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Section 24
Affirmative Mental Health Practices
With LGBTQ+ Clients

Question 24 | Test | Table of Contents


Empathy has scaled the pinnacle of success and attained an unchallenged nominal status in American society, a status unmarked by a cloud of either a negative connotation or a negative functional meaning. Its history in American psychology goes back to 1909 when Titchener translated the writing of Theodore Lipps (1903), specifically his translation of the concept of Einfühlung as empathy The original German refers to an aesthetic experience, and its meaning lies close to motor mimicry (Allport, 1968). It was only later that the concept acquired the meaning of the generalized ability to understand others.

The meaning of empathy was transformed in American society, particularly by those values which stress similarity and self-perception. The current definition of empathy is often confused with a second potential interface between persons-sympathy, a concept with a much longer and troubled history. Preceding the time of Adam Smith, it later declined, fell into disrepute, and now is confined primarily to pleas for compassion and to studies of children (Allport, 1968).

The rich history of empathy has yielded several subtle analyses that have been conducted in German, a language which stimulates a rich analysis of emotional states that is difficult to translate into English. The peak of analysis may have been reached with Scheler (Allport, 1968), who distinguished eight different levels ranging from motor mimicry, Einfühlung, to a mystical union of all with the One. A quick glance at the eight levels yields an interesting, if superficial, rhythm between differences and similarity. Thus, all the even-numbered levels of Scheler- levels 2, 4, 6, 8-suggest states of similarity, summarized as simultaneous feelings, identification between persons, affiliative fellow feelings though the feelings themselves are separated, and the unity of all. These similarities of the even levels appeal to Americans and contrast with the odd-numbered stages, which refer to differences or at least lack the common bond of the even levels. While Einfühlung refers to motor mimicry and is correctly translated as empathy, the concept does not necessarily suggest a similar feeling. The similarity is in terms of the act, not of the persons. The term has even been used to describe the impulse to tilt the head to look at a picture hanging at an angle on the wall. Level 3 refers to the emotional contagion which sweeps from person to person in a crowd. (It is the emotion which brings people together, not the persons themselves as in identity, level 6.) The next two levels reflect increasing degrees of intellectual detachment, feelings that are altruistic but lack the common emotional bond of level 6, characterized by affiliative fellow feelings. Level 5 represents persons who know how others feel, but the understanding of the other is conscious and detached, distinguishing the self from others. The self understands how others feel but does not necessarily endorse their actions. At the final level of empathy, 7, the self senses the state of mind of the other and prizes and respects it.

Scheler's levels easily incorporate the ideas both of sympathy and empathy. Even-numbered levels show a clear progression from a temporary fusion of self with others to the complete unity of Scheler's mystical level 8, often identified with religious feelings. Empathy, in the odd-numbered levels, suggests a separation between self and others. It is a more complex progression than sympathy: uniqueness and difference would appear to have infinite roots. Scheler's analysis is tentative and must be considered suggestive at best. Nevertheless, it draws attention to at least two interfaces that occur in intercultural communication. Wispé (1968) derived the etymological structure of both sympathy and empathy and finds that connotations of negative affect predominate. In sympathy, the simpler of the two interfaces, I (the subject) know that you are in pain and I sympathize with you. I use my own feelings as the barometer; hence, I feel my sympathy and my pain, not yours. You are judged by my perception of my own feelings(Wispé, 1968, p. 441).
Empathy, based on differences, is the more complex interface. Wispé makes an important distinction when he separates empathy as an act from empathic understanding (1968, p. 441). It is possible for the counselor to attain empathic understanding through the mechanism of sympathy. Our discussion will focus on the act itself, identifying four components for the interface: (1) Empathy is the self-conscious awareness of the consciousness of others. (2) The effort to understand the other person encompasses not only the presumed consciousness, but also the perceptions of the others' thoughts and feelings and the muscular tensions of kinesics. The empathizer (at least in the case of the Japanese) also attempts to understand the causes of the other's temporary state of consciousness. (3) The empathizer focuses on the imagination that serves to transpose oneself into another rather than upon own feelings as in sympathy. (4) Empathy denotes an active referent: the empathizer attends to the feelings of another and goes so far as to feel the other's pain (Wispé, 1968, p.441).

The abstract discussion of sympathy and empathy can be relieved and brought closer to the issues encountered by counselors and clients through examples. In a workshop for counselors built around psychodrama, one example involved a police officer who was called to investigate a citizen's threat to kill the president of the local draft board. The officer was informed that the citizen had just learned that his son, a draftee, had been killed in Vietnam. When the officer approached the citizen, he encountered a man possessed by grief and hate. The officer responded by taking great pains to identify his own feelings as a young man and those of others he knew in Vietnam. This is sympathy.

An internal monologue of a counselor, corresponding to sympathy, might in part reconstruct the above counseling session thus:

I feel good about this session. He (the client) was speaking more openly about his feelings; that's movement. It has taken a longtime. I felt very good when he admitted his fear to reveal his inner feelings. I felt he took me into his confidence. I now feel that we can get to the bottom of this problem. I am sure that he will be a better person because of it.

In the example, reconstructed from many episodes, notice the American value judgment as to the desirability of "let it all hang out". It is the counselor's feelings and intuitions that assess the behavior of the client displaying the paradox in psychology: self-assessment relies primarily on intentions and feelings while other-assessment stresses behavior. This psychic asymmetry seems anchored in sympathy while empathy appears more balanced. In the same scene regarding the Vietnamese War, a second police officer entered the house of the citizen, spotted a picture on the wall, began to talk about it, and engaged the man in conversation about the objects that both perceived. Out of this conversation developed information about the family and the son who had been reported killed, without the police officer ever establishing a basis of personal similarity with the man or with the dead son. The officer did respond to the emotions of the citizen but did not use his own emotional identity to guide his responses. This is empathy. The Japanese are known for it; an everyday example from Japan serves to illustrate it:

K. was speaking with her friend but also listening to the conversation between her husband and the foreign guest in an adjoining room. After an hour or so she noticed that the speech of the guest slowed and his voice became a little husky. She remembered that they had talked late into the night after a hard day's journey and another leg of the journey would begin in a few hours. In a few minutes K. left her companion, walked into the adjoining room and spoke with her husband in Japanese. He translated to the guest that his wife had said that his (the guest's) conversation now revealed that he was tired and that she would serve refreshments.

The two interfaces, sympathy and empathy, may be approached from another direction and described in relation to defense mechanisms. Sympathy, encircling personal responses and emotions, is part of the domain of introjection. The outward movement of empathy, in which the person engages the emotions of the other, clearly brings the interface close to the mechanism of projection. The distinctions between the two concepts seem to match, so that we can refer to sympathetic introjection and empathic projection. The important question for counseling and communication posed by the matching concepts is whether sympathy goes along with projection and empathy with introjection. The choice in American society seems to have been made both for introjection and sympathy.

Perhaps it is rash to propose sympathy as the interface Americans prefer when it is empathy that has attained a nominal status. Whichever the case, Americans create a sense of understanding and of intimacy with others when they refer to a common experience in the past, as Mead (1964) has pointed out. They search for a place visited in common. They search their lives for people they have known and they examine shared experiences. They identify similar roles in sympathy. For persons who develop interfaces of empathy, however, there is a shared domain but there is no intent or desire to share identities in either time or space or to integrate roles. The sympathetic or empathetic interface exhibited by a person can be seen as an extension of the self-concept, which probably governs the kind of interface that the person habitually employs in social exchanges. in American society, the confusion between sympathy and empathy can be explained as a confusion between acts and understanding and can also be associated with the dominant concept of the self which has prevailed in the society.

The dominant pattern of the American self-perception lacks clearly recognized structures of values and beliefs (McClelland, Sturr, Knapp, & Wendt, 1958). There are motivating needs and required responses, but the self is known by actions and by fears of dependence, a core value called self-reliance (Hsu, 1972). Each individual should be his own master, control his own destiny, and attribute his successes and failures in society to his own efforts (Hsu, 1972). As a general rule, individualism prevents Americans from forming deep and abiding bonds with others. Typically Americans establish a general belongingness with other persons while retaining a private inner core of the self (Rogers, 1964), inaccessible and isolated in a subjective world from the "selves" of all other persons. Others are not usually given the same subjective existence so that the "self" is different from other selves in a sweeping subjective sense that cannot be matched by differences between any two "others." The American self is unique: it is the quantum of the culture (Stewart, 1971b). The meaning of identity derives from the individual's happening, his doings and attainments. Americans put little stress on the individual as a link between ancestors and progeny and give little thought to an individual's membership in family, clan, or some other collectivity. Aspects of the political, social, or economic orders likewise leave the self vacant and do not flesh it out. There is no reason for the existence of the American self other than in itself. Simone de Beauvoir remarked that Americans consider their existences as accidents (1964). Meaning and values are derived from an almost impersonal affiliation in social groups. The only bond for persons whose real selves are inarticulate and inaccessible-since there is no reason or "cause" for them-is a common purpose or goal in action, in groupings that accommodate persons on the basis of needs which are seen as universal.

The reluctance of Americans to perceive themselves as members of a category or a class has been often noted. It is reflected in the lack of ideology in political parties, relative disengagement from philosophies, and constant stress on performance. Pragmatism replaces abstractions, theories, and even a priori values as criteria for choice and decisions. The high value placed on concepts of decision, choice, and preference in American society suggests that the favored terms employed to describe personality ideals have the effect of severing the individual from the group.

It is doubtful that the self exists as an empirical phenomenon completely separate from attitudes, values, or other psychological constructs. At the same time the subjective feeling of a self exists as an empirical phenomenon, although it is often taken for granted (Epstein, 1973, p. 405). These aspects of self-perception have led to the view that the self is a theory held by the individual about himself, even though he may not necessarily be aware of the significant features in his own self theory (Epstein, 1973). The individual also holds theories about the nature of the world, the nature of the self, and the interaction between the two. These are subjects that have been treated as aspects of the culture of the individual (Stewart, 1971 a) and that open up the area of cultural differences in personal theories about the self.

The undifferentiated notions of American identity, dependent on social norms for direction, help to explain the confusion of empathy and sympathy while still maintaining the label empathy as a historical relic. The tendency among Americans is to insist on their own individual feelings, choices, and preferences and to use their evocation to establish a bond, i.e., a similarity basis, with another person. Thus the distinctions between the two interfaces seem appropriate. Sympathy has been the ideal of conventional wisdom in American society, while empathy is the necessary interface in intensive interactions of intercultural communication.
-Counseling Across Cultures, Paul Pedersen, Juris Draguns, Walter Lonner, and Joseph Trimble (eds.), The East-West Center: Hawaii, 1981

Personal Reflection Exercise #10
The preceding section contained information about the interface between counselor and client. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Assessing the Implementation of an LGBTQ+ Mental Health
Services Training Program to Determine Feasibility and
Acceptability During the COVID-19 Pandemic

Fish, J. N., King-Marshall, E. C., Turpin, R. E., Aparicio, E. M., & Boekeloo, B. O. (2023). Assessing the Implementation of an LGBTQ+ Mental Health Services Training Program to Determine Feasibility and Acceptability During the COVID-19 Pandemic. Prevention science : the official journal of the Society for Prevention Research, 1–15. Advance online publication. https://doi.org/10.1007/s11121-023-01505-5


Peer-Reviewed Journal Article References:
Ellis, A. E., Meade, N. G., & Brown, L. S. (2020). Evidence-based relationship variables when working with affectional and gender minority clients: A systematic review. Practice Innovations, 5(3), 202–217.

Kangos, K. A., & Pieterse, A. L. (2021). Examining how lesbian, gay, and bisexual Christian clients’ perceptions of therapists’ cultural humility contribute to psychotherapy outcomes. Psychotherapy, 58(2), 254–262.

Levenson, J. S., Craig, S. L., & Austin, A. (2021). Trauma-informed and affirmative mental health practices with LGBTQ+ clients. Psychological Services. Advance online publication.

QUESTION 24
What is a key factor in using empathy with LBGTQ clients? To select and enter your answer go to Test.

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