What We’ve Said

What we’ve said about Empathy

14 points from 9 episodes, newest first

Also searched as empathic mirroring, mirroring

In short

Empathy in the room means showing the patient you understand their inner experience, simply and for real, and the most basic tools are the small moves that keep them talking. It also comes from recognizing in ourselves the states we see in patients, and a patient's own capacity for it is something we assess.

What it is

  1. Be real and simply perceive what is going on. If you can show a patient that you understand their internal experience and their past experiences, that is the empathy.

    “Be real. Simply perceive what's going on. And if you can demonstrate to a patient that you have an understanding of their internal experience and their past experiences, that's the important part. That's the empathy”
    17:42Detecting Subtle Signs of Psychosis: Assessment of Voices, Delusions, and PsychosisFeb 2026
  2. Containment is part of it. If you are not doing some containment, you are not really having a conversation so much as both talking at the same time.

    “If you're not doing some amount of containment, technically, you're not really having a conversation so much as you're both talking at the same time”
    45:11Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026
  3. Containment processes what the patient says and hands it back in a form they can hear. Mirroring shows the person that they have an individual self that is seen, important and recognized.

    “containment as more of processing and putting thoughts into a container and metabolizing thoughts in a way that they can kind of hear back and mirroring as a way to show that this person has an individual self that can be seen and is important and recognized”
    4:37Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026

Mirroring: keeping the patient talking

  1. The first level of intervention is anything that gets the patient to keep talking and continue their narrative without changing its trajectory or content.

    “I'm going to define it as getting the patient to talk more to continue their narrative without changing the trajectory or content of the narrative”
    1:57Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026
  2. Prompting people to keep going on one line of narrative often gets you a richer story and more information than asking specific questions.

    “you may find that you get a richer narrative or more information that you would not have gotten if you prompt people to continue talking on one line of thought one line of narrative rather than asking specific questions”
    8:47Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026
  3. Keep a wide variety of nonverbal acknowledgment sounds in your back pocket.

    “it's important for psychiatrists, clinicians, psychologists, therapists to have a wide variety of hmms and hmms in their You know, in their back pocket to try out nonverbal acknowledgement sounds very important, right”
    2:59Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026
  4. Name what you notice: "I can feel how sad you are touching on these memories again right now." Saying just that may keep the patient speaking.

    “You can say, you know, I can feel how sad you are touching on these memories again right now. Just by saying that, you may cause the patient to continue speaking”
    5:53Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026
  5. Punctuate: emphasize a particular word or turn of phrase the patient just used. You add no new content, only highlight something they said.

    “You basically punctuate by basically emphasizing some particular word or turn of phrase that someone has just said to you. Okay. You're not introducing new content, but you're just sort of highlighting something that they've said”
    6:39Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, InterpretationJun 2026

With delusions

  1. Do not argue with the delusions, and do not agree with them either. Living in the patient's world is not the same as agreeing with it.

    “Don't argue with the delusions, but also don't agree with the delusions. Right. You have to keep in mind that when you live in the world of the patient, you're not. agreeing with the delusions necessarily”
    14:37Detecting Subtle Signs of Psychosis: Assessment of Voices, Delusions, and PsychosisFeb 2026

Assessing a patient's empathy

  1. Notice whether the patient can automatically access and describe other people's reactions and motivations, or mostly tells it as other people doing things to them.

    “Do they seem to be able to automatically access and describe the reactions and internal motivations of other people? Or do they mostly conceptualize things outside themselves? Like all these other people are doing things to me”
    34:34Assessment of Personality: Practical Assessment in a Short TimeframeMay 2025
  2. When someone's micro-expressions do not match the other person's in conversation, it reflects some breakdown in rapidly comprehending what the other person is feeling.

    “when a person doesn't have the micro expressions that match another person during a conversation, it's some kind of a breakdown of the ability of that person to fully and very rapidly comprehend what is going on in the other person emotionally”
    14:41You Can See Everything Psychological Analysis by Clinical & Forensic PsychiatristsOct 2026
  3. Apparent kindness is not always empathy. In psychopathy it may come not from a moral core that has weighed other people's reactions but from what is easy and pleasurable in the moment.

    “It's not because he has some kind of a strong moral core where he has deliberated and felt about other people's reactions. It's because it seems to be easy and doable and pleasurable in the moment that he does it”
    The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026

Empathy for the patient

  1. Making personality pathology about us versus them misses that all of it is part of ourselves, and discrete categories blind us to the ways any of us could go mad. The best writers on personality find in themselves the pieces they see in others.

    “When we make this stuff about us versus them, we really miss that all these aspects are a part of ourselves. The best writers in regards to understanding personality are the ones who can find the pieces inside of them that are in the other people”
    1:04:07The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026
    Also said in 1 more episode
    “I think these discrete categories blind us to the ways in which we all have the And we could all go mad in one way or another”
    32:00Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid PersonalityNov 2024Guest episode
  2. We all operate at different levels of functioning. Be honest and you will see the times you have regressed yourself; breakups are a big one.

    “We all have the ability to operate at different levels of functioning. And if you are honest with yourself, you'll see that there's a ton of times in your lives that you regress. During breakups, that's a big one”
    22:03What Psychiatrists Get Wrong About Personality DisordersOct 2024

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From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.