Empathy in Hypnotherapy: Beyond Feeling, Toward an Interactive Skill

If empathy is exhausting you, it’s not empathy that’s the issue. It’s the version you were taught.

Recently, I watched an experienced therapist declare, quite proudly, that they no longer “do” empathy. Several practitioners piled in with relief and validation. Some said empathy had nearly destroyed their practice. Others admitted they’d been drowning in other people’s pain for years, questioning whether they were even suited for this work.

I get it. I really do.

But here’s what troubles me: when therapists abandon empathy wholesale, they’re usually working from a definition of empathy that guarantees exhaustion. They've been told empathy means absorption — that to understand someone, you must in some way become like them. That “good therapists feel what their clients feel.”

No wonder so many burn out.

So before we throw away one of the most profoundly human capacities we have, we need to get clear on what empathy is, and what it isn’t.

The Lie That Burns Therapists Out

Ask most people what empathy means, and they’ll say some version of:
“It’s feeling what someone else feels.”

This one line has silently harmed an entire generation of therapists.

Because it leads to a brutal internal logic:

• If my client is grieving, I must grieve.

• If they’re terrified, I must feel their terror.

• If they’re drowning, I must drown too.

And so therapists absorb session after session. They carry emotional residue into the evening. They lie awake replaying trauma that isn’t theirs. They start wondering if they’re “too sensitive” for this profession.

Others cope by shutting down. They go flat and distant. Clients seeking connection sense it instantly.

Both patterns come from the same misunderstanding.

The Three Types of Empathy 

Modern social neuroscience has been crystal clear about this for two decades (Decety & Jackson, 2004; Eisenberg & Eggum, 2009).

There are three distinct types of empathy — and most therapists have only ever been taught the one that burns them out.

1. Affective Empathy

The fast, automatic resonance

This is the kind of empathy everyone thinks of first. It’s quick, embodied, involuntary. You see someone cry and your chest tightens. You hear panic in their voice and your breathing shifts.

This resonance isn’t a choice. It is automatic, it’s a biological survival mechanism rooted in evolution (Dondi et al., 1999; Leppänen & Nelson, 2009).

But here’s the crucial part:

Feeling it is not the same as keeping it.

Affective resonance spikes quickly, but healthy therapists regulate it quickly too. When practitioners say, “I don’t feel empathy anymore,” what they often mean is:

“I don’t stay stuck in affective resonance.”

That isn’t coldness.
That’s regulation.
That’s skill.

Unregulated affective empathy is what leads to empathic distress, which is one pathway to burnout (Hodges & Klein, 2001; Figley, 1995).

Affective empathy is natural, and it provides useful information.
It is not meant to be carried.

2. Cognitive Empathy

Understanding without drowning

Cognitive empathy is perspective-taking. It is the ability to understand what someone feels and why they feel it, without needing to feel it yourself.

This is the empathy therapists should be using most of the time. It utilises the regions of the brain responsible for mentalising and perspective-taking (Brunet et al., 2000; Moriguchi et al., 2007; Sabbagh et al., 2009).

It feels like:

• curiosity

• clarity

• psychological space

• “Ah! I see why you responded that way.”

But cognitive empathy has a trap: if you lean on it alone, you become analytical, distant, overconfident in your interpretations.

Cognitive empathy gives you a map.
But a map isn’t the terrain.

3. Interactive Empathy

Where transformation actually happens

This is the empathy hardly one teaches explicitly.
And it’s the one that actually facilitates change.

Interactive empathy isn’t a state inside you. It’s a process taking place between you and the client.

It’s empathy as feedback loop:

1. You offer your best understanding.

2. The client confirms, corrects, or refines it.

3. You adjust.

4. They deepen.

5. A more accurate shared reality emerges.

This is what Carl Rogers called “accurate empathy” (Rogers, 1957).
It is the foundation of co-regulation and mutual understanding (Siegel, 2012).

It involves a therapist truly sensing and understanding a client's inner world from their perspective, as if they were the client, but without losing their own sense of self. Even more importantly it is about trying to accurately perceiving and communicating the client's feelings and experiences back to them, and it is considered one of the core conditions for a therapeutic relationship.

And it looks like magic in the room.

Example:

Therapist: “It sounds like the hardest part wasn’t the event, but the sense of powerlessness.”
Client: “No, not powerless. The unfairness.”
Therapist: “Ah! So it was about injustice, not helplessness.”
Client: “Yes.” (Shoulders soften. Breathing deepens. A shift begins.)

That tiny correction, that moment of clarity emerging, is the beginning of therapeutic change.

Not because of a technique.
Because of attuned interaction.

Why Empathy Matters More Than Your Techniques

Decades of psychotherapy research show the same thing:
the therapeutic relationship predicts outcomes more reliably than method (Elliott et al., 2011; Norcross & Lambert, 2018).

Empathy is the engine of that relationship. It creates:

• safety

• honesty

• attunement

• motivation

• responsiveness to hypnosis

Without empathy, technique becomes mechanical, like a script anyone could read.
With empathy, even simple suggestions reshape lived experience.

This is why your presence matters more than your protocol.

The Missing Piece: Compassion

Some therapists say, “I don’t do empathy. I do compassion.”

But the science is clearer:

Empathy gives you information.

Compassion gives you regulation.

Empathy tunes you into a client’s emotional world.
Compassion keeps you steady while you navigate it.

Empathic distress activates pain and threat circuits.
Compassion activates caregiving and reward circuits (Goetz, Keltner & Simon-Thomas, 2010; Klimecki et al., 2013).

Compassion doesn’t drain you.
It energises you.

It is the antidote to burnout the field has been looking for.

Empathy Is A Dance: Synchrony and Rapport

Sometimes you meet with a client and the session simply clicks.
The room feels different.
Change feels inevitable.

There’s a reason for that.

Research shows that in states of empathic attunement, therapist and client physiology often aligns, heart rate, skin conductance, micro-movements (Marci & Orr, 2006; Koole & Tschacher, 2016).

This synchrony isn’t mystical.
It’s regulation.

Your nervous system sets the tone.
Theirs follows.

This is empathy acting as a silent somatic suggestion.

Practical Empathy (That Won’t Destroy You)

Before each session:
Ground for 60–90 seconds. Breath, posture, presence.

During the session:

• Lead with curiosity.

• Offer tentative reflections (as hypotheses, not facts).

• Welcome correction, it is the process. It's OK to not quite get it.

• Mirror lightly (never mirror distress).

Between sessions:
Reset your physiology. Breathwork, movement, or brief self-hypnosis.

Throughout the day:
Choose compassion over absorption.
Boundaries over merger.
Presence over contagion.

Addressing the Fears

“If I empathise, I’ll drown.”
Only if you confuse empathy with emotional fusion.

“Isn’t empathy what causes burnout?”
Unregulated affective empathy does.
Balanced empathy prevents it (Figley, 1995; Eisenberg & Eggum, 2009).

“What if I’m just not naturally empathetic?”
Empathy is trainable, especially cognitive and interactive empathy (Klimecki et al., 2013).

From Empathy to Insight to Change

The purpose of empathy isn’t to share suffering.
It’s to illuminate experience.

When you offer a precise reflection and your client says, “Yes — exactly that,” or “No, not exactly,” something reorganizes inside them.

Clarity precedes change.
Every time.

Interactive empathy creates the conditions for that clarity to emerge.

Empathy Reimagined

Empathy properly understood is not what burns therapists out.
It’s what keeps us alive in this work.

• Affective empathy gives warmth.

• Cognitive empathy gives clarity.

• Interactive empathy creates change.

• Compassion keeps you steady.

Empathy becomes dangerous only when it collapses into emotional fusion.
Empathy becomes transformative when it becomes a calibrated, co-created process.

Now you know. Empathy is not simply weight for you to carry. It’s the bridge that you will build together, that carries both you and your client somewhere new.

References

• Bohart, A. C., & Greenberg, L. S. (Eds.). (1997). Empathy Reconsidered: New Directions in Psychotherapy. American Psychological Association.

• Brunet, E., Sarfati, Y., Hardy-Baylé, M. C., & Decety, J. (2000). A PET investigation of the attribution of intentions with a nonverbal task. NeuroImage, 11(2), 157–166.  ​

• Dondi, M., Simion, F., & Caltran, G. (1999). Can newborns discriminate between their own cry and the cry of another newborn infant? Developmental Psychology, 35(2), 418-426.

• Eisenberg, N., & Eggum, N. D. (2009). Empathic responding: Sympathy and personal distress. In J. Decety & W. Ickes (Eds.), The Social Neuroscience of Empathy (pp. 71-83). MIT Press.

• Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48(1), 43-49.  ​

• Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Brunner/Mazel.

• Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: An evolutionary analysis and empirical review. Psychological Bulletin, 136(3), 351-374.

• Klimecki, O. M., Leiberg, S., Ricard, M., & Singer, T. (2013). Differential pattern of functional brain plasticity after compassion and empathy training. Social Cognitive and Affective Neuroscience, 8(8), 873–879.

• Koole, S. L., & Tschacher, W. (2016). Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance. Frontiers in Psychology, 7, 862.

• Leppänen, J. M., & Nelson, C. A. (2009). Tuning the developing brain to social signals of emotions. Nature Reviews Neuroscience, 10(1), 37-47.

• Marci, C. D., & Orr, S. P. (2006). The effect of emotional distance on psychophysiologic concordance and perceived empathy between patient and interviewer. Applied Psychophysiology and Biofeedback, 31(2), 115-128.

• Moriguchi, Y., Ohnishi, T., Lane, R. D., Maeda, M., Mori, T., Nemoto, K., Matsuda, H., & Komaki, G. (2007). Impaired self-awareness and theory of mind: An fMRI study of mentalizing in alexithymia. NeuroImage, 32(3), 1472-1482.

• Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303–315.

• Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103.

• Sabbagh, M. A., Bowman, L. C., Evraire, L. E., & Ito, J. M. B. (2009). Neurodevelopment of Theory of Mind and Neural Processing of Emotion in Infancy and Early Childhood. In Decety, J., & Ickes, W. (Eds.), The Social Neuroscience of Empathy (pp. 71–83). MIT Press.

• Siegel, D. J. (2012). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (2nd ed.). Guilford Press.