Empathy and Sympathy and Their Roles in Psychotherapy

Empathy and Sympathy both have a place in the practice of psychotherapy.  Let me first define psychotherapy.  According to the American Psychiatric Association, “Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.”.  In essence, “mental illnesses and emotional difficulties” are suffering, with mental illness suggestive of an organic etiology, and emotional difficulty I might say as errors in judgment, both of which involve an over-appropriation of irrational thinking.

A summary of Merriam Webster, Dictionary.com, Britannica, and Urban Dictionary generally agreed that empathy is defined as understanding another person’s feelings from a vicarious perspective, whereas sympathy is more about compassion and care toward another’s suffering.  Empathy is feeling another’s suffering (being with another emotionally, a shared FEELING state) and sympathy is compassion, care, and support toward another’s suffering (helping another through, an external ACTION state).  Engaging only in empathy is commiserating.  Engaging only in sympathy is somewhat detached and impersonal.  Dale Carnegie in his book, “How to Win Friends & Influence People”, summarized how one might express sympathy, “I don’t blame you one iota for feeling as you do.  If I were you, I would undoubtedly feel just as you do” (pg 181). What Dale just described was empathy.  I will address his sympathetic approach later in this paper.

Empathy

Sympathy

From the Greek root of both empathy and sympathy – pathos, we find “experience of suffering”.  Specific to Stoicism, pathos refers to “complaints of the soul”, “emotion”, or “passion”, which we all know as Stoics is the irrational appropriation of goodness or badness.  Now this pathogenic experience of emotion is, as I just stated, dependent on the perceived value of the subject of thought (good, bad, or indifferent).  This state of suffering “pathos” is a result of faulty logic (reason), a faulty understanding of physics (the world), and/or a faulty application of ethics.  Logic, physics, and ethics are all interdependent, and you will see how they align in Cognitive Behavioral Therapy (CBT) which is the most common form of psychotherapy.  In CBT, the basic theory is that we have thoughts (logic) about the world (physics) that affect our moods (pathos), which affect our behaviors or how we act: our character (ethics).  The goal of CBT is to identify incorrect assumptions, or faulty beliefs about the ourselves, others, or the world, we replace those beliefs with more rational beliefs (logic) which should have a positive effect on our mood states (pathos) from which we can have more appropriate reactions/behavior: “character” (ethos/ethics).

Now all this follows Epictetus’ mantra – “It’s not things that disturb you, but your opinions about them that do” (Encheiridion, par 5). In summary, our pathos is dependent on our logic.  Now as a psychotherapist, if I am only empathetic, vicariously experiencing your suffering (I see my logic the same as your logic), then I am in commiseration with your suffering.  I am not in a position to advise you away from it unless I step out of the commiseration and move into my role of guide.  Many clients come to me, having previously been in therapy with someone else, telling me that the therapist simply validated their feelings but offered no solutions.  This is a concrete form of Rogerian client-centered therapy, where the therapist’s main role is to exhibit genuineness, unconditional positive regard, and empathetic understanding.  This is not to say the Rogerian approach lacks sympathy, but to highlight its heavy emphasis on the active process of empathetic understanding.  This brings me back to my main point – that both empathy and sympathy have a place in psychotherapy.  I think the best definition of empathy I have found is from the book “Sympathy: A History” by Susan Lanzoni:

“the ability to step into and walk in another person’s shoes and then to step back into one’s own shoes again, and, in so doing, to feel along with, to understand, and to insinuate one’s self into the feelings of another person”. (pg 101)

This is a deeply spiritual undertaking, to “walk in” and “to insinuate oneself into the feelings of another”.  From this perspective only can one truly feel the depth of another’s pathos. To truly walk in those shoes, one must abandon all personal values and adopt those values of the client.  Personal values only cloud one’s perception of the client’s phenomenological experience.  Now key to this point, so as not to commiserate, is to “then step back into one’s own shoes again”.   It’s the equivalent of sticking your head under water to see, feel, and hear everything that’s down there, and then come back out above the surface and be freed from it.  We’ve seen similar allegories in many sci-fi films, where people cross over into alternate realities via a portal, and come back, having seen the darkness therein.  Once you are back in your own shoes again, and only then, can you engage the therapeutic practice of sympathy – compassion, care, and support.

In one translation of Meditations I found no use of the word “empathy” and only five uses of the word “sympathy”, referring primarily to the relationship between two physical objects or the relationship between the mind and body, none related to the interaction between people.  Marcus Aurelius made a veiled reference to empathy:

“Failure to read what is happening in another’s soul is not easily seen as a cause of unhappiness: but those who fail to attend to the motions of their own soul are necessarily unhappy.” ~ Meditations 2.8

This passage suggests that unhappiness is a result of being so moved by the unchecked passions. 

And he follows with warning of the dangers of blind empathy:

“Don’t let the impression of other people’s grief carry you away indiscriminately.  Help them, yes, as best you can and as the case deserves, even if their grief is for the loss of something indifferent, but do not imagine their loss as any real harm…’Yes, but they are important to these folk’.  Is that any reason for you to join their folly?” ~ Meditations 5.36

The therapeutic empathetic and sympathetic response is the observation and acceptance of others’ experience of distress along with feelings of compassion, sorrow, or pity for another’s hardships.  Now I know some prokoptons (those who are making progress along the Stoic path) out there are thinking, “Now wait a minute, aren’t compassion, sorrow, and pity all passions?  Don’t Stoics avoid passions?”  We can certainly have feelings of compassion, sorrow, and pity, Stoics just aren’t carried away by them.  It is human to have such feelings.  “Stoicism is about the domestication, not necessarily the elimination of emotion” (Taleb, pg 156).

I’ve had clients say to me, “I don’t think you understand the depth of my suffering”.  I might reference Heraclitus:

“(Souls) do not step into the same rivers. It is other and still other waters that are flowing. And (those) souls take their spirit from (those) waters.” ~ Fragment 20 (Harris)

The river of suffering one may be drowning in is known only to them, in depth, current, and murkiness.  Another can imagine that suffering only from conveyed words and physical expression the torment another must feel.  One person’s river of suffering may have different depths, currents, and murkiness, all the same yet foreign to another person’s experience.  I might say this is an objective subjectification of experience.  We feel alike, at different stages and in different ways and places in time and context.  A therapist’s job is to help one out of that chasm of despair in time.  The current time may be to grieve and pay respect to what one has lost, but soon it will be time to recover and pay respect to oneself.  

Seneca’s “Of Consolation: To Marsha” has been criticized as lacking empathy, but is replete with offers of sympathy, in true Stoic fashion.  Having grieved the loss of her son Metilius for more than three years, Seneca urged Marsha to weigh if “grief ought to be deep or unceasing”.  He later provided Marsha with examples of her own superior moral character, and asked that she “act up to your maxim of doing nothing which you could wish undone, or (have) done otherwise” in regard to her mourning.  He then implored her to consider her friends and her noble lot in life and not be taken so fully by her loss, referencing others who have lost loved ones and grieved and recovered.  Further, he suggests, “if fate can be changed by tears, then by all means cry it out, but if death cannot be brought back to life by sorrow, then let our futile grief be brought to an end.”  He bounders on the edge of empathy, but his stern words prevent him from embracing it fully, “But,” say you, “sorrow for the loss of one’s own children is natural.” Who denies it, provided it be reasonable?”

“Nature requires from us some sorrow, while more than this is the result of vanity. But never will I demand of you that you should not grieve at all. … Let your tears flow, but let them also cease, let deepest sighs be drawn from your breast, but let them also find an end.” ~ Seneca to Polybius 18:6

In this passage, Seneca acknowledges that it is our nature to succumb to the passion of grief, albeit briefly.  Prolonged or excessive grief yields to yet another passion, that of vanity, or of wailing, respectively.  

There are many Stoic references to sympathy, the art of helping people out of their self-imposed misery. Simply lead by example and reference the virtues such as joy, indifference to indifferents, cheerfulness, good spiritedness, contentment, charity, faith, acceptance, and calmness.  And it may well be an approach to take with Stoics to focus on the sympathetic approach alone, since most passions are the result of an unhealthy attachment to indifferents. Marcus Aurelius suggests that opinion is the source of our pain, not actual events; Musonius suggests that those of noble mind temper their passionate expressions rather than wear them on their sleeves.  Epictetus, like Musonius, perhaps more permissibly so, suggests passionate expression should be moderated:

“Take away the opinion, and there is taken away the complaint.” ~ Marcus Aurelius (Meditations 4.7)

“…it is petty to be vexed or put out by such things.  He will calmly and quietly bear what has happened, since this is appropriate behavior for a person who wants to be magnanimous.” ~ Musonius Rufus (Lectures, pg 50)

“I am not saying that it is not permissible to groan, only do not groan in the centre of your being.” ~ Epictetus (Discourses, pg 125)

I might say, “When in Rome…” and take this approach with the Stoics; the Greeks probably wouldn’t like that reference.  But what about non-Stoics who may not hold such strict philosophical practice? “Empathy with others not only reduces anger but also punctures vanity, its cousin” (Robertson 2020, p. 208).  A Stoic may want to be careful about preaching about the lofty position of resilience when helping others through difficult times.  Modern psychotherapy’s use with the non-Stoic masses requires a more empathetic initial approach.  Let’s reflect on the concept of Phenomenological Psychology, which is the study of the subjective experience, an approach to psychological subject matter which attempts to explain experiences from the subject’s point of view.  Doesn’t this sound like a textbook definition of empathy?  

We begin the phenomenological psychotherapeutic process by engaging in the discovery of the subject’s experience.  Take into consideration the myriad of influences that form one’s phenomenological world, without personal bias (walking in those shoes for a moment).  Imagine you are being guided through the murky depths in great depiction by the client.  Try to be right there with them, seeing, feeling, experiencing.  Now to bridge the empathetic to the sympathetic, one might use another method such as a Gestalt Therapy – sort of a “here and now approach”, getting the client to focus on what is ACTUALLY happening (reality, in accord with nature) vs what one thinks SHOULD be happening (opinion of reality, what one wants to happen).  This jump to the here and now is classic Gestalt style, but also part of the Rogerian approach as well.  This is the caring and helping phase – leading one toward present time acceptance, maybe even from a cosmological perspective.  Below, Heraclitus speaks on cosmological perspective, perceived value vs true value, and on love of fate “amor fati” in context with true value:

“The fairest universe is but a heap of rubbish piled up at random…” ~ Fragment 40 (Harris)

“To God all things are fair and good and right, but men hold some things wrong and some right” ~ Fragment 61 (Burnet)

“It is not good for men to get all they wish to get. It is sickness that makes health pleasant; evil, good; hunger, plenty; weariness, rest.” ~ Fragment 104 (Burnet)

Returning to Dale Carnegie; as I mentioned before, his use of the term sympathy in definition was more akin to empathy, however his approach throughout the chapter on sympathy was the actual strategic deployment of a technique of persuasion (dialectic) to win people over.  What he did was manipulate (redirect) people’s opinions by commiserating with them in their own negative emotion.  In a way he would pity them (excessively pander to their emotions) so much to a point that they begin to see their own error in judgment and then autocorrect.  This technique is rather Socratic in a way; you lead them to their own new conclusion by manner of dialectics.  The art of persuasion is broken down into two forms:  Rhetoric (to a large audience such as on a stage; think politics) and the dialectic, more 1:1 (like psychotherapy).  We will focus on dialectic since we are talking about psychotherapy. 

          Both approaches involve three key elements: logos (logic), pathos (emotion), and ethos (ethic).  Do these sound familiar to you?  Carnegie went on to persuade, through pandering discourse, a person to change how she feels about a particular thing (pg 189).  In the example he uses, he resolves to “a sort of game I could play…After all, if I were she, I’d probably feel just as she does.”  He goes on to pander – how right she is to feel as she did, so much so, to a point that she is able to rise above the emotional murkiness and find logic in renewed perspective, sort of explaining herself rationally to him.  THIS is the empathy/sympathy that Carnegie refers to, the walking with, escorting through, and lifting up of another’s soul.  

Carnegie states “Three-fourths of the people you will ever meet are hungering and thirsting for sympathy.  Give it to them and they will love you…the people who come to you irritated, bigoted, and unreasoning deserve very little discredit for being what they are.  Feel sorry for the poor devils.  Pity them.  Sympathize with them” (pg 184).  This is closely related to one of my favorite Marcus Aurelius quotes:

“Today I shall meet people who are meddling, ungrateful, aggressive, treacherous, arrogant, dishonest, jealous, malicious, unsocial, and surly. All this has afflicted them through their ignorance of true good and evil. I cannot be harmed by any of them, as none will infect me with their evil. Nor can I be angry or hate them, their nature is akin to my own.” ~ Meditations 2.1

Modern psychotherapy as you have seen has embraced new spins on Stoic practice in many forms.  Another is the concept of “Radical Acceptance” commonly used in recovery programs and individual psychotherapy, specifically Dialectical Behavior Therapy (DBT).  In DBT, Radical Acceptance is when you stop fighting fate, the same as the Stoic practice of Amor Fati.  You completely and totally accept something in your mind, your heart, and your body.  This is putting faith in the providential nature of the cosmos.  Pain is pain.  Suffering is pain plus non-acceptance.  Radical Acceptance transforms suffering into ordinary pain.  There are three parts to radical acceptance:  1) Accepting that reality is what it is, 2) Accepting that the event or situation causing you pain has a cause, 3) Accepting life can be worth living even with painful events in it.  I am reminded of this in a scene from Bye Bye Birdie, when Dick Van Dyke sang “Put on a Happy Face” to Janet Leigh.  I remember Dick, across most every role he played, as a man of constant positive regard:

“Gray skies are gonna clear up, Put on a happy face;
Brush off the clouds and cheer up, Put on a happy face.
Take off the gloomy mask of tragedy, It’s not your style
You’ll look so good that you’ll be glad Ya’ decide to smile!”

To conclude, I have identified multiple present-day “cutting edge, evidenced based, empirically validated” psychotherapeutic techniques that all piggyback on 2300-year-old Stoic practices.  While the concept of empirical validation was not yet recognized in the philosophies of antiquity, and “evidenced-based” was not a term commonly used until the last 30 or so years, the interventions of these modern-day therapies can be directly attributed to the founding principles of Stoic philosophy.  Additionally, empathy and sympathy existed in practice more than 1500 years before they were actually formulated in the English language and certainly well before the industry of psychotherapy ever existed.