In today’s podcast, we will illustrate one of the less known M = Methods in TEAM therapy. It’s called Forced Empathy. Lately, it’s been getting a lot of enthusiastic support from individuals in my training groups, so I thought I’d include it in the podcast series on role-playing techniques.
I’m joined today by our wonderful and brilliant host, Dr. Fabrice Nye, and two individuals from my Tuesday evening training group at Stanford: Rhonda Barovsky, PhD, and Robert Mitchell, PhD, as well as Stephanie James, a psychotherapist and Licensed Clinical Social Worker from Fort Collins, Colorado. Stephanie recently interviewed me for her terrific radio show / podcast called TheSparkPod.com and I was delighted that she visited our training group today.
In the podcast, Robert describes a problem with his 11-year-old son Max, who frequently gets into conflicts with his younger sister. I thought the example was only partially successful. I was struggling with bronchitis the night we recorded it, and others were tired, too. I might repeat a podcast on this technique to let you see it again, as it is potentially powerful. However, it might be somewhat helpful for you to get a bit of a feel for how this potentially powerful techniques works.
After the podcast, I received this wonderful email from Robert:
“On the drive home after the podcast I did remember the sudden insight that was so helpful to me during the Forced Empathy. The reason I touched your arm was that I realized that Max really believes what he’s saying as he says it. When he logically reviews it later, he doesn’t, but in that moment, I suspect he does believe it.
“My aha of the podcast was that I have been negating his feelings, assigning them as misplaced emotions or manipulation. I came to this assessment because in the heat of the conflict, what he is saying appears to involve distorted cognitions, assertions and remembrances. In those moments, I have tried to apply the Five Secrets, but with mixed results, because I realize now that I’ve been trying to get him to see that he’s wrong, as opposed to seeing the world through his eyes.
“Again, thank you for everything you do for both myself and for the group. I really value the training experiences that you’ve created for all of us!”
The following is a document I wrote several years ago for my Stanford training group. You can review it if you’d like to learn more about this technique.
I want to thank Leigh Harrington, MD for collaboration in creating this document
Goal: To help the patient to see a relationship conflict from the other person’s perspective, and to see his or her own role in the conflict more clearly.
Important note: Forced Empathy can only be used to help someone who has agreed to examine his or her own role in a conflict and stop blaming the other person. The patient must agree to focus entirely on changing himself or herself and to stop trying to change the other person.
Therapists who do not understand this will discover that this, or any, interpersonal technique will fail. Unresolved resistance in relationship problems is extremely powerful and will sabotage any technique designed to enhance intimacy and understanding.
Rationale: Distortions like Mind-Reading, Labeling, Should Statements and Blame, to name just a few, can intensify relationship conflicts. For example, when you’re angry with someone, you may have thoughts like these:
- She’s a jerk.
- All he cares about is himself.
- She always has to be right.
- He always has to get his way.
- She never listens.
- He always has to be in control.
Patients may not be motivated to give up these distortions because they feel good when they are directed at someone else! Angry patients may enjoy seeing the other person in a highly unflattering light, so they may cling to their distortions.
In addition, these kinds of distortions will function as self-fulfilling prophecies. For example, if you think of someone as “a jerk,” you will treat that person like a jerk; then he or she will probably get mad and act like a jerk. You don’t realize you are creating your own interpersonal reality, and you may be convinced that you are seeing the other person as he or she “really is.”
One of the goals of T.E.A.M. therapy is to pinpoint your own role in the problem and to see things through the other person’s eyes. Forced Empathy is one technique that can sometimes help with this.
How to do it: Invite the client to participate in a unique kind of role-play exercise. The patient will play the role of the person she or he is in conflict with and you, the therapist, will play the role of a good friend of the person. Explain that you will ask him or her about this conflict. The patient should do his or her best to answer all the questions honestly.
Here’s a tip: When you are playing the role of the friend, imagine that you are a therapist, and you are asking the person the patient is in conflict with how he or she feels, and why he or she feels that way, using the Five Secrets of Effective Communication and other interviewing techniques. As a therapist, you would do this in a supportive, exploratory way, with no judgment at all. We do this all the time with our patients, so that’s the skill to draw on when you use this technique.
Here’s an example: Let’s imagine our client, Susie, is having a conflict with her friend Paul.
Tell Susie that there are three rules:
- “When you play the role of Paul, you have to agree to tell the truth, the whole truth, and nothing but the truth. You are not allowed to rationalize or to be defensive. Do you agree?”
- “In addition, I want you to speak from the perspective of Paul’s conscious and subconscious mind as best you can. Do you agree?”
- “Finally, I want you to share all of Paul’s feelings, including anger and frustration, in an uninhibited way. Will you do that as well?”
The friend (played by the therapist) starts by saying:
Friend (therapist): “Paul, I hear that you’re having a conflict with Susie. Is that true?
Client (Susie playing the role of Paul): “Yes, I guess we are.”
If the client says no, you tell them they’re not following the rules.
Friend (therapist): “Tell me what’s going on with you and Susie. How has it been for you?”
As the Friend, the therapist can ask Susie questions along these lines:
- “Paul, tell me how you feel about Susie.”
- “Does she irritate you? Tell me what she does that turns you off.”
- “Tell me why you don’t trust her. What are some of the things she’s done or said that seem dishonest or untrustworthy.”
- “Why do you think she does that?”
- “Tell me more about why this is upsetting to you.” (You can do an informal Downward Arrow Technique here.)
As the Friend, the therapist must empathetically align with Paul, using the Five Secrets of Effective Communication: The Disarming Technique, Thought and Feeling Empathy, Inquiry, “I Feel” Statements, and Stroking.
Therapist (friend) follow-up questions can focus on goals like these:
- Identify the thoughts and feelings of Paul, the person the patient is in conflict with.
- Highlight the (usually benign) motives of the person the patient is in conflict with: “So you’re telling me that you’re concerned that if you listen to Susie, or give in to her, she’ll take advantage of you and you’ll end up getting hurt? Are you saying that you back off because she sometimes seems kind of pushy?”
Or “So you are telling your daughter you will not go to her wedding because you love her so much and fear she’ll be unhappy with this man?”
Or “So are you saying it’s your desire to give your grandchild things you were unable to give your son that drives you to shower him with gifts?”
You can see that this is the same Positive Reframing technique we often use during Paradoxical Agenda Setting. Essentially, you transform malignant motives into benign motives. This is arguably a Buddhist concept. The idea is for the patient to see that if he or she were the “enemy,” he or she would likely be feeling and behaving in the same manner.
This means giving up the notion that the person the patient is in conflict with is some kind of horrible human being. Some patients will not be willing to do this. That’s why skillful PAS must come first. As I mentioned earlier, it is very rewarding to label and blame others because this makes us feel morally superior. Even therapists sometimes fall into this trap, usually without realizing it!
- Pinpoint the precise things the patient does or says that upset the person the patient is in conflict with: “So you are saying that Sam is being too tight fisted with his child, and that is judgmental toward you for being generous?”
- Identify and align with the parts of the client the conflict person may appreciate.
“You’re right; I’ve heard Susie is a real go getter.”
Or, “Yes, I’ve heard Sam really wants to teach his son the value of money.”
At the end ask, “You’ve been playing the role of Paul (or Sam, or whoever), how is that for you?”
Responses Dr. Harrington has heard from patients when using this technique:
“I was able to see Paul’s side, and see my part my part in the problem as well.”
“I’m always running my script, and I started to see his script.”
“This gives me some insight and new ideas about how to approach my supervisor.”
Key points: A strong therapeutic alliance will be required. You must empathize with the client skillfully and should be getting a 20 on Therapeutic Empathy Scale before jumping into this method.
Another key point will be skillful Paradoxical Agenda Setting (PAS). Teaching interpersonal techniques to patients without using PAS first will rarely be effective. By the same token, imposing Forced Empathy on a patient who wants to see the “enemy” in a negative light will rarely or never be effective. As a result, you’ll conclude that Forced Empathy isn’t a very good technique when the real problem may simply be unresolved resistance.
The “dark side” of human nature: One concept that seems very difficult for therapists to grasp and accept is that there is a “dark side” to human nature. One the one hand, we are motivated to have loving, peaceful, joyous relationships with others. But at the same time, dark motives often compete with the positive motives, and we may not really want a closer or more loving relationship.
Why would we want bad relationships with others? What are the lower forces that compete with our desires for love and intimacy? there are many benefits to identifying someone as your “enemy,” including:
- You can blame the other person (or group) for the problems in your relationship.
- You can tell yourself that you are right, and she is wrong.
- You can feel self-righteous and morally superior.
- You can feel angry and justify getting back at the other person or group.
- You can get others to collude with you and agree that the other person is “bad.”
- You can put up a wall and protect yourself from the risk of getting hurt.
- You can attach pejorative labels to the other person.
- You can see other people in black-or-white terms. This makes things simple and clear.
- You can feel a sense of excitement.
- You don’t have to examine your own role in the problem, which can be shocking and humiliating.
- You can play the role of victim, or martyr, and feel sorry for yourself.
If you may discover that your patient does not want help with a relationship problem, can simply Sit with Open Hands and ask if there is something he or she does want help with.
* Copyright © 2018 by David D. Burns, MD
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May 20th, 2018 Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!
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“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
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June 4 -5, 2018 Calgary, Canada
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Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and http://www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
Dear Dr David,
I feel it’s a really cool technique. Thanks
to everyone David, Robert, Rhonda, for demonstrating it on the podacst. I feel it could really help a lot for moments when I find myself totally unable to understand the other persons perspective and get caught in other blame and self blame cycle.
Specially for Dr Fabrice: I love ur procedural interventions. The way u give a summary from time to time is something I really look forward to learning. It is concice and gives a take away message .
– thanks and warm regards
Thanks for the kind words. You’re right, Fabrice is a treasure! david