The Presence Beneath The Words:
Considering The Depths and Dangers of Empathy
Clinical Intervention II
Dr. Bonnie Settlage
December 13th, 2015
While I have not yet begun my practicum, and continue to have difficulties in finding a site to accept me, in the handful of therapy sessions I’ve had with clients, I have learned quite a bit about my strengths and weaknesses in that role. These, as I suppose should be no surprise, are also the strengths and weaknesses which bless and torment me in my day-to-day interactions with people, in phone calls with relatives or in schmoozy small talk at holiday parties. And, as I continue to learn more about myself and uncover insights about the nature and sources of my behavior, I have come to acknowledge that these quirky and characteristic strengths and weaknesses are, to a great degree, biological; in that, whether I like it or not, I have the mind of my father, the sensitivity of my mother, and so on, and that many of these peculiar and subtle traits, temperaments and ways of thinking, are genetically-determined and will, undoubtedly, come to influence and define difference facets of the therapeutic relationship. I would like to discuss these traits in greater detail later in the paper.
While working with clients who have experienced trauma could be considered some of the most emotionally taxing psychotherapeutic work a therapist can undertake, even without this extreme PTSD-type content, the danger of burnout or “compassion fatigue” is still real and ever-present for the mental health profession, especially when work loads begin to mount and the limits of one’s capacity for empathy become apparent. While empathy is a precious and powerful resource in the therapeutic relationship, the thought of being bombarded, hour after hour, with client after client, each dumping huge grief, sadness, insecurities, and fears onto their open-hearted receptive counselor, it is easy to imagine how quickly this precious resource could be spent, as one instinctively adopts a defensive mental posture in the face of such pain and suffering, to protect themselves from such pain, themselves.
Vulnerability and empathy are intimately related, and it is that open-hearted type of listening that is felt in the presence of the therapist, as opposed to those cues of active listening which are merely heard or seen. Rather, when someone is feeling with you, it is those subtle body language cues which are imbued with an emotional quality or warmth that only vulnerability, the lowering of defenses, can truly and authentically provide. The eye contact which becomes so-slightly hazy, as the pain of the client’s loss wells up in the chest, or the ache in one’s voice when they fully feel for someone the care for. These are precious and beautiful things, these are gifts of authentic and vulnerable presence we typically save only for our loved ones, as we know and feel how expensive and potentially dangerous it is to feel so deeply and fully for another person, that you may cry for them. To achieve such a meaningful and, in some cultures, considered sacred state of empathic sensitivity 8 times a day, 5 days a week, feels, in some way, like a sin; as if we were to cheapen and commodity the most precious and authentic depths of our heart, on cue, when we “clock in” and those “customers” start lining up for their share of what remains of our heart.
Haha! So melodramatic, I know! But this is, in one way, how the faculty of empathy in the psychotherapeutic relationship can be seen and, on the same coin, how the established dangers of burnout, “secondary traumatic stress,” or compassion fatigue, can be conceptualized.
The Extremes of Empathy
While traveling through Lapland in Northern Finland earlier this year, I lived with a practicing shaman who introduced me to the ancient healing traditions of her area of Northeastern Scandinavia. She showed me the songs of the old shamans, and the way they used them to guide and heal the “dis-spirited,” who had been abandoned by their guardian spirits, or who had been a victim of some physical, mental, or spiritual illness. These unique illnesses, so I came to learn, tend to follow a traumatic event, or are the traumatic event. It is the shaman’s duty to become very sensitive with the person, so that they may become aware of the subtle energetic signature of the illness or blockage within the nervous system of the client, and then to allow flow and release of that dark or negative content, out of the system.
This may seem tangential, or unrelated to my intended profession as a therapist, but I’m merely trying to set a background for the comparison I wish to draw. What was perhaps most moving for me, personally, about this “medical cosmology” of my ancestors is the use of the crying song. This shaman I was living with played me one of these old songs, in which the healer convenes with the community or a single individual and accepts all of their trauma and pain into themselves, reciting all of the losses, one by one, allowing the depths of the suffering to well up within them, until their voice begins to crack, and tears begin to flow, and a kind of deep sobbing occurs as she closes her eyes and sings for the client with all of her heart. Hearing these old songs was deeply moving and, despite trying to resist, I too soon welled up and started to cry with her, for the loss and the hurt, though I could not understand what she was saying in Finnish, I could, at the same time, very deeply tell what she was saying and there was so much pain following that trauma that I could not even attempt to hold it all in, and so the tears flowed, there in the car, and I sobbed until I could not even drive and had to pull over.
This ancient shamanic technique, of reflecting the trauma of a person or a community back to them, but filling it with the emotional content that the traumatized had yet to fully express, the grief or wailing of mourning, is a means of utilizing empathic connection in a particularly powerful way, to allow the movement and shifting of emotion for the client, as they are able to process and metabolize the traumatic event fully, after the act of communal crying is encouraged and normalized. Yet, empathy of that extreme degree is, obviously, exhausting and after 20 minutes, you could hear the fatigue but also the deep relief in the shaman’s voice as her voice stopped quivering and her breath became calm once more. To imagine performing such a powerful and authentic act, on the hour, 8 times a day is simply not feasible, although may be appropriate for a group therapy intensive.
As I learn more about how to connect meaningfully with clients, my shyness and insecurity becomes a limitation to authentic rapport. Yet, this quiet thoughtful aspect of my personality is, so I’ve come to learn, a trademark of my people, the stoic Finn being even a caricature or stereotype, well known outside the region. So how can I, who does not talk, come to talk for a living? I feel active listening and a “heart forward” approach will supplement the need for constant chatter we Americans seem to have, even in therapy. When that moment of silence comes, I’m learning not to nervously scramble to fill it but, instead, let it be, and hold it for some moments with the client. This, more often then not, seems to allow the client to dive a bit deeper into their problem, and, all at once, break the silence with an insight or some subconscious content from beneath the surface of their problem. And so my self-perceived weakness, my awkward silence gradually reveals itself to be a strength, at least in some respects. It is my personality, my own nature and nurture, which inform my therapeutic technique, moreso than any theory or clinical framework. It is with each failure and breakthrough that I develop as a person, and learn how to better myself.