Empathic reflection

Robert Elliott, Art Bohart, Dale Larson, Peter Muntigl, Olga Smoliak

Research output: Chapter in Book/Report/Conference proceedingChapter


Therapist empathic reflections are used to communicate understanding of client communications and experiences. Originally associated with person-centered and experiential psychotherapies, they have been adopted by psychotherapists from a range of approaches. We begin with definitions and subtypes of empathic reflection, drawing on relevant research and theory, including conversation analysis. We distinguish between the response mode empathic reflection, reviewed here, and the relational quality of empathy (reviewed in previous meta-analyses). We look at how empathic reflections are assessed and present examples of successful and unsuccessful empathic reflections, also providing a framework of the different criteria used to assess their effectiveness. In our meta-analysis of 43 samples, we found virtually no relation between empathic reflection and effectiveness, both overall and separately for each of six effectiveness criteria. Although not statistically significant, we did find weak support for reflections of change talk and summary reflections. We hypothesize that good and poor reflections routinely cancel each other within studies, indicating the need to look more carefully at the quality of empathy sequences in which empathic reflections are ideally calibrated in response to empathic opportunities offered by clients and sensitively adjusted in response to client confirmation/disconfirmation. We conclude with diversity considerations, research limitations, training implications, and therapeutic practices.
Original languageEnglish
Title of host publicationPsychotherapy Skills and Methods That Work
EditorsClara E. Hill, John C. Norcross
Place of PublicationOxford
PublisherOxford University Press
ISBN (Print)9780197611012
Publication statusPublished - 28 Sept 2023


  • empathic reflections
  • reflections
  • psychotherapy
  • psychotherapy process
  • psychotherapy outcome
  • meta-analysis
  • conversation analysis


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