Therapist empathy and client outcome: an updated meta-analysis

Robert Elliott, Arthur C. Bohart, Jeanne C. Watson, David Murphy

Research output: Contribution to journalArticlepeer-review

225 Citations (Scopus)
330 Downloads (Pure)


Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r-.28 (p .001; 95% confidence interval [.23, .33]; equivalent of d-.58) for 82 independent samples and 6,138 clients. In general, the empathy-outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy.

Original languageEnglish
Pages (from-to)399-410
Number of pages12
Issue number4
Publication statusPublished - 1 Dec 2018


  • empathy
  • meta-analysis
  • psychotherapy process-outcome research
  • psychotherapy relationship
  • therapist factors


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