Ariel Cook

Empathy Misses and How to Be There for Someone Suffering: A Therapeutic Guide
Empathy is foundational to therapeutic work. Brené Brown identifies common empathy misses, patterns of response that interrupt connection and unintentionally cause harm (Brown, 2021). This guide synthesizes Brown’s framework with contemporary research from clinical psychology, social neuroscience, trauma-informed practice, and counseling science. The goal is practical: to help clinicians, trainees, and caregivers notice empathy misses and replace them with attuned, evidence-based responses that support regulation, insight, and healing.

What is an empathy miss
An empathy miss is a response motivated by discomfort, fear, or the need to fix, which ends up invalidating, blaming, minimizing, or redirecting the suffering person. Brown highlights eight common empathy misses: sympathy versus empathy, judgment, disappointment, discharging discomfort with blame, minimizing or avoiding, comparing or competing, speaking truth to power without empathy, and unsolicited advice or problem solving (Brown, 2021). Each of these responses can be understood through clinical theories about validation, attachment, and the neurobiology of social engagement.

Sympathy versus empathy
Sympathy expresses concern at a distance, whereas empathy involves perspective taking, affective resonance, and compassionate action (Brown, 2021). Social neuroscience shows that empathy engages mirror and mentalizing networks, facilitating shared affect and understanding (Decety & Lamm, 2006). In therapy, reflective listening and affect labeling promote neural convergence and reportably reduce distress, enabling clients to process painful material rather than shut down (Lieberman et al., 2007). Clinicians should prioritize naming emotion and experience rather than expressing pity, for example, saying, “That sounds devastating, and I am here with you” rather than “I am so sorry for you.”

Judgment
Judgment undermines the core therapeutic conditions described by Carl Rogers: unconditional positive regard, empathic understanding, and congruence (Rogers, 1957). When clinicians or loved ones judge, clients experience shame and concealment, which impede treatment progress (Tangney & Dearing, 2002). Therapists can practice cognitive defusion techniques, noticing judgmental thoughts and returning to a curious, exploratory stance. Supervision and reflective practice help providers become aware of countertransference that fuels judgment.

Disappointment and moralizing responses
Responders sometimes silently register disappointment in the person’s choices, conveying implicit moral standards that evoke shame. Research on self-compassion indicates that shame-based responses reduce motivation and increase avoidance, whereas compassionate acceptance fosters accountability and behavior change (Neff, 2011). In practice, clinicians can use compassionate language that balances accountability with warmth, for example, “I hear how hard that was, and I also wonder what you might want to try next.”

Discharging discomfort with blame
Blaming others for pain often reflects the helper’s need to alleviate their own unease. Attribution research shows that blaming supports psychological distance but corrodes trust (Weiner, 1995). Trauma-informed care explicitly warns against retraumatizing clients by shifting responsibility onto them (Substance Abuse and Mental Health Services Administration, 2014). When blame arises, clinicians should pause, regulate their own arousal, and orient questions toward context and meaning rather than fault finding.

Minimizing or avoiding
Minimization, including attempts to cheerlead or prematurely normalize suffering, blocks emotional processing. Linehan’s dialectical behavior therapy highlights the importance of validation in reducing emotional intensity and promoting safety (Linehan, 1993). Validation can be brief and behavioral; acknowledging the reality of distress provides a foundation for co-regulation. Simple statements like “That makes sense given what you experienced” are powerful regulatory tools.

Comparing or competing
Self-disclosure can be therapeutic when timed and used to build alliance, but premature comparison shifts focus away from the client and risks invalidation. Clinical empathy research indicates that reflective listening and patient-centered responses increase perceived provider empathy and adherence to treatment compared with provider-centered problem solving (Halpern, 2001; Riess et al., 2012). Therapists should ask permission before sharing personal stories and ensure any disclosure is used to illuminate the client’s experience, not the therapist’s.

Speaking truth to power without empathy
Holding people accountable matters, but punitive confrontation without understanding is often counterproductive. Nonviolent Communication offers a structured approach to name observations, feelings, and needs without blame, thereby increasing the chance of collaborative change (Rosenberg, 2003). In therapeutic settings, timing and containment are critical; empathy first, confrontation later when the client has had space to feel understood.

Advice giving and problem solving
Helping professionals often feel pressure to solve, yet research in motivational interviewing shows that directive advice can trigger reactance, decreasing readiness to change (Miller & Rollnick, 2013). Reflective listening, eliciting the client’s values, and supporting autonomy increase intrinsic motivation and durable change. Begin with exploration: “What do you want to happen?” then collaboratively generate options.

Integrating trauma-informed and attachment-informed practice

Trauma-informed approaches emphasize safety, trustworthiness, choice, collaboration, and empowerment, and these principles align with compassionate empathic work (SAMHSA, 2014). Attachment theory highlights the role of caregiver responsiveness in co-regulation across the lifespan; therapists function as attachment figures in corrective relational experiences (Bowlby, 1988). Co-regulation strategies include paced breathing, grounding exercises, and clear, predictable interventions that reduce hyperarousal and enable mentalizing.

Neuroscience of empathy and regulation
Empathy involves both affective resonance and cognitive perspective taking, supported by overlapping neural systems (Decety, 2011). Compassion training and mindfulness increase activity in regions associated with emotion regulation, such as the prefrontal cortex, and reduce amygdala reactivity (Davidson & Begley, 2012; Lutz et al., 2008). Clinicians who cultivate presence through regular mindfulness practice show improved empathic accuracy and lower burnout rates (Krasner et al., 2009).”

Practical skills and scripts for clinicians and caregivers
– Ground, attend, and reflect. Pause for one deep breath, orient to the client, and reflect content followed by feeling. “You were turned away when you reached out, that felt terrifying.”
– Validate before problem solving. “That makes sense. No wonder you feel overwhelmed.”
– Name empathy misses when they occur. “I notice I am starting to try to fix this, and I want to sit with you instead.”
– Use scaling and curiosity. “On a scale of one to ten, how intense is this right now?” and “What feels most important to name?”
– Offer brief co-regulation exercises. “Would you like to try a grounding exercise together for two minutes?”
– Seek permission before disclosure. “I have had a similar experience, would you like me to share briefly or would you prefer I stay with your story?”

Supervision, reflection, and clinician self-care
Clinician awareness of empathy misses requires ongoing supervision and self-reflection. Regular peer consultation, mindfulness practice, and attention to vicarious trauma reduce the likelihood of reactive empathy misses (Figley, 1995). Institutional supports such as reasonable caseloads and reflective spaces are essential for sustaining empathic practice.

Conclusion
Empathy misses are common and human, yet avoidable when clinicians and caregivers combine Brené Brown’s practical insights with evidence from psychology, neuroscience, and trauma-informed practice. The therapeutic stance that supports healing is one of regulated presence, validation, curiosity, and collaborative problem solving. Empathic competence is not an innate trait but a set of skills that can be trained, practiced, and sustained with supervision and self-compassion.

References

Barrett-Lennard, G. T. (1998). The empathy cycle: Refinements and clarifications. In A. I. Miller (Ed.), Empathy in counseling and psychotherapy (pp. 31-49).

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

Brown, B. (2021). Atlas of the heart: Mapping meaningful connection and the language of human experience. Random House.

Davidson, R. J., & Begley, S. (2012). The emotional life of your brain. Hudson Street Press.

Decety, J. (2011). Dissecting the neural mechanisms mediating empathy. Emotion Review, 3(1), 92-108.

Decety, J., & Lamm, C. (2006). Human empathy through the lens of social neuroscience. The Scientific World Journal, 6, 1146-1163.

Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20).

Halpern, J. (2001). From detached concern to empathy: Humanizing medical practice. Oxford University Press.

Herman, J. L. (1992). Trauma and recovery. Basic Books.

Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Bantam.

Krasner, M. S., et al. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284-1293.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Lieberman, M. D., et al. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421-428.

Lutz, A., et al. (2008). Attention regulation and monitoring in meditation. Trends in Cognitive Sciences, 12(4), 163-169.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Neff, K. (2011). Self-compassion: The proven power of being kind to yourself. William Morrow.

Riess, H., et al. (2012). Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum. Journal of General Internal Medicine, 27(10), 1280-1286.

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

Rosenberg, M. (2003). Nonviolent communication: A language of life. Puddledancer Press.

SAMHSA. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Substance Abuse and Mental Health Services Administration.

Singer, T., et al. (2004). Empathy for pain involves the affective but not sensory components of pain. Science, 303(5661), 1157-1162.

Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. Guilford Press.

Weiner, B. (1995). Judgments of responsibility: A foundation for a theory of social conduct. Guilford Press.