The art of empathic confrontation and boundary setting is one of the most important skills of the schema therapist. Empathic confrontation supports the therapeutic process of patients who avoid their own emotional experiences, display a passive-aggressive attitude, as well as express open hostility or a dismissive attitude.
Find out what empathic confrontation is, what are the steps of empathic confrontation, and how can it help in your daily psychotherapeutic work?
Schema therapy – authenticity and empathy of the therapist
In order to confront patients with different elements of their functioning, it is necessary to take care to build an authentic and safe relationship, throughout the psychotherapy process.
Empathy fosters safety in the therapeutic relationship and reduces the frequency of defensive reactions in the client. When the therapist is confrontational, the empathic introduction of the message weakens the impulse to defend or counterattack.
Empathy is not kindness or sympathy. Showing empathy requires understanding the other person; the client’s thoughts, experiences, coping styles and unique life story.
A therapist’s authentic attitude, on the other hand, expresses consistency, in what he or she says and does. The therapist should express his or her thoughts and feelings in a direct and truthful manner. Our clients are very sensitive to falseness and signs of insincerity and when words do not coincide with our actions. Schema therapy and its basic tenets emphasize authenticity and empathy as important healing factors.
Empathic confrontation and healthy boundary setting
During therapeutic processes, we have experience working with clients who try to distract themselves from deeper work involving emotions, e.g. long and detailed storytelling or excessive intellectualization. Another group of clients (especially those with narcissistic traits) may avoid painful emotional material and the risk of revealing vulnerability, through passive-assertive behavior, e.g., being chronically late for sessions or canceling sessions at the last minute. As well as, through active outbursts of anger and criticism when asked to do homework or follow other rules of the process.
In such situations, it is useful to use empathic communication. Empathy when using confrontation affects the reception of the message and the maintenance of the covenant. However, what is key is the follow-up part of the message, which shows the client’s difficult, often maladaptive coping strategies. Coping strategies or coping modes in many cases protect the client from the lack of realized needs, however, they often have a number of negative consequences in his adult life, e.g. loneliness, feeling hurt, feeling controlled or left out, etc.
What is empathic confrontation?
Empathic confrontation is an interaction used in schema therapy. The term “confrontation” can be misleading, as it does not mean being confrontational or aggressive with the client. Empathic confrontation is a corrective response by the therapist, used to point out to the client their maladaptive ways of coping. This type of message is uttered when the client is in an maladaptive coping mode.
The therapist uses empathic confrontation to help the client see the connection between his or her behavior and past experiences, and to support the client in identifying alternative ways of responding. The goal of empathic confrontation is to help the client recognize how his or her strategies affect his or her life and relationships, while providing support and validation of his or her experiences.
The therapist highlights problematic behaviors emerging in the coping mode, in terms of how they are not currently meeting the client’s needs. For example, pushing people away through attacking behaviors that prevent the contact and closeness he needs.
Examples of empathic confrontation
Suppose a client with a pattern of abandonment avoids close relationships for fear of being abandoned. During therapy meetings, he tends to rationalize his position, with little contact with his emotional side. In this case, the therapist may use empathic confrontation to help the client recognize the impact of this avoidance on his life and relationships. The therapist might say, “I see how difficult it is for you to trust others and let people get close to you. However, I also see how this avoidance keeps you isolated and prevents you from experiencing the love and connection you desire.” Tell us what you think about this, do you notice these kinds of tendencies in yourself?
Another example of a therapist’s message to a client who has a pattern of defectiveness and uses a compensatory strategy such as criticism towards the therapist.
“I know that your intention is not to hurt others. I know how many wrongs you have experienced and often your only defense and protection was to counterattack, but today your words make me feel further away from you and harder to empathize. I think these kinds of comments can hurt the interlocutor and make them defensive towards you. What do you think about this?
The most important steps of empathetic confrontation
The therapist’s empathy is used to express an understanding of the causes of maladaptive behavior, based on early experiences. At the same time, pointing out how these patterns are self-destructive and block the satisfaction of the client’s needs in the present. Finally, the therapist suggests a specific alternative behavior that is more likely to help the client meet his or her needs.
We can present the empathic confrontation in the following steps
- The therapist names the behavior to be curtailed.
- He formulates a personal concern for the client.
- Relates the client’s behavior to the appropriate coping mode or parenting mode.
- Determination of modes including the conditions of its emergence, positive function e.g. protective
- Identification of the negative consequences of the mode occurring in the current therapeutic situation, e.g. “If you violate my boundaries, I start to withdraw and empathize less with you.”
- The patient is asked if he/she also knows of other situations in which a certain mode occurs.
- Talking about the negative, long-term consequences.
- Normalization of the client’s experiences, emphasizing concern for Child Mode. The therapist assures the patient that he does not want to (e.g., punish, abandon) him, but expresses concern that such behavior may bring relief to the patient in the short run, but will be problematic in the long run.
- The therapist challenges the patient. Define again rules, boundaries, a common agreement. If necessary, announce specific consequences to minimize certain behaviors.
The patient’s aggressive behavior
Remember that not every empathic confrontation needs to be filled with a great deal of empathy, especially when the patient oversteps boundaries, has aggressive statements or behaviors that make the therapist feel threatened.
Sometimes the boundary should be set directly and unequivocally “I know that threatening me may not have been your intention, but I don’t feel comfortable with this and this behavior is unacceptable to me. We both have the same rights. Your words violate my right to feel safe and respected.” I suggest you take a, momentary break and breathe more deeply.”
When assertive messages don’t work and transgressing behavior continues, set gradual, increasingly serious consequences with the patient, e.g., ending the meeting early or eventually, terminating the process.
Pros of empathetic confrontation
- Building a safe relationship, while respecting the boundaries of both parties.
- Increasing the client’s self-awareness and reflection on their own relationship mechanisms.
- Experience of cooperation.
- Reducing tensions and conflicts.
- Improving communication.
- Developing problem-solving skills.
- Increasing relationship satisfaction.
Basic tips for the therapist
- Be in touch with your boundaries during therapy work.
- Take care to be in Healthy Adult mode during therapy. Solidify and cohere the sensitive part.
- Do a conceptualization of the patient, name their coping strategies.
- Use your authenticity in the relationship.
- Try to understand the patient’s coping mechanisms and their sources.
- Remember that the client’s sensitive child exists, although it may often be invisible behind a wall of defenses and protections.
Empathic confrontation helps the therapist and client maintain the therapeutic alliance. It is a technique that fosters a distinction between past and present experiences. It allows naming the coping strategy, its function, its source of origin and its present consequences.
Through empathic confrontation, we are able to get in touch with our clients, with their past wounds, the shame behind the barricaded coping strategies.
Bibliography:
Jacob Gitta Arnoud Arntz, Schema Therapy in Practice. Working with schema modes
Gillian Heath , Helen Startup. CREATIVE METHODS IN SCHEMA THERAPY. Innovations in clinical practice. GWP 2023
Michiel van Vreeswijk , Jenny Broersen , Marjon Nadort, Wiley-Blackwell Handbook of Schema Therapy: Theory, Research and Practice, Wiley-Blackwell 2012
Eckhard Roediger, Bruce A. Stevens, Contextual Schema Therapy: An Integrative Approach to Personality Disorders, Emotional Dysregulation, and Interpersonal Functioning, Context Press 2018
https://psycnet.apa.org/record/2020-17548-017