The Therapist and the Tuna: Thoughts on Empathy and Limit Setting

Of the many reasons that people cite for getting into the field of counseling, it is rare, if not unheard of, to hear people say “I want to go into the field of counseling because I’ve always wanted to be a strong authority figure.” But at Academy MetroWest, that’s one of the primary goals we have when we begin training interns or new staff members. Without the ability to present yourself as being in charge, you are not likely to be a particularly effective counselor on our staff.

Our groups look very little like the stereotypical view people have of group therapy. Personally, I formed my initial perceptions of group therapy by watching Bob Newhart and his amusingly quirky group members discuss their issues and foibles on the eponymous sitcom in the 70’s. In our groups, instead of sharing our feelings in an office, we run around playing cooperative games in a gym and let those issues play out experientially.

Despite their different appearances and approaches, our groups have a lot in common with traditional group therapy. In both models, the primary mechanism for growth lies in the therapeutic relationship formed between counselor and client. The dynamics of this relationship were first spelled out by the psychologist Carl Rogers in his books On Becoming a Person, Client-Centered Therapy, and others. He identified factors such as empathic listening, unconditional positive regard, and congruence (or being genuine) as three of the critical ingredients necessary for therapeutic change. The idea is that as a client shares aspects of his or her life that are embarrassing, humiliating, or otherwise difficult to speak about, the therapist tries to understand their perspective and then reflect that understanding in a genuine, non-judgmental manner. In a successful therapeutic relationship, the client is in a position to say to him or herself “My therapist has heard some of the worst things about me but seems ok with me anyway. Maybe I can start going easier on myself too.”

Our approach to empathy is based upon the assumption that all kids are motivated to succeed and connect. Granted, that motivation is not immediately obvious in every child we see but after 30 years of running groups, I'm still convinced that, on some level, all kids share those goals. So, in order to help them get there, we strive to create conditions in which success and connection are as attainable as possible. In creating those conditions, setting firm, consistent limits can be the most empathic therapeutic response there is.

Helping some of our clients attain success within our setting can be an uphill battle. The presenting problem we encounter most frequently among our clients is ADHD, a condition that sometimes leads to problems in environments like our noisy gym. We ask our kids to place themselves in this challenging environment and attain success so thoroughly and consistently that they develop resilience and self-confidence. In essence, we tell them "Here you go, child with ADHD. Go run around in this loud, stimulating, distracting gym and, while you're doing that, make sure to manage your behavior, connect with other group members, regulate your emotions, and...oh yeah...have fun and success while you're at it."

The only way this expectation becomes realistic is through the imposition of a lot of structure into our proceedings. This is where that empathic conception of limit setting comes into play. When people hear the word 'empathy,' they tend to think of it as existing solely in a calm, patient, supportive world populated by people like Carl Rogers. I'm a big Carl Rogers fan. But go ahead and watch these videos. Then decide for yourself how well his approach would work with a gym-based group of hyperactive 10 year old boys.

I suspect it would not go well. In the first video, Rogers emphasizes the concept of 'congruence' or genuineness. It's a vital concept. But in the second video, Rogers shows his genuine self to be gentle, patient, and reassuring. Fine traits all of them. But I'm guessing his approach might change were he confronted with my hypothetical group of hyperactive boys.

The problem that Rogers would encounter were he to use that same approach with my hypothetical group is that it's just not an empathic way of responding to them. In his book Client Centered Therapy, Rogers writes "...it is the counselor's function to assume, in so far as he is able, the internal frame of reference of the client, to perceive the world as the client sees it, to perceive the client himself as he is seen by himself, to lay aside all perceptions from the external frame of reference while doing so, and to communicate something of this empathic understanding to the client." In our gym, he could do all the empathic perceiving he'd care to do but he'd have a hard time communicating it to the client using such a gentle delivery when the client in question is running around like a maniac. What he'd need is the same theoretical formulation but with a presentation that reflects his understanding of the containment those kids need in order to succeed. The group members would need to be able to attend fully enough to be able to set and follow an agenda. Without that, they'd never be in a position to reap the benefits from therapy. With so many stimuli competing for the kids’ attention, a truly empathic response would need to be more forceful and emphatic than the one Rogers demonstrates in the video.

"We got a rule here. They can say what they want to say but I can say what I want to say too. Very seldom does a player try to cross a line. There is a line. They know where it is."