Another reason to go with a client-centered therapist, including for a substance abuse disorder:
Is Low Therapist Empathy Toxic? (2013)
One of the largest determinants of client outcomes is the counselor who provides treatment. Therapists often vary widely in effectiveness, even when delivering standardized manual-guided treatment. In particular, the therapeutic skill of accurate empathy originally described by Carl Rogers has been found to account for a meaningful proportion of variance in therapeutic alliance and in addiction treatment outcomes. High-empathy counselors appear to have higher success rates regardless of theoretical orientation. Low-empathy and confrontational counseling, in contrast, has been associated with higher drop-out and relapse rates, weaker therapeutic alliance and less client change. The authors propose emphasis on empathic listening skills as an evidence-based practice in the hiring and training of counselors to improve outcomes and prevent harm in addiction treatment...
From the evidence to date, it appears that empathy is a reliable predictor of counselors’ success in treating at least alcohol use disorders. In fact, empathy may exert a larger effect in addiction treatment than has been generally true in psychotherapy, accounting in some studies for a majority of variance in client outcomes (e.g., Miller et al., 1993; Valle, 1981). Najavits and Weiss (1994) observed that in addiction treatment, outcome differences among therapists may be larger than those in psychotherapy more generally. Why would this be so? One possibility is that historically in American addiction treatment, low-empathy confrontational counseling has not only been an acceptable therapeutic style, but has at times been lauded as essential (Janzen, 2001). Tactics such as shaming and demeaning, head-shaving, sarcasm, shouting insults in a client’s face, and “attack therapy” (Yablonsky, 1965), all of which were once regarded as acceptable if not essential in addiction treatment, would be unusual if not outright malpractice in the treatment of virtually any other mental disorder. Use of such practices continues, though no longer representative of addiction treatment, and this legacy has probably contributed to broader variance in provider empathy in this field than would be true in behavioral health more generally. Whenever the range of a variable is restricted its predictive power tends to be diminished. For example, whereas Graduate Record Examination (GRE) scores do predict the ability of applicants to function in post-graduate training (Kunzel & Hezlett, 2007), they are less powerful in predicting grades once students have been admitted to graduate school and the range of GRE scores is compressed. If empathy is an important determinant of treatment outcomes and if addiction treatment providers manifest a wider range of empathic skills relative to psychotherapists, then empathy would be expected to be a more robust predictor of outcomes in addiction treatment than in psychotherapy more generally, precisely because of the presence of more low-empathy counselors.
Outlier therapists with outstandingly poor client outcomes are often found in addiction treatment studies (Luborsky et al., 1985; McLellan et al., 1988; Miller et al., 1980; Project MATCH Research Group, 1998; Valle, 1981). Available evidence links implicates low empathic skill as a marker of this outlier status (Miller et al., 1980; Valle, 1981). From the ethical minimum of “First, do no harm,” it is reasonable to screen for and teach accurate empathy as a key therapeutic skill regardless of theoretical orientation (Norcross & Wampold, 2011). We know of no therapeutic approach where low empathy has been linked to better outcomes in any area of health care. It is both possible and ethically sensible to screen potential providers of addiction treatment services for skillfulness in accurate empathy as an important general factor impacting client outcomes. Of “evidence-based practices” currently being promoted, this seems to us to be one of the most promising to improve outcomes and prevent harm in addiction treatment. In contrast to the notion that empathy represents error variance or that it is unscientific to explore its impact on client improvement, it is our contention that empathy represents a critical component of successful treatment that merits both scientific investigation and greater emphasis in treatment endeavors.
Is Low Therapist Empathy Toxic? (2013)
One of the largest determinants of client outcomes is the counselor who provides treatment. Therapists often vary widely in effectiveness, even when delivering standardized manual-guided treatment. In particular, the therapeutic skill of accurate empathy originally described by Carl Rogers has been found to account for a meaningful proportion of variance in therapeutic alliance and in addiction treatment outcomes. High-empathy counselors appear to have higher success rates regardless of theoretical orientation. Low-empathy and confrontational counseling, in contrast, has been associated with higher drop-out and relapse rates, weaker therapeutic alliance and less client change. The authors propose emphasis on empathic listening skills as an evidence-based practice in the hiring and training of counselors to improve outcomes and prevent harm in addiction treatment...
From the evidence to date, it appears that empathy is a reliable predictor of counselors’ success in treating at least alcohol use disorders. In fact, empathy may exert a larger effect in addiction treatment than has been generally true in psychotherapy, accounting in some studies for a majority of variance in client outcomes (e.g., Miller et al., 1993; Valle, 1981). Najavits and Weiss (1994) observed that in addiction treatment, outcome differences among therapists may be larger than those in psychotherapy more generally. Why would this be so? One possibility is that historically in American addiction treatment, low-empathy confrontational counseling has not only been an acceptable therapeutic style, but has at times been lauded as essential (Janzen, 2001). Tactics such as shaming and demeaning, head-shaving, sarcasm, shouting insults in a client’s face, and “attack therapy” (Yablonsky, 1965), all of which were once regarded as acceptable if not essential in addiction treatment, would be unusual if not outright malpractice in the treatment of virtually any other mental disorder. Use of such practices continues, though no longer representative of addiction treatment, and this legacy has probably contributed to broader variance in provider empathy in this field than would be true in behavioral health more generally. Whenever the range of a variable is restricted its predictive power tends to be diminished. For example, whereas Graduate Record Examination (GRE) scores do predict the ability of applicants to function in post-graduate training (Kunzel & Hezlett, 2007), they are less powerful in predicting grades once students have been admitted to graduate school and the range of GRE scores is compressed. If empathy is an important determinant of treatment outcomes and if addiction treatment providers manifest a wider range of empathic skills relative to psychotherapists, then empathy would be expected to be a more robust predictor of outcomes in addiction treatment than in psychotherapy more generally, precisely because of the presence of more low-empathy counselors.
Outlier therapists with outstandingly poor client outcomes are often found in addiction treatment studies (Luborsky et al., 1985; McLellan et al., 1988; Miller et al., 1980; Project MATCH Research Group, 1998; Valle, 1981). Available evidence links implicates low empathic skill as a marker of this outlier status (Miller et al., 1980; Valle, 1981). From the ethical minimum of “First, do no harm,” it is reasonable to screen for and teach accurate empathy as a key therapeutic skill regardless of theoretical orientation (Norcross & Wampold, 2011). We know of no therapeutic approach where low empathy has been linked to better outcomes in any area of health care. It is both possible and ethically sensible to screen potential providers of addiction treatment services for skillfulness in accurate empathy as an important general factor impacting client outcomes. Of “evidence-based practices” currently being promoted, this seems to us to be one of the most promising to improve outcomes and prevent harm in addiction treatment. In contrast to the notion that empathy represents error variance or that it is unscientific to explore its impact on client improvement, it is our contention that empathy represents a critical component of successful treatment that merits both scientific investigation and greater emphasis in treatment endeavors.
