douglas (12:25.122)
Yeah, there's this idea in the writing of short stories and novels, show don't tell. Instead of explaining what the character is thinking or explaining their features, their characterological features, what you do is you put them in a scenario and you let the reader see them act.

Dr Jonathan Douglas (12:34.03)
Mm-hmm.

Douglas (12:54.328)
which allows the reader to then infer what it is that the person is like by virtue of how they respond to circumstances. So this is analogous, rather than claiming, understand, Jonathan, I have such a very in-depth understanding of what you're going through. If I can, in response to what you're telling me, I can encapsulate it and deliver it back to you in such a way that you recognize yourself in what I'm saying, then you...

may claim you understand me, that's your job, it's not mine.

Dr Jonathan Douglas (13:31.117)
I think, you know, there's some fascinating parallels to some other fields here. You know, you speak about Ralph Fiennes, you know, who plays the Commandant in Schindler's List. He plays Lord Voldemort in the Harry Potter movies. And he's a wonderful, warm, compassionate human being.

Douglas (13:43.085)
Yikes.

Dr Jonathan Douglas (14:00.825)
But he steps into these characters that embody pure evil.

Douglas (14:09.176)
Nicely described, yes.

Dr Jonathan Douglas (14:09.505)
And yeah, yeah, yeah. And it's sort of a similar process. We don't have to endorse what our clients are experiencing. We don't have to. And in fact, I think a lot of ways, as you point out, even positive judgment can get in the way.

Douglas (14:33.78)
Absolutely. To endorse or to judge negatively both puts a divider between you and the person. Judgment creates a boundary. And empathy is a boundary crossing vehicle. So to go in and make sense of what choices they've made, what actions they've taken, what it is that they're feeling in response to the swirling that's going on.

Dr Jonathan Douglas (14:43.107)
Mm-hmm. Mm-hmm. Mm-hmm.

Dr Jonathan Douglas (14:50.563)
Mm-hmm.

Douglas (15:04.203)
the idea or the orientation to the world that they've developed. We're not going in to endorse it, to agree with it, to disagree with it. We're going in to make sense of it. then holding firmly to that commitment helps prevent a judgment dividing us from them. But if you're a new clinician, that can be challenging. It can seem like

Dr Jonathan Douglas (15:18.605)
Mm-hmm.

Douglas (15:34.616)
And I think for a lot of the lay public it's like this too, if you make an effort to understand somebody that you would normally not have anything to do with, it seems like an implicit endorsement. And so people want to discount those that they are, well, we'll say it's strongly disgusted by, by not wanting to even think about them and certainly not wanting to get to know them because that would somehow undermine their own integrity.

And I think our job as clinicians is to not get caught up in that, I think, unfortunate idea and recognize that you can commit to knowing the experience of another person without undermining your own sense of self.

Dr Jonathan Douglas (16:23.597)
You tell a very powerful story in your book about working with, I gather, a young man who was torturing animals. What a challenging thing that must be to suspend judgment in that moment. Can you say a little bit more about that?

Douglas (16:34.583)
Yes.

Douglas (16:44.172)
Yeah, this was actually assigned to my practicum in the clinic. so it was with a team. And the young clinician who was assigned the case initially was an animal activist who went out of her way to protect feral cats. So she would go in and make sure that they got fed, make sure they got neutered.

Dr Jonathan Douglas (17:00.206)
Mm-hmm.

Douglas (17:13.486)
an animal lover, just a wonderful, wonderful person in a warm presence in the universe. And so she was assigned this case and it made her so nauseated just the thought of seeing him. She wisely said, I can't see him. We have to know our limits, right? And she felt like she would compromise her principles if she were to grant him.

Dr Jonathan Douglas (17:30.007)
Right. There are limits and you have to know our limits for sure. Yes.

Douglas (17:41.55)
basically the assumption of humanity. So when someone discusses, it's comfortable to treat them, to think of them as a monster, because then they've got nothing to do with us. That's cool for a lay person, for a clinician. If you can't do that, then you wisely assign them to somebody else, you refer them out. But if we're going to do our job, then the idea of them being a monster,

Dr Jonathan Douglas (17:43.769)
Hmm.

Douglas (18:10.33)
is not a helpful one to hold on to. So to discover how does it make sense for this young man to find himself compelled to torture these animals and the relief that it gave him, temporary relief that it gave him as he was trying to manage addiction and relationship.

Dr Jonathan Douglas (18:12.812)
Right.

Douglas (18:37.378)
very, very high relationship stress and loss and a whole host of things. And torturing became for him a short-term solution attempt that he acknowledged it, disgusted it, disgusted and worried him as well. And he wanted it to change, but he felt like he couldn't. And so that was the entry point to go in and make sense of how it was that he found himself looking forward to going home to.

to hurt them.

Dr Jonathan Douglas (19:08.579)
Yeah. Yeah.

by stepping into that world, you help him to gain a deeper understanding of his own symptom and where it's coming from and what problem it's solving in his life.

Douglas (19:27.65)
Yes, and if you hold yourself at arm's length, it's one thing to judge others, but if you hold yourself at arm's length, so he's finding it abhorrent and can't look at it, then it's held in a place that can't change. He's doing his best to keep it from happening using his willpower. That's always gonna fail. So what we were able to do was...

Dr Jonathan Douglas (19:46.029)
Mm-hmm.

Douglas (19:55.232)
As I was making sense of it, he was making sense of it along with me. I think, at least the way that I made sense of what we were doing is he then changed his relationship to himself and changed his relationship to what he was doing. And at that point, he no longer felt like he had to. And over the course of half a dozen sessions, he stopped and he went back to Narcotics Anonymous and...

made some other important changes.

Dr Jonathan Douglas (20:27.053)
he found a different solution.

Douglas (20:28.834)
he found a different solution, a different way of managing the overwhelming pain that he was experiencing.

Dr Jonathan Douglas (20:36.887)
Right, right. There's an idea, a very common idea today, I think. That, you know, again, thinking about acting, right, you know, in order to play a character, you have to share certain identity features with that character. There's the idea, I think it's very common in our client population.

to say, well, this is my identity. I need to find a therapist with that identity.

Douglas (21:12.215)
Yes.

Dr Jonathan Douglas (21:14.591)
What are your thoughts on that? I mean...

Douglas (21:19.714)
It's fundamentally the logic of AA. If I'm going into addiction treatment, then most addiction programs are going to have former addicts who are there counseling because they've made it through and so that I can look up to them and feel inspired by the example and trust that they know what they're doing when they're making suggestions for me.

Dr Jonathan Douglas (21:43.641)
Mm-hmm.

Mm-hmm. Mm-hmm.

Douglas (21:49.95)
And for some people that works really well and that's an essential component of them being able to trust the clinician. I know that you know enough about what I'm going through by virtue of you having gone through it.

Of course, it's never precise. And so if you were, if you took that idea to its logical conclusion, there'd be basically no one that could be your clinician because no one would have had your exact experience. So then the question is, well, how much of it? I was addicted to, the client says I am addicted to alcohol. My, my.

therapist was addicted to opioids, is that close enough? Or is the difference between those two substances, does that make a difference? So how much similarity is necessary for there to be an alignment? And the logic of empathy is different. Instead of saying we have to line up in certain characteristics in order for me to be able to be useful, what's required is for me to have compassion.

Dr Jonathan Douglas (22:46.798)
Right.

Douglas (23:02.52)
curiosity, imagination, skill to be able to then use all of those to help me project my imagination inside of the client's experience so that they start to recognize themselves in the descriptions that I'm offering. And at that point, if I do it well, all the differences between me and the client become for the client irrelevant. They go...

into the background. We're a different gender, different ages, different, bajillion different things. And it doesn't matter because I know enough, demonstrating knowing enough about them over the course of some number of sessions that they feel, as you said, feel profoundly heard and seen. And it's at that place, that's a great starting point then to figure out, from...

inside of this world, now what are some options for doing something different? And we can collaborate on figuring out something that's different, that bubbles up from inside their world instead of being imposed from outside, from my outside clinical expertise.

Dr Jonathan Douglas (24:23.363)
That skill set that you describe of putting aside judgment and bringing that curiosity to the client's experience.

It sounds like that could and should and probably in many cases would be a universal thing. That is the process that cuts across cultural boundaries. However you want to define culture, whether it's workplace culture, racial culture, cultural culture, ethnicity or what have you, all those different things that make up one's identity.

But do you find that there are cultural differences in the experience of empathy? Like are there certain things that, know, certain cultures that, you know, their experience of empathy is so different that, you know, we need to adjust, you know, for that group.

Douglas (25:29.506)
I don't know about any particular group. We have to adjust recognizing always assuming our own experience of some kind of some type of relationship with another person or some kind of emotional turmoil and assume we get into trouble anytime we assume that we have a handle on what it's like to be say terrified.

And therefore, when we recognize and comment on, bring forth a description of terror in the client, that there's going to be some kind of resonance between those two.

Douglas (26:16.044)
What I've noticed with a few clients, I wouldn't categorize it as a group, but the experience of being empathically engaged can be, for many people, as you said, but it isn't universal, supportive feeling.

Douglas (26:41.339)
feeling the humanity of the connection. But I have had some people for whom it's threatening. And so maintaining a distance from a clinician, either because being concerned that the clinician will bring forth something or make some kind of decision about the person's safety.

Dr Jonathan Douglas (26:48.76)
Yes.

Douglas (27:09.516)
and therefore it's important to keep the clinician at bay. Or I tell a story in the book about working with a woman and her son wanting to be able to connect again after many years of being alienated. And the woman, was the mother that had contacted me and she was very angry at the way her son had treated her over the years.

And so she wanted to redress it and she wanted to have a coming back together. And I made the mistake in the first session, which turned out to be the only session, because really I think of that mistake of making, and it was an assumption on my part, that the alienation from her son had been painful.

Dr Jonathan Douglas (27:38.521)
Mm-hmm.

Dr Jonathan Douglas (28:05.826)
Right.

Douglas (28:06.93)
And I said something to that effect when they were both there. And she went off on me with vehemence that she was furious at the way he had treated her, he and his new wife, and it was unfair and it was inappropriate and no son should treat a mother that way. But pain? It wasn't painful.

And I realized much too late after the session was over that, again, this is an assumption, but I assumed that she lost face. That for her to be the mother and be respected was incredibly important to her. And for her to be in pain would be to be vulnerable for him to then see her in a light that wasn't looking up to his mother as this powerful.

Dr Jonathan Douglas (28:47.726)
Yeah.

Douglas (29:06.828)
matriarch and it was unacceptable for that to be in the room.

Dr Jonathan Douglas (29:12.567)
Wow. Wow. And of course, it's so difficult for you as the therapist in that position. Because what's what's happened is you've you've triggered a powerful dynamic there, where she has to defend, right?

Douglas (29:32.6)
She has to defend and she's gonna defend against me.

Dr Jonathan Douglas (29:35.769)
Of course I am making the assumption and I kind of think it's a valid one that there is a lot of pain there, right? That there is underneath there, you know, there is pain but the message is you're not allowed to touch it and I'm not going to go near it.

Douglas (29:54.252)
Yes, very well put. And it is possible that it wasn't just her saying inside, you outed me, you bastard, I gotta take you down. It could well be that she had only for the last, I think they've been at odds for about five years, that she didn't experience it as pain, she experienced it as fury. And so,

Dr Jonathan Douglas (30:07.224)
Right.

Dr Jonathan Douglas (30:20.035)
Yes.

Douglas (30:21.322)
It maybe didn't resonate at all for her anyway because it didn't register though.

Dr Jonathan Douglas (30:29.441)
It's a really interesting example. I do remember that example from the book, because it's a powerful one.

Douglas (30:36.302)
Yeah.

Dr Jonathan Douglas (30:37.789)
And it's an example that sort of reminds me, because my own response to that, there really is pain there. It's not empathic, right? It's not empathic for me to bring that judgment and that assumption to that place, even though it may well be accurate. And I think that's a challenging moment.

Douglas (30:47.532)
Yep. Yep.

Dr Jonathan Douglas (31:04.801)
Right. For, for a therapist, I try to do with moments like that is go, okay, that hypothesis, I'm not going to let go of it. Right. But it's not going to be helpful right now. It's not going to be heard. Right. The timing is off here. This person is not ready, you know, to hear that. And, you know, it's a fumble, as you say, to, to try to push that.

have the humility. That's another part of it, think. Maybe something that comes through, I think, is the need for tremendous humility as we approach our clients.

Douglas (31:50.894)
to commit to there not being an objective truth that we are in possession of or capable of arriving at. So even the idea that, you know, my default would be yours, there's pain there, clearly there's pain. But that's a description, that's a description from outside. But from inside, which is why I was saying I'm not sure that we'd register for her, from inside, if she doesn't clock it that way, then...

Dr Jonathan Douglas (31:58.201)
Mm-hmm.

Dr Jonathan Douglas (32:02.861)
Mm-hmm.

Dr Jonathan Douglas (32:06.573)
Mm-hmm.

Dr Jonathan Douglas (32:10.297)
Exactly.

Douglas (32:20.726)
It's irrelevant what we think from outside.

Dr Jonathan Douglas (32:23.961)
Exactly.

Douglas (32:25.354)
inside of her fury, so let's just use that. If I can get inside of her fury and acknowledge her fury that she agrees with me, and then there's the question of how that fury has been holding, helping her feel safe or to manage somehow the alienation over the last five years and what she's been looking at for a resolution, if I can stay in there.

And so that everything that I say she can agree with, then there's a potential to be able to do something. The moment I'm espousing a position that doesn't accord with her own internal experience, and she has to correct me and she then has to protect herself from my misunderstanding, we don't have a therapeutic relationship to do anything with. So the humility is in part saying, screw the objective.

Dr Jonathan Douglas (33:02.125)
Mm-hmm.

Douglas (33:24.532)
sensibility and let's just work inside the logic of the client's world.

Dr Jonathan Douglas (33:30.677)
Mm-hmm. Mm-hmm. Yes.

Dr Jonathan Douglas (33:36.875)
There are also these moments, of course, where, and I think you point this out very well, that it's not just about holding that mirror up, right? It's not just a reflection, you know, to the client. As you put it, it's a refraction, right? We want to deepen their self-awareness. We want to deepen, you know, the interaction, right?

Douglas (33:53.816)
Yeah.

Dr Jonathan Douglas (34:07.881)
And we are going to make stumbles as we do that because we are sort of taking a stab, you know, you've said A and I'm curious about A plus B, right? We're adding a little bit to it, right?

Douglas (34:26.156)
Yeah, the metaphor of reflection, the idea that we're to mirror back what the client is saying, comes out of Rogers. It does imply that there's a correct, a one right, accurate depiction that captures the essence of it.

Douglas (34:54.252)
that ignores the problem completely, the problem of translation. An emotion, I go into this in the book, we probably don't have time here, but an emotion, Lisa Feldman Barrett has made very clear, an emotion, experience of emotion is itself, she wouldn't use this language, but it's basically a translation of...

Douglas (35:16.27)
person's recognition of body sensation, self-awareness of body sensation, that's then categorized in such a way that it's made sense of in terms of an emotional, named emotion. So you have a translation process between sensation and the characterization of it as an emotion. Then you have the client's description of that emotion or a description of a scene that's the enactment of that emotional orientation to the world.

Dr Jonathan Douglas (35:34.669)
Yes.

Douglas (35:45.966)
Another translation, therapist is listening to it, gets a feel for it, makes sense of it as best as he or she can, describes it, another translation, another couple of steps of translation, client hears that description and then translates that back into checking that out, how does that feel in my gut as far as, so multiple, multiple steps of something going across a boundary to be translated.

Dr Jonathan Douglas (36:14.873)
Mm-hmm.

Douglas (36:15.266)
There's no mirror in there. There's just multiple, multiple, transportations across some kind of boundary, boundary between sensation and, language, a boundary between language of one person and the language of another translated back into body sensation, et cetera. so I use, yes, the idea of it being a refraction, like a prism.

Dr Jonathan Douglas (36:17.625)
Mm-hmm.

Douglas (36:44.268)
So we're not going for pure essence. We're going to get in the ballpark of something that can be recognized and then we're working within the parameters that that language description provides. And that's where therapy comes in. It's possible to characterize the person's experience in such a way that they both agree with, because basically our story, or what we say back to them is a

Dr Jonathan Douglas (36:44.579)
Yeah.

Douglas (37:14.07)
is itself a kind of categorization of it.

characterization. So it has to resonate enough with their own experience that they can recognize themselves in it. But it is possible then to provide a characterization that has therapeutic possibilities inherent in it. And so that then when they're agreeing with what it is that we're saying that accords with their world,

there is an infusion there of an opening that it's not hopeless. And that can be very, very subtle. And they can find themselves agreeing with the possibility that something could be different and discovering that along with us.

Dr Jonathan Douglas (37:57.443)
Yes.

Dr Jonathan Douglas (38:10.925)
I reminded, you know, in my own training of, you know, the use of the word contact, right? It's that moment of contact, which I think comes from Gestalt theory. You know, it's something that, you know, is occurring in the space between us. And it's a little bit, a little different from what either one of us is experiencing. We're both experiencing this thing suddenly getting bigger, brighter.

more powerful as we connect, right, in that discussion. It's like, it puts me in mind of...

Zen and the art of motorcycle maintenance. You know, there's this space, there's the subjective and there's the objective and then there's this thing that exists between those two things. Right? Yeah. Yeah.

Douglas (38:52.652)
Yes.

Douglas (39:01.506)
Yeah, it's all relationship. It's like what's unfolding in our conversation. We're each offering perspectives and they're joining and they're diverging and the conversation is something that we're both contributing to and that is encompassing both of us and that's bigger than both of us. Yeah.

Dr Jonathan Douglas (39:25.357)
Yes, yes, exactly, exactly, exactly. And at least one of us is getting a lot out of it. Good, good, good. Yes, exactly, because this is the process, right? It's not, how is that movie? There's some movie from the 1980s.

Douglas (39:32.91)
Thank

What both of us are.

Douglas (39:46.03)
Good news,

Dr Jonathan Douglas (39:55.275)
It was a they they did a wonderful parody of mirroring, right? Of, you know, there is a therapist with a, you know, a patient on a ledge. Right. You know, it was just I hear you saying you're going to jump, you know. Yeah.

Douglas (40:01.358)
Hmm.

Douglas (40:10.66)
well, I don't know about a movie, but there was a story that was a send up of Rogers that was that was.

a description of how ineffective and dangerous it was to parrot the other person. And it was playing out the scenario where the patient said, I'm suicidal and the therapist says, you're suicidal. Yes, I think I'm going to jump. You think you're going to then the patient jumps and goes, ah, and it ends, the scenario ends with the therapist going, ah. Yeah, so that's,

Dr Jonathan Douglas (40:31.8)
Yes.

Dr Jonathan Douglas (40:37.944)
Exactly.

Dr Jonathan Douglas (40:48.333)
Yeah. Yeah.

Douglas (40:52.564)
absolutely a parody, but it points to there is in that process if you're only organized around

this attempt to perfectly mirror, there is no directionality to that other than it can become this self-enclosed, hermetically sealed quality of suffering. And we're going in there to connect, but with there being an exit sign someplace.

Dr Jonathan Douglas (41:14.637)
Mm-hmm.

Mm-hmm.

Dr Jonathan Douglas (41:23.459)
Yes.

Dr Jonathan Douglas (41:26.937)
I'm thinking of the Tom Hanks movie about Mr. Rogers.

Douglas (41:34.914)
and

Dr Jonathan Douglas (41:36.833)
which I was, I'm sure you've seen it. I was blown away by that movie. had actually, when I saw it, I had just read the biography of Mr. Rogers. And we're talking here about Fred Rogers, not Carl Rogers. Just to get confusing, right? And.

Douglas (41:40.301)
Yep.

Dr Jonathan Douglas (42:01.923)
So I was really impressed with the movie because I recognized it was, you know, pulling one story from here and another story from there, but basically sticking very, very closely to real events, real conversations that people had had with Fred Rogers. And so, you know, it didn't feel like there was a lot of writing, you know, being involved there, you know, other than the knitting together, it was a real representation.

of how this man communicated.

Dr Jonathan Douglas (42:36.471)
And part of what he does, of course, is so personal. Right? It's a very profound empathy.

But he draws upon his own emotional experience, I think, as well, and uses that very carefully, you know, and always with an eye towards the experience of whoever he's talking to. In our case, of course, it would be a client, right?

I'm curious about how you would characterize your use of your emotional experience within a session.

Douglas (43:19.234)
Well, there's that and then there's the making use of your own history. Yeah. Let me start on the second one.

Dr Jonathan Douglas (43:24.249)
Right, which could be two very different things.

Dr Jonathan Douglas (43:30.232)
Mm-hmm.

Douglas (43:33.196)
If I go to you as my therapist and I go to you because I have heard your reputation, so I arrive at the first session and I am already impressed by you before I've met you. And we start talking and I tell you something personal and you respond by telling me something from your life that

Dr Jonathan Douglas (43:51.437)
Mm-hmm.

Douglas (44:03.308)
that resonates in some way with what I'm saying, that I could very well experience that as a profound demonstration of empathic understanding and be really moved that you would be that open with me and take sustenance and inspiration from what it is that you tell me.

Dr Jonathan Douglas (44:32.057)
Mm-hmm.

Douglas (44:32.491)
So it could be a delivery of an empathic understanding that wouldn't be very meaningful.

Dr Jonathan Douglas (44:38.905)
Mm-hmm.

Douglas (44:41.248)
If I go to you and you're the only guy on my insurance panel that could get me in soon enough and I've had bad experiences with therapists and I show up and I'm not terribly impressed before I've ever met you, I'm not impressed. And same scenario, you tell me something. I could hear that same story as...

you inappropriately using the session to using me as a sounding board, rather than that you have some kind of therapeutic intent behind it. And I could position myself in opposition to you because you're blabbing about you and we're not talking about me. So there's inherently in the offering of a meaningful story that's going to land and make a difference. It depends so much on how the client's positioned to hear it.

Dr Jonathan Douglas (45:14.713)
right.

Dr Jonathan Douglas (45:21.763)
Mm-hmm.

Douglas (45:39.886)
And I've, in my live supervising, have seen instances where the therapists attempt, and these were mostly, these were therapists in training, so they weren't coming in with a lot of credibility when the clients were coming to them, not necessarily looking down on them, but I remember one young woman, she was in her early 20s, seeing a couple probably in their late 40s, early 50s, and she was a lovely, personable person.

Dr Jonathan Douglas (45:52.397)
Mm-hmm.

Douglas (46:08.686)
and she's in the session and she just sounds like an automaton and so officious. And so we took a break and I said, so what's with the tone? And it turned out she was afraid she wouldn't be taken seriously. And so she was trying to sound like a therapist and she was coming across as officious as she was pissing them off. It was a disaster. Okay, so with that in mind, I don't tell stories about me.

Dr Jonathan Douglas (46:12.803)
Yes.

Dr Jonathan Douglas (46:20.887)
Yeah.

Right.

Dr Jonathan Douglas (46:27.673)
Yeah.

Douglas (46:37.92)
I may have a story about me, but the way that I share it is I knew a guy once, so that I don't complicate the relationship. If it's not about me and they think the story is stupid and they tell me it's a stupid story, they aren't having to worry about insulting me. They can discount the story without discounting me. So I do it one step removed so I preserve the relationship with them.

Dr Jonathan Douglas (46:46.702)
right.

Dr Jonathan Douglas (46:58.851)
Mm-hmm.

Dr Jonathan Douglas (47:02.349)
Mm-hmm.

Dr Jonathan Douglas (47:06.425)
you

Douglas (47:06.7)
And if it's a meaningful story and it really grabs hold of for them, it'll do that regardless of who's the protagonist in the story.

Dr Jonathan Douglas (47:15.479)
Right, right.

Douglas (47:17.354)
In the, and there's another reason informing that, my, as you know from reading the book, my suggestion for developing empathic imagination is not to follow the old cliche and put yourself in the other person's shoes, but rather to leave yourself behind and do more like Ray Fiennes and leave Ray Fiennes.

back in the dressing room and went on set, be Voldemort. So that you don't bring yourself along as a comparison mechanism. If you're in a session and the person is describing something and you're going into your history to say, I know something about that, because something like that happened to me, it's now your relationship with yourself trying to then...

Dr Jonathan Douglas (47:51.383)
Right.

Douglas (48:16.568)
get into connection somehow with the client. And it can get you into a difficult place when the client is making a choice that you yourself didn't make when you're in a similar situation or would never make. I would never do that. And the moment the therapist is thinking, why on earth would the client do that? You're into judgment. And they're making that judgment in part because they're accessing their own history as a way to try to

Dr Jonathan Douglas (48:30.808)
Mm-hmm.

Douglas (48:45.102)
get a feel for what's going on with the client. So you can't get rid of your history. It's not like you got an embodied history, but you won't have to make reference to it. So when I'm listening to a client's story, Douglas is nowhere to be seen. I'm just doing my best to project my imagination into the center of the story. And I'm looking around as them so that

when they tell me, and then I picked up the cat and I hurled it at the wall, my response is, of course I did.

Dr Jonathan Douglas (49:22.755)
Mm-hmm.

Mm-hmm.

Douglas (49:27.158)
not, my God, how on earth could you do that? And if I can get to the place where, of course, I, as the client, did that, I now know that I'm making sense of it, and that's where I want to hang out.

Dr Jonathan Douglas (49:43.597)
Mm-hmm. Mm-hmm.

Douglas (49:47.926)
If I got a human responsive nausea to that, it typically happens after the session is over rather than when I'm inside it, except to the extent that it's perhaps somehow informing me about what's going on for the client. Because it wasn't, he wasn't doing it out of, let's talk to him, out of...

Dr Jonathan Douglas (50:10.317)
Mm-hmm.

Douglas (50:17.07)
wasn't the thrill of it. wasn't getting, it would be wrong to say he got enjoyment out of it. He got relief. And he described driving home having cotton mouth. So he's got physiological reaction going on that we might deem call anxiety or something, anticipatory anxiety. So there's a lot swirling around and my job is to get inside of the logic.

Dr Jonathan Douglas (50:23.736)
Right.

Douglas (50:46.248)
that's where I want to hang out. So my personal history and my own love of animals, notwithstanding, I'm going to do my best to embody his position in his story.

Dr Jonathan Douglas (51:03.051)
It's an interesting choice of word to embody.

Dr Jonathan Douglas (51:08.941)
You know, on the one hand, your, your efforts to understand, to put yourself into the client's shoes with that curiosity and humility, leaving your ego at the door. Right. It's, it's a very intellectual process. I'm wondering about what's going on in your body in those moments.

Are you using your physiology to understand the client's emotion?

Douglas (51:48.938)
I am. I use throughout the book, rather than just talk about empathic understanding, I talk about making sense of the client. I've used it several times if we've been talking. So, making sense means to understand, but there's a sensory quality to it. Making sense is using visceral referent as a way to help flesh out the understanding that you're getting.

So it isn't always, it's not just intellectual. You're not figuring out a thing out. You're feeling into.

Dr Jonathan Douglas (52:24.857)
It's not a puzzle, right? Yes, you're right. Yeah, yeah, yeah.

Douglas (52:26.478)
Well, there is a puzzle quality to it. And I talk a lot about logic, but it's kind of body logic. I think of emotion as a way of getting inside of making sense of relationship. When you feel an emotion, it's your relationship to a circumstance, your relationship to other people, your relationship to your own experience. So back to what you were saying earlier, it's all the relationship,

So you use relationship as a vehicle to develop that understanding and very much using my own, whatever my body's communicating to whatever I'm reading from my body to help inform that.

Douglas (53:15.786)
No two people, it's going to be the same. So you don't have to have it as a requirement, but any kind of hints that happen along the way becomes very helpful. I wrote a book about suicide assessment and that came out of running a clinic and having young clinicians doing assessments of troubled people. And when it came time to doing a suicide assessment,

them getting very scared. And then them getting into a conversation with themself about, this isn't about me, this is not, so I have to quell my anxiety in order for me to be able to be fully professional and fully present with this person in front of me. And in that conversation with themself to try to protect their professional integrity by arguing with their emotional response, it gets bungled up.

So my suggestion to them was, if you're feeling anxious, then use it as a way to help inform. If you're feeling anxious about whether or not this person is on the edge of taking their life, that probably can give you some kind of entry into what's going on for them. So you don't necessarily have to comment on it, but don't try to dispel it.

allow it to be a vehicle to enter further into their world.

Dr Jonathan Douglas (54:47.949)
Beautiful, beautiful. I think that's a fantastic moment I wish to wrap up. I want to thank you so much. So the book is Empathic Engagement in Clinical Practice, which is not nearly as good a title as the title of your other book, Quickies, a Guide to Brief Sex Therapy.

Douglas (55:07.502)
Yeah, I have a whole story about the title of that book, but we don't have time.

Dr Jonathan Douglas (55:11.545)
But so it's an APA published book, I believe, correct? Yeah, very good. Very good.

Douglas (55:16.61)
Yes, it is. There's a companion video as well.

Dr Jonathan Douglas (55:22.281)
Yes, I saw that and I am intrigued. thinking I might just chase that down because that strikes me because the book strikes me as a fantastic training resource. And I think the video could really bring it home. Right.

Douglas (55:33.07)
Thank you.

Douglas (55:36.96)
APA is really great. They had me come in, they found some clients that were interested in being filmed and being interviewed by me and one of them we ended up using. And so there's the interview that's there. And then there's an interview with me ahead of time and then an interview with me by the host about pieces that were pivot points during that interview. So it is, it's a great way of teasing out the dynamics of empathy.

Dr Jonathan Douglas (56:06.973)
I it. I love it. think I will chase that down because I think it's, you know, what a wonderful tool that would be. Right. So, yeah. Well, thank you so much. I appreciate again, your patience, you know, getting us all set up and thank you so much for a great conversation.