Empathy Regulation in Clinical Science: Regulating the Therapeutic Emotional Circuit

Is a more empathic therapist more effective? Classic models in clinical science rightfully describe empathy as an important therapeutic tool, but emerging evidence indicates that it can interfere with therapeutic goals in some settings. Here, we provide a contemporary framework that addresses this tension. We propose a model in which empathy and emotion regulation combine to create a “therapeutic emotional circuit” in which emotions flow from therapist to client and back to the therapist again via empathy. Critically, therapists can use empathy regulation to modulate this emotional flow to achieve specific goals for both their own and their clients’ emotional experiences. We then illustrate how optimal empathy regulation diverges across two empirically supported interventions: To best support clients, exposure therapy requires down-regulating affect sharing, whereas motivational interviewing requires up-regulating this empathic process. This model challenges classic intuition, revealing new directions for clinical research, training, and practice.