Is low therapist empathy toxic?

Psychol Addict Behav. 2013 Sep;27(3):878-84. doi: 10.1037/a0030274. Epub 2012 Oct 1.


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.

MeSH terms

  • Counseling / education
  • Counseling / methods*
  • Empathy*
  • Humans
  • Professional-Patient Relations*
  • Psychotherapeutic Processes*
  • Substance-Related Disorders / therapy*
  • Treatment Outcome