I know just how you feel

When people talk with psychotherapists, the best results occur if both feel similar emotions, when both “like” each other. But do most therapists really connect with patients this way? No one has ever tried to directly measure the biology of empathy between the two.

To fill this gap, a group of researchers at Harvard Medical School and Massachusetts General Hospital measured involuntary biological reactions by both patients and therapists during a regular psychotherapy session. Attention and inattention, expressions of pleasure and satisfaction, and words of care and understanding also were caught on videotape.

“To our knowledge, this is the first study of the physiology of shared emotions during live psychotherapy sessions,” notes Carl Marci, the Harvard psychiatrist who led the study. “We were pleased to find evidence for a biological basis of empathic connections. Our results suggest that therapists perceived as being more empathic have more positive emotional experiences in common with patients.”

That’s good news, given that other research has shown that lack of empathy is the best predictor of a poor outcome for patients.

So, can therapists be rated by empathy? “Empathy is important, but it’s not the whole story,” Marci explains. “It’s not sufficient to determine the outcome of therapy.”

He and his colleagues are now looking at empathy over a longer term, 20 sessions rather than one. They also add more physical measurements of patients during therapy, including heart activity. And brain scans will be done to see what empathy does for the brain.

The skin-y on empathy

In the experiments already completed, physical measures of mental connections were made by recording skin “sweating,” that is, how electric conductivity of skin varies with emotional arousal during a session. It works on the lie-detector principle. When people lie, or emotions jump, their nervous system increases the conductivity of their skin. This shows up as peaks on a roll of graph paper or computer screen.

“In many other studies, skin conductivity was consistently the most sensitive physical measure of emotional and empathic responsiveness,” Marci notes. “Skin conductivity measures during social interaction are very sensitive indicators of arousal.”

For example, skin changes have been used in studies of women watching scenes of 5-month-old infants expressing emotions such as distress or pleasure. High-empathy women exhibited much larger skin responses than low-empathy women. High-empathy responses were more likely to match facial expressions of the infants. In the Harvard study, when a patient and a therapist were in concordance, their peaks and troughs marched together like waves rolling onto a shore.

The research included 20 patient-therapist pairs working together at Harvard-affiliated Massachusetts General Hospital in Boston from September 2003 to June 2005. Patients included 11 males and nine females between the ages of 21 and 44. They were being treated for anxiety and mood disorders such as depression, often described as the “bread and butter” of outpatient psychiatry.

Screening eliminated subjects who showed evidence of homicidal or suicidal tendencies, active psychosis, or substance abuse. Those chosen had been seeing the male therapists for more than 10 sessions. Skin conductance measurements of both therapists and patients were made simultaneously during the 45-minute sessions, which were videotaped.

Patients’ ratings of high and low empathy moments consistently matched the peaks and troughs of skin measurements. Two independent observers, college graduates who didn’t know the goals of the study, rated three-minute segments of the videotapes. They scored interactions as positive, neutral, or negative by using descriptions such as “shows positive regard,” or “shows antagonism.”

“The observer ratings suggest that patients and therapists show significantly more positive solidarity and positive regard during high versus low skin conduction concordance,” Marci comments. “Taken together, the results of our study show a biological basis for the feeling of connection. Patients perceived the empathy of the therapists, and therapists felt positive social-emotional experiences in common with their patients.”

Wired for empathy

Marci and colleagues Jacob Ham, Erin Moran, and Scott Orr published their findings in the February issue of the Journal of Nervous and Mental Disease. In the article, they note that their results suggest a distinct nervous network for empathy and emotional responsiveness that is “implicated in the ability to take another’s emotional perspective.” In other words, empathy is a physical as well as a mental thing, a shared network that creates common representations of “self” and “other” wired into the brain at birth. The researchers believe that coordinating and contrasting these representations takes place in the front of the brain just behind the temple, where sensory, emotional, and cognitive inputs from many parts of the brain become integrated for use as behavior and in making judgments.

The ultimate goal of acquiring such knowledge,” Marci says, “is to improve therapeutic techniques and develop resources for teaching medical students and physicians to be more empathic.”

Applying the knowledge, however, could go beyond the field of medicine. How about using “empameters” for tracking feelings between teachers and students, employers and employees or wannabe employees, military brass and those they command, and people who seek the assistance of dating services?

“Sensors for measuring skin conductivity and heart activity, along with computers to analyze the data, are becoming small enough to use outside a psychotherapist’s office,” Marci points out. “It’s becoming easier and faster to measure the social grease that helps make relationships and group dynamics flow. We’re in the earliest phase of a very exciting potential.”