Breaking Boundaries With Empathy: How the Therapeutic Alliance Can Defy Client/Worker Differences

by Sharon Lacay, LMSW, ASW

One of the special qualities about being a social worker is having the opportunity to work with people from all walks of life. It is our job to meet our clients where they are; however, the journey to get there is sometimes easier said than done. Just as in our daily lives, in the field, we come into contact with people who are different from ourselves; who may be a different gender, have a different culture, be from a different socio-economic status, differ in age, or be struggling with an issue that we ourselves have never faced before. For students gaining professional experience in a field placement setting, it is both inevitable and imperative to develop the skills needed to engage, assess, and effectively treat individuals and communities with whom we may have little in common.

This process begins with empathy. According to The Social Work Dictionary (Barker, 2003), empathy can be defined as “the act of perceiving, understanding, experiencing, and responding to the emotional state and ideas of another person.” The act of empathy reflects one of NASW’s core values, dignity and worth of the person, by guiding us to respect everyone’s unique situation, strengths, weaknesses, and what is important to them about their presenting issue and treatment plan.

Even for the most experienced professional, working with people who are different from ourselves can be both challenging and rewarding. It is often in our experience as an intern in field placement that we are initially faced with dealing with worker-client differences. It can sometimes be awkward or scary, but it is those experiences that will force us to break through boundaries and rely on the power of empathy to engage our clients and develop sound interventions with them.

In my second year of graduate school, my field placement was in a domestic violence and sexual assault crisis center. One of my assignments was to facilitate a long-term adult survivors counseling group. Each of the six group participants was at least twice my age, and I was a little apprehensive, to say the least. Before this placement, I had only worked with children and adolescents. The thought of relating to these much older women seemed almost impossible. We were at different stages in our womanhood and in life, and I questioned how I could truly be effective in helping them. When I shared my hesitations with my supervisor, her advice was to be genuine, confident in my skills, and to use my words and expression to show empathy. It sounded like a solid plan, but deep down I was hoping it would never come up in group.

Two sessions in, my fears were confirmed when one of the women remarked that I looked young and that I may not be able to understand where she and the others were coming from. She continued and voiced her doubts that I may not be able to appreciate their seasoned wisdom about life. In response, I paused for a moment and gathered my confidence. I remembered what my supervisor had suggested and all that I had learned about meeting a person where he or she is. I said, “You are right. I’m not an expert on life, or yours. One of the great things about being a part of this group is that we can learn from each other. I’d love if you told me more about yourself, what you think makes you strong, and what you hope to gain from our work together.”

This took her by surprise, and I felt a sigh of relief when she smiled and noticeably let her guard down. By validating her reluctance and showing that I wasn’t there to tell her how to live her life or how to heal, she saw me as an ally. Once I saw how powerful this approach was, I continued to grow my empathy skills in group and in supervision. By being honest about how I felt around mitigating our different life experiences, I became less afraid or offended when a client questioned my abilities. Always acknowledging their trepidations, I was eager to learn from them and showed a genuine interest in what they had to offer in our work together.

Why is empathy so crucial to social work?

Studies have shown that “patients with an empathetic therapist tend to progress more in treatment and experience a higher probability of eventual improvement” (Norcross, 2011). Carl Rogers (1975), who is often thought of as a leader in the exploration of the unique therapeutic relationship, initially described how the function of a therapist’s ability to convey empathy can enable clients to experience possible meanings to what they are saying and feeling more clearly.

The importance of these findings in regard to the social work profession is astronomical. The majority of our clients are suffering from losses, illness, poverty, and institutional injustices that often require intensive treatment or service planning. For that treatment to be meaningful, we need to lay a foundation that will set our clients up for success. Being able to reflect an understanding of our client’s situation in our assessment, intervention, and even during termination can increase the sustainability of potential outcomes.

Part of what social workers stand for is the idea of change. This can mean small changes in one person’s behaviors or large changes in a community or in the world. We can help create or seed change by developing client self-awareness, efficacy, and flexibility. If we now know that creating a climate of understanding and compassion helps client engagement and responsiveness, then why not integrate empathy into every interaction we have with the people we serve?

How to break the boundaries

Since the day you started social work school, you’ve been hearing the term “client centered treatment.” This epitomizes the idea of incorporating empathy into client-worker relationships. You are taught to use skills such as active listening, or tuning in as a way to convey your wish to meet clients where they are. These are great tools, but not the only ones you need.

Purposefully asking questions is one of the best ways to show that you understand and want to understand more deeply. Even before you begin to ask your client questions, it is crucial to be aware of your language. Language sensitivity can be described in many ways, but here are a few ideas to get you started:

Use unbiased language. When working with clients who have different levels of ability, are of a different culture, or are of a different race, you may have difficulty with engagement if you use labels or slurs to describe them or their experiences.
Reflect the same language a client uses to describe a feeling or experience. For example, if a woman who had an abortion refers to her experience as a “choice“ or “decision,” it is best not to then refer to her abortion as something that “she did” or “completed.”
Have an awareness and separation of your own personal judgments that can ostracize a client (for example, referring to a person who struggles with substance use as an “addict” or “substance abuser”).

Asking questions is a skill. There are some wonderful resources out there that can help you formulate thought-provoking questions that show your clients that you authentically care and want to know more. When deciding what questions to ask, you first want to focus on addressing preliminary treatment information.

What led them to seek help from you?
When did the presenting issue begin?
What are their goals for working with you?
How would they know that things were improving?

Referring back to the example of my experience working with clients older than myself, what worked in that situation was that I honored the differences that I had with my clients, provided validation of their concerns, and expressed an enthusiasm to change. Part of this approach was modeling an understanding and an ability to be flexible. Since that experience, I have wondered how I could have done that if I hadn’t shared my feelings and emotions around being different from them.

In 2009, Gerdes and Segal developed a social work model of empathy that introduced a concept called Affect Sharing, which describes a social worker’s experience of having automatic emotional and cognitive responses that are the same or shared with their clients. The research suggests that following the experience of Affect Sharing, the social worker is then faced with the decision of whether to take Empathetic Action (Gerdes & Segal, 2009). Part of the decision to take action requires a reflection on the impact of those automatic emotional and cognitive responses.

This requires a level of self awareness that all of us are capable of developing. Just as we ask our clients to tell us what their sharing is bringing up for them, ask yourself: How is this information affecting me emotionally and in my thought process?

Being able to disclose these feelings to clients can set the stage for discussing issues as they relate to a person’s inner beliefs, fears, and desires. Although it may be part of your role, you should never feel that you need to interpret what a client is presenting. Empathy is natural to humans (especially helping professionals!) and can act as a source of information about how to help our clients.

Most recently, I took this approach when I was in an individual counseling session with a woman who had experienced severe mental and physical trauma over the course of her thirty years. It was our first time meeting, and she was giving me a laundry list of all of the “bad” things that had happened to her, never taking a moment in between.

I began to feel overwhelmed. Inside, I felt as though I was shrinking, and I wanted a moment to process what I was hearing. When it felt like a good time, I asked my client to pause for a moment. I told her that I was hearing a lot of heavy information and suggested that we both take a breath. She agreed, and as we both took a deep breath and then exhaled, I felt the tension settle.

I said to her, “Hearing this has been a little overwhelming. I’m wondering if we can go a little slower so I can hear your whole story—how has it felt so far to share it with me for the first time?” She responded that no one had ever asked her how she felt speaking about it before, or acknowledged that it was a real weight that she carried around with her. Rather, they avoided talking to her about it or suggested that she quickly move forward from it, because it was simply too painful.

Expressing empathy isn’t presented in a pity package, but rather it is a true gut reaction and identification of what another person or group has experienced. If you ever find yourself struggling to connect with clients or feel where they are, it’s always okay to say, “Can you tell me more?”

I believe that everyone has the capacity to relate to others. It may not be obvious what you have in common with a client who is completely different from yourself, but as you continue your career, whether it’s working with groups or individuals or developing new policies, you will be forced to put yourself in shoes other than your own. Take the time to reflect, ask purposeful questions, and learn about the unique issues that people deal with. You may be surprised at how you can gain insight into your client’s mind by reflecting on your own.

References

Barker, R. L. (2003). The social work dictionary (5th ed.). Washington, DC: NASW Press.

Gerdes, K. E., & Segal, E. A. (2009). A social work model of empathy. Advances in Social Work, 1 (2), 114-127.

Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidence based responsiveness (2nd ed.). New York: Oxford University Press.

Rogers, C. (1975). Empathetic: An unappreciated way of being. Counseling Psychologist, 5, 2-10.

Sharon Lacay, LMSW, ASW, received her BA in psychology and Master of Social Work from Stony Brook University in Long Island, New York. She recently moved to Berkeley, California, and is pursuing a career working with youth and families in crisis.