Tag Archives: empathy

Physical Contact with Clients


What are your beliefs about physical contact with clients?  What questions should you ask yourself before engaging in physical contact?  How do you know when it is not a good idea?  What are some of the potential negative outcomes?  How do these risks and benefits weigh out?

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My beliefs regarding physical contact with clients are “mixed.”  Although I can certainly see benefits in some situations (increased sense of empathy), I see some serious risks as well (misinterpretation of the action, dependency).  I am not a “touchy feely” person by nature, so this isn’t something I anticipate having huge issues with.  I am innately more likely not to touch someone “non-erotically.”  I would probably err on the side of caution for no other reason than “that’s the way I am.”  Although I do have a desire to convey caring and compassion, I honestly don’t feel like I need to touch someone to convey that.

There are a number of questions I would need to ask myself before I would ever consider touching someone.  Gender… if I wouldn’t touch someone of the opposite sex of the client in that situation, I probably wouldn’t do it at all.  Age… honestly, I would be more comfortable hugging someone who was elderly than I would someone who was younger than me.  I would consider the current diagnosis of the client, especially any history of sexual or physical abuse.  If any history of abuse is present, including being raped, molested, sexual addictions or intimacy issues… it’s probably a safe bet not to touch them.  I would also be very careful with paranoid or borderline personalities as it has real potential to evoke a negative response.

Also, I would consider the context of the therapeutic relationship… if it is individual therapy in a private practice setting I would be much more cautious than if it were in a group setting.  I would also need to consider the length and the level of trust that has been established with a client.  I would be much more inclined to touch someone if we had discussed the issue previously, or if we had a long standing therapeutic relationship/alliance.  In any case, I would probably ask the client if it is ok with them if I touch their hand, etc.

I would consider the potential benefits of such an action, weighing my personal motivations and potential interpretations on the part of the client.  All touch is reciprocal – one cannot touch without being touched… and I’m just not comfortable with touching.  I agree with the text that if touching occurs, it should be a “spontaneous and honest expression of the therapist’s feelings and always done for the client’s benefit.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 316)

In any event, documentation of the type and frequency of touch, along with my personal rationale for employing it, is critical.  This is increasingly important if touching is subsequently misinterpreted and a malpractice lawsuit is levied.  Perception is reality for clients, and what is considered “appropriate” to me may not be “appropriate” to the client.  Another potential negative outcome could be pre-mature termination.  If the client is no longer comfortable with the clinician as a result of non-erotic touching, more harm has been done than good.

In conclusion, I think the risks outweigh the benefits in most situations.  It’s not that I consider it taboo or anything, I just don’t think I need to touch someone in order to convey caring, sensitivity, or understanding.  I can convey warmth and empathy with my voice.  My aversion to touching clients has less to do with the potential negative outcomes than it does with my belief that other methods are as effective or more effective.  If we drill down to a point where a client is crying and in obvious distress, I am of the belief that a certain degree of distress is healthy.  Touching a client provides a false sense of security in my opinion, premature resolution, and a certain sense of dependence.  In as much as I am there to help a client, I am there to promote independence, not dependence on the clinician.  In more ways than one it has the potential to be counterproductive for the client, and for that reason, I am going to use touch very judiciously.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

 

Intuition, Introspection, and Empathy in the Context of Clinical Supervision


The qualitative value of a supervisory relationship is as unique as the component parts.  The relationship between supervisor and supervisee can be conceptualized as a living entity that refuses to conform to a definitive list of “ideal traits.”  No two supervisory relationships are the same; just as no two supervisors, or supervisees, are identical.  Despite the absence of a definitive list of qualities that are desirable in a supervisee, Pearson (2004) has endeavored to compile a catalog of traits he considers paramount to the success of the supervisory relationship.  Included in his inventory are “psychological-mindedness and openness, dependability, interpersonal curiosity, empathy, willingness to risk, intellectual openness, habit of developing personal knowledge, minimal defensiveness, introspection, receptivity to feedback, and personal, theoretical, and clinical flexibility.”    (Pearson, 2004, p. 362)  To that list I would add effective written and oral communication skills, integrity, initiative, intuition, decisiveness, enthusiasm, and a sense of humor.  This essay will explore what I consider to be three of the most prominent aspects of a successful supervisee.

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Intuition can be described as “immediate understanding, knowledge, or awareness, derived neither from perception nor from reasoning.”  (Colman, 2009, p. 390)  Intuition is a cornerstone of the Jung-Myers psychological typology; it is also a foundational element of my personality and character.  Intuition runs through me.  I am generally good at analysis and I enjoy “the complex.”  I express interest in anything and everything, probably with too little discernment.  I have an aptitude for ignoring the standard, the conventional, and the authoritative.  I am always on the lookout for new projects, although I rarely bond with anything or anyone involved in those projects.  I have been described as a mesmerizing communicator.  I am content moving forward with a project despite having little more than a “rough draft” to work with.  I typically depend on the ability to improvise as situations develop.  Intuition runs through me.

Intuition runs through me, but it has its limitations.  I have a distinct tendency to neglect essential preparation at times, instead relying on ad-libbing.  I am fluid in thought and action, to a fault no less.  Routine tasks bore me to tears; I will seldom do the same thing, the same way, twice.  Repetition makes me restless. I am very apt to be flighty… I gravitate to one new interest after another.  I have been known to engage in brinkmanship with my career, often putting myself and my family in jeopardy.  I often find myself “working against the system” just for the joy of being one-up, and I revel in being a master of the art of one-upmanship.  In my employment history I have frequently offered unnecessary challenges to those who have power over my professional success.  And finally, I am my own worst critic.  Intuition runs through me.

In my opinion, fine tuned intuition is the difference between good and great.  Research into the micro-expression of emotions indicates that people with “good intuition” are able to accurately identify complex medleys of emotional expressions in just a fraction of a second with remarkable accuracy.  (Gilhooley, 2008, p. 106)  Within that context, I would like to make a conscious effort to refine my personal intuition under supervision.  I would like to gain insight into areas where I can trust my intuition, as well as confirm and deny areas where I have an intuition deficit.  All of these intuitive traits will need to be disclosed, balanced, and addressed with my clinical supervisor if I am to have a successful supervisory relationship.  Intuition runs through me, for better, or for worse.

When intuition fails me, and it inevitably will, introspection will pick up where it left off.  Introspection is generally defined as “a method of data collection in which observers examine, record, and describe their own internal mental processes and experiences.”  (Colman, 2009, p. 390)  It derives from the Latin ‘spicere,’ meaning ‘look,’ and ‘intra,’ meaning ‘within’; introspection is a process of looking inward.  (Macdonald, 2006, p. 356)   While some argue that no weight should be placed on the introspective institution (Carruthers, 2009), I believe the self-discovery process of introspection can pay dividends by building a supervisory relationship that is more productive.  Supervisors are expected to function in a variety of roles, including teacher, counselor, and consultant.  (Pearson, 2004, p. 363)  Time is money; we should all endeavor to make the best use of time.  My goal is to employ introspection to the extent that the importance of the “counselor” role is diminished, and the role of the “teacher/consultant” is emphasized.  This will be a real test of my boundary setting skills.  I envision that my effort to apply introspection will allow the supervisor to take on more of an educational or consultative role, thereby allowing them to focus more on traditional efforts such as conceptualizing techniques or interventions.  As an added bonus, introspection allows me to recognize my own comfort level, to assess my own personal history, and to identify and confront personal bias where it exists.

Empathy represents “the capacity to understand and enter into another person’s feelings and emotions or to experience something from the other person’s point of view.”  (Colman, 2009, p. 248)  Greater client satisfaction and increased confidence in empathetic providers have led to empathy being considered as a prerequisite to competence.  (Looi, 2008)  Empathy is recognized as an important component in the advance of a positive treatment relationship, even to the extent that it has been described as “the most significant discriminating factor for predicting treatment outcome.”  (Clark, 2010, p. 96)

I am cognizant of my personal deficit in this area.  All the intuition and introspection in the world doesn’t innately give someone like me the ability to walk in another person’s shoes…  it is a skill that I will need to continue to develop and refine.  “Having problems is not the problem; not dealing with our problems is the problem.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 394)  One specific goal I have, and one primary criterion in my selection of a supervisor, is to find a mentor who can develop my empathetic awareness.  To that end, I endeavor to find a supervisor I can trust with my weaknesses, and that I can rely upon to help me develop areas in which I have deficits.

A successful supervisory experience doesn’t come without planning.  I understand that I have very high, perhaps unrealistic, expectations of a supervisor.  Best case scenario, I maximize the professional growth that can be realized by a perfect supervisory situation.  Worst case scenario, I make the best of a less than idyllic situation.  By exploring competencies under supervision, we as supervisees have the opportunity to refine qualities like intuition, introspection, and empathy.  In any case, assessment of competencies and the pursuit of “the ideal traits” is a lifelong endeavor in continuing education.  It only begins with clinical supervision.

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References

Carruthers, P. (2009). How we know our own minds: The relationship between mind reading and metacognition. Behavioral and Brain Sciences, 32(2), 121-182. doi: 10.1017/S0140525X09000545

Clark, A. J. (2010, Apr). Empathy and sympathy: Therapeutic distinctions in counseling. Journal of Mental Health Counseling, 32(2), 95-101. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=2026599301&sid=30&Fmt=3&clientId=4683&RQT=309&VName=PQD

Colman, A. M. (2009). Oxford dictionary of psychology (3rd ed.). Oxford, NY: Oxford University Press.

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Gilhooley, D. (2008). Psychoanalysis and the “cognitive unconscious”: Implications for clinical technique. Modern Psychoanalysis, 33(1), 91-128. Retrieved from http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?index=2&did=1596619281&SrchMode=1&sid=17&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1274204301&clientId=4683

Looi, J. C. (2008, Apr 7). Empathy and competence. Medical Journal of Australia, 188(7), 414-416. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1465911401&sid=29&Fmt=3&clientId=4683&RQT=309&VName=PQD

Macdonald, C. (2006, July). Introspection and authoritative self-knowledge. Erkenntnis, 67(2), 355-372. doi: 10.1007/s10670-007-9072-z

Myers, I. B. (n.d.). The 16 MBTI® types. Retrieved May 18, 2010, from http://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/the-16-mbti-types.asp

Pearson, Q. M. (2004, Oct). Getting the most out of clinical supervision: Strategies for mental health. Journal of Mental Health Counseling, 26(4), 361-373. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=733122011&sid=2&Fmt=3&clientId=4683&RQT=309&VName=PQD