the physiology of empathy

The discovery of mirror neurons lends a new dimension of understanding to empathy, countertransference and projective identification that was not previously available, says Babette Rothschild

'We are born with the capacity… to experience what others experience and participate in their experience by virtue of the way we are grabbed by their nervous system. One of the real questions is not, "How in the world does this happen?" We're beginning to have a really good idea. The real question is "How do we stop it from happening so that we are not the prisoner of someone else's nervous system all the time?" There have got to be a lot of brakes in the system.'

Daniel N. Stern¹

AS CLINICIANS empathy is our major, greatest, and most reliable tool for helping our clients. Empathy helps us relate to our clients, to have a sense of what they are feeling. It also helps put the client's past into perspective by having a deep understanding of how their history is affecting them in their daily life and in the therapy room; we can relate. Empathy enhances our insights, increases the accuracy of our hunches, and sometimes even helps us to seemingly 'read the client's mind'. Without empathy, we could not be the effective psychotherapists and counsellors that we are. Our capacity for empathy is centrally necessary to our work. Though vital, empathy has remained a rather mystical concept. Just how does it 'grab' and connect us, one to another? Must empathy always capture us unawares, or is it possible to say yea or nay to its force? How can we maximise or minimise it to enhance its usefulness?

Vital answers to these questions are emerging from an unexpected source. Neuroscience is taking a giant leap forward in helping us to understand how we 'catch' another's mental state, even another's deepest emotions. A new perspective on empathy is emerging from the academic halls of science.

Embodied empathy
One of my college friends, Nancy, was studying to be a physical therapist. She had the intriguing habit of mimicking the walking style of a total stranger as she followed behind on a public street. It was how she taught herself gait analysis, by feeling it in her own body. Copying the stranger's way of walking gave her practice in identifying where someone was stiff or to locate the source of a limp. I was fascinated and made her teach me how to do it. (We were careful to keep a safe distance and never to exaggerate our mimicry so no one ever noticed.) Sometimes I would indulge in this practice when on my own, just for fun. It was captivating to sense a characteristic of another person. At times I noticed that it not only changed my way of walking and feeling in my legs, but also had an effect on my mood. I didn't think much about it until I started working as a clinical social worker.

On my first job in the mid-1970s, I began to notice peculiar things happening in my body while I worked with my clients. Some of my reactions could be credited to first-time nerves, but I sometimes wondered if there was more to it than that. I particularly remember my somatic reactions to Allison. She was pale, sat very still, and her voice was nearly inaudible. As we slowly worked together, I would often feel light-headed. When I paid attention to what was happening in my own body, I found that my breathing had become very shallow, nearly undetectable. No wonder I was lightheaded, I wasn't getting enough oxygen!

Turning my attention to Allison, I noticed something similar in her; her chest was barely moving. I was taken aback; why were we breathing alike? I wondered if it was just a coincidence, or if there could be a correlation. Then I remembered how mimicking walking patterns in college had sometimes affected my mood. I wondered if something like that could be going on with me and Allison. Was I light-headed from my own nervousness or more a result of mimicry of Allison's breathing? If our respiration was actually synchronised, I thought, it was totally unconscious on both our parts.

In all the graduate school discussions on the therapeutic relationship, including transference and countertransference, no one had ever mentioned bodily reactions. I was intrigued and curious. I didn't really know what to read or who to ask, so I took my observations and questions to my supervisor. To say I was disappointed in her reaction would be an understatement. She was more sceptical than amazed. She could neither account for my somatic symptoms, nor did she really believe my experience. All in all, she thought my hypothesis was very odd. Though she knew about emotional empathy – that she could feel what her client was feeling – she did not believe that somatic states could likewise be shared.

After that supervision I was determined never to tell that supervisor anything of the like again. I could accept that she had not observed or experienced the same phenomenon, but I was dumbfounded that she was so critical and dubious. She was not even interested in investigating if the same thing might be happening to her or to talk with anyone else about it. Was the leap from a concept of emotional empathy to one of somatic empathy so ominous? Luckily, I never doubted my experience. My college mimicry experiments helped me to believe that I could trust my sensations. But I was not sure I could trust my conclusions. I would need to look further if I was to find any reliable answers.

Body psychotherapy
Over the next 20 years, I developed an interest in and studied bodypsychotherapy. I found that colleagues and teachers from those disciplines had a mostly contrary reaction to that of my first supervisor. Body psychotherapists seemed simply to accept that their bodies were 'in tune with' or 'resonating' with their clients. Like actors, they regarded their bodies as their 'instruments'. They never questioned 'shared' sensations. Sometimes they would attempt to actively invoke mutual states through copying the way a client sat, stood, or moved, (similar to my friend's gait mimicry) – dance therapists had originated the practice, calling it 'postural mirroring'. They assumed that what they felt in their bodies was correct, whether they were applying it to their own individual experience, or shared experience with clients. Though I was heartened by the confirmation of my observations, I was concerned about the blind acceptance.

When I began to delve into the neuroscientific literature in the early-1990s a whole new world opened up for me. At first it was my interest in traumatised individuals and PTSD that drew me to neuroscience. But after a decade of writing and teaching, my concern grew for those colleagues and students who complained of ill-effects from working with trauma clients. New names for these conditions emerged in the professional literature including 'compassion fatigue' and 'vicarious traumatisation'. I began to wonder if those conditions could have anything to do with the phenomena of 'catching' another's sensations or emotions that had awakened my interest so many years before? Was this somatic empathy? Could 'postural mirroring' have any bearing on the negative experiences of trauma therapists? What was the connection between my college experiments with gait mimicry, my experience with Allison, and the suffering of my professional colleagues?

Eureka!
I nurtured my curiosity at the library, on the internet, and with PsychInfo and Medline databases. I discovered a vast literature on empathy, mostly coming from social psychologists. There are numerous experimental studies that demonstrate the commonality of emotional expression, identify unconscious physical and facial mimicry, and confirm autonomic nervous system synchrony. Though scientists could locate effects of empathy in the brain, astonishingly, until the mid-1990s, no one had looked for a source of empathy in the brain! Even then, the discovery of brain-to-brain empathy was an accident.

In Italy a neuroscience research team led by Giacomo Rizzolatti² and Vittoria Gallese³ was studying grasping behaviours in monkeys. They attached electrodes to the monkeys to observe precisely which neurons fired when a monkey grasped an object with its hand. The research was routine: monkey grasps, specific neurons fire.

One day, though, something strange and amazing happened with one of the primate subjects. In an instant, the definition of interconnectedness, the notion of empathy, changed forever.

During a break, one of the human researchers hungrily reached out to get a raisin for himself. Simultaneously, neurons in the monkey's brain fired. Curious, the team looked closer at their monitor. What they saw was astounding: The neurons that fired were the exact same neurons the researchers had noticed to be firing when the monkey grasped a raisin itself. The same neuron activated by the monkey's own behaviour was also activated by it seeing that behaviour performed by the researcher. The team was enormously intrigued and proceeded to delve further into this brain-to-brain connection. They named these newly discovered connector cells 'mirror neurons' because they appeared to reflect the activity of another's brain cells.

The discovery was totally unexpected. Nothing like it had ever been seen before. This accidental occurrence was the first clue in neuroscience to the possible existence of a neuronal mirror system. The response in the monkey's neurons was not just simple recognition, 'I know what the researcher is doing'. That kind of observation is activated elsewhere in the brain. What happened between the monkey and researcher necessitated a new concept, a new theory. The monkey's neurons fired as if it had made the same movement itself.

Sometimes mirror neurons will actually stimulate a mirrored movement. They appear to be activated by observing a behaviour or an action. Automatic smiling and yawning in response to another's smile or yawn are the most common examples of mirror neuron activity between humans. Mirror neurons are also probably at work when you watch sports on television and find your thighs tensing or your breathing accelerating in sync with the physical effort you are observing. They are potentially activated in any interaction, also the therapeutic relationship.

As the excited cry of 'Eureka!' spreads throughout the halls of neuroscience and psychology, there is growing speculation that mirror neurons are central to, if not the foundation of, empathy. Renowned neuroscientist, V.S. Ramachandran⁴ has voiced tremendous excitement at the discovery of mirror neurons. He enthusiastically predicts that mirror neurons have the potential to revolutionise psychology in a similar manner to DNA's revolution of biology.

There still exists a huge gap in understanding and applying the significance of mirror neurons. The therapeutic relationship seems an obvious laboratory for identifying their role and effects.

Clinical applications
The discovery of mirror neurons lends a new dimension of understanding to empathy, countertransference, and projective identification that was not previously available. Both conscious and unconscious physical processes are elicited through synchronisation with clients. Their sensations, behaviours, and emotions can be vicariously experienced via passive engagement (as with the monkeys) or an active process of mimicry. The more mindful a therapist is of her own body, the more she will be able to choose to engage mirror neurons where valuable information is to be gained, and to stop their effect where there could be risk to her or her client's wellbeing.

Both conscious and unconscious mimicry can make a therapist vulnerable to 'catching' a client's somatic states and/or emotions. Social psychology studies⁵ have demonstrated time and again that it is common for people to unconsciously copy one another's facial expression, synchronise breathing rates, and mimick the other's partial or complete posture. Through doing so, emotions have also been shown to be shared. This happens regularly in the therapy room as well and can go either way: therapist to client, or client to therapist.

You can consciously mirror one or more aspects of your client's behaviour when you want to get a feel for what it is like to be in your client's skin – as I did in college, feeling my mood change as I imitated someone's way of walking. Though no scans have yet been done, it appears likely that mirror neurons figure actively in these phenomena.

Purposefully synchronising with your client can be a ready aide to information gathering. It can increase empathy on many levels. As mentioned before, this practice has been used for many years by dance and other body psychotherapists. One caveat, though: just as verbal communication can have a gap between speaker and listener, somatic communication can too. Never forget that what you 'catch' from your client is coming in through your own filters. It is not 'pure' information. So you must check accuracy with your client in some way, don't just assume that what you seem to catch is correct. If, for example, you mimic your client's head tilt and get a feeling of anxiety in your chest, you might ask him what he is feeling in his chest rather than assuming it is 100 per cent the same. What you catch can also help to guide your questions.

An example will help to illustrate: Fred had grown up with a tyrannical, abusive father who beat him regularly. He came for therapy because of problems dealing with authority on his new job – his first following graduation from college. Though he clearly knew his early history, he was unable to see or feel a connection between his current anxiety and his childhood experiences. One day he arrived for his session deeply depressed. He had been having suicidal thoughts and was very worried. As I asked him to describe what 'suicidal' felt like in his body, I tuned in by copying his flat facial expression. In my own body I began to feel the sense of deadness and numbness he described. It reminded me of the freezing response that is a natural reaction to inescapable threat. A light bulb went on in my mind. 'Fred,' I asked, 'have you ever seen a mouse that was caught by a cat?' Yes, he had having grown up in a rural area. 'What happens to the mouse?' I asked. 'It plays dead,' he replied, becoming interested. We discussed the protective mechanisms of the freeze response. Then I asked if he had ever experienced that himself. 'Yes, sometimes when I was beaten.' Many times his body had lost all power and/or became numb, 'went dead'. A light bulb went on in Fred's mind. For the first time he made a connection between his childhood horrors and a current emotional state. He began to talk excitedly about his 'internal mouse', and his thoughts of suicide receded. It was an important breakthrough, facilitated by my resonance with the sensation of deadness that accompanied Fred's depression and thoughts of suicide.

What about the risks?
Of course, there can be risks to mimicking client behaviour, especially if you forget what you've been doing. I learned this lesson the hard way.

A few years ago Ronald was furious with me, so much so that for the first hour of a double session he could not talk at all. He sat half facing away from me, tense and seething. I tried to make verbal contact with him saying any insightful or sensitive thing I could think of: 'You seem very angry…' 'It looks very difficult for you…' I had the feeling that my words projected about a foot from my mouth and then fell flat on the floor with a loud 'thud!' He would have nothing of my interventions and was not available for contact. So I decided to hold my tongue and let him work it out. To fill the time I proceeded to actively copy his tense posture: I clenched my jaw, held my hands tightly, and tensed and rounded my shoulders. I hoped to sense a little of what was going on with him.

Copying Ronald's posture had two results: The first was that soon after, he loosened a little and began to talk. I've since learned that mimicking another's posture can nonverbally convey understanding. Whatever the mechanism, Ronald became more available. He expressed much (but not all) of his anger and we were able to resolve enough of the issues for him to leave in a fairly comfortable state.

The second result of my mimicry struck after Ronald left. When he closed the door, I was very uncomfortable; I was now seething. I have never felt as angry before or since that day. I was furious and I didn't know why: Was I angry with Ronald? Had something been triggered from my own life? I looked for reasons to explain my state, but could not make sense of it. It was first when I talked with a colleague that I remembered copying Ronald's posture. Only then did I find relief. Evidently, when I became absorbed in the interaction with Ronald, I forgot about my intentional mimicry and literally confused the anger I 'caught' from Ronald as anger relevant to my own life. I nearly drove myself crazy with it.

I have received a variety of opinions about this situation when I have shared it with colleagues from various psychotherapeutic disciplines. There are many who are sure that what occurred was projective identification. They insist that Ronald 'put' his feelings into me and 'induced' me to become angry. I disagree. I clearly remember active participation, mimicry, which made me vulnerable to be infected by Ronald's anger.

As a result of that and similar experiences, I now have a counter-hypothesis to the traditional understanding of projective identification: Perhaps it actually occurs as it did between Ronald and me, though unconsciously. When a therapist is suffering from the impact of a projective identification, she may need to look no further than her own body to identify if she mimicked her client's posture, synchronised her breathing with his, or if she copied his facial expression. I propose that any of those commonly automatic behaviours could result in misconstruing 'projective identification'.

Client mirrors therapist
Clients may also unconsciously copy the therapist, though this is less often recognised. Actually, many psychotherapists have long made use of mirror neurons with their clients instinctively. When, for instance, you silently slow your own breathing and your anxious client subsequently slows his, you are engaging his mirror neurons. No words need to be exchanged for the client to match your slower respiration and calm down; it seems to just happen. Sometimes what a client catches from the therapist is helpful, though sometimes it is not.

Once, upon returning to my then home of Copenhagen following a long visit to the US, I had a particularly bad case of jetlag. Though very tired, I jumped right into my work schedule as usual and managed to get by. However, one particular client, Helle, 'caught' my state, though she didn't know it. At the end of her session I asked per usual, 'How are you feeling?' Helle proceeded to describe my jetlag in precise detail, 'I feel exhausted, very tired, especially in my forehead. I also feel heaviness in my chest. And I'm hungry, but I shouldn't be. I ate a good lunch before I came.' I suggested that she get up and walk around a little. I wanted her to get connected with her own movements and out of my somatic influence on her mirror neurons. After pacing a bit, she returned to her chair and reported she felt much better, the exhaustion and hunger had lifted! I then told her how I was feeling and that she had described my sensations exactly. She was not terribly surprised as she knew she was vulnerable to 'be infected by' the sensations and feelings of others. But she hadn't realised that merely by shifting her position (in this case walking around) she could so easily stop that infection and come back to feeling herself.

Taking charge
The 'brakes' for interfering with the consequences of mirror neurons and empathy that Stern (in the opening quote) is looking for are actually readily available, easily applied, and astoundingly simple. Though mirror neurons fire unconsciously, increasing self-awareness of their effects can both illuminate and increase their usefulness and also help to avoid their pitfalls. Getting in the habit of checking periodically to discover if you have been automatically mimicking some aspect of your client's observable behaviour, as I found myself doing with Allison, is one way to reduce the negative effects of empathy. If you are suffering from vicarious traumatisation or compassion fatigue,⁶ it might be a good idea to check this often. You might be taking your clients home with you, and in your body, much more than you realise. Learning to distinguish when your sensations and feelings are purely your own and when they are confused with 'catches' from your client will be useful for mediating such countertransference difficulties.

Conclusions
Now that I am aware of mirror neurons and the empathy they underlie, I am often able to creatively use them to my advantage.

Suzanne remembered her childhood bout with polio well. Though she had made a full recovery and had full use of her arms and legs, there were scars. We worked on many aspects of her illness with eye movement desensitisation and reprocessing (EMDR). The worst part for Suzanne was the memory of abandonment that still lingered from her month-long confinement in an iron lung. Recalling the sense of loneliness and restriction was overwhelming. The central negative cognition associated with her ordeal persisted, 'I can't move on my own behalf.' Mimicking the position of Suzanne's legs I began to feel stiff in my own. It occurred to me that, on some level, Suzanne still believed that she could not move, this despite the everyday evidence that she could. In a hope to counter that belief, I proposed that the next time Suzanne felt immobile while processing with EMDR, we would make one slight alteration: I wanted her to use physical walking for the bilateral stimulation. My own legs relaxed when she started to move, but that was not the point. Suzanne felt relieved as she continued to walk. She got the message on both mind and body levels that she could move now. Mirroring her posture had led me to an original intervention because I could feel in my own body what might be needed.

On the other hand, when I work with Terry, I have found that I need to keep alert of my tendencies to mimicry. When my attention wanders, I can suffer after he leaves. Admitting that my mirror neurons are often engaged unconsciously has helped me to be more forgiving when I find myself affected by Terry in ways that I have not chosen. Instead of blaming him for my uncomfortable feelings I am now better able to use my discomfort to remind myself to pay attention to what I am doing with my own body, to take stock of which way I have made myself vulnerable. Then it is possible for me to choose whether I continue being affected (if there is benefit to be had), or if I stop the effect (when it will likely be more harmful than helpful). Any behaviour that brings me back to the sensations and feelings of my own body and out of the synchronisation with Terry helps me to put on the brakes. I stretch, sigh, drink some water, get up to get a pencil, or write some notes. The idea is that I need to frequently do something that stops my mirror neuron system from habitually being engaged. Such simple interventions have helped me to take charge of when and how much I am tuned in to Terry. My practice with him has helped me to handle similar difficulties with other clients.

Either way, the discovery of mirror neurons is making it possible for us to better understand the empathy we feel with our clients, and to better regulate and control it. Tuning in or tuning out, the therapist gains control over a process we previously thought was beyond our reach.

© 2004 Babette Rothschild, MSW, LCSW

Babette Rothschild, M.S.W., L.C.S.W., is in private practice in Los Angeles and gives professional trainings worldwide. She's the author of:

• The Body Remembers: The Psychophysiology of Trauma & Trauma Treatment, (WW Norton, 2000)
• The Body Remembers Casebook: Unifying Methods and Models in the Treatment of Trauma and PTSD, (WW Norton, March 2003)

Emails to the author can be sent to: babette@trauma.cc. www.trauma.cc.

References

1. From his 2002 keynote address at the Los Angeles conference of Lifespan Learning Institute: Attachment: From early childhood through the lifespan. (Cassette Recording No. 609-617).

2. Rizzolatti G, Fadiga L, Gallese V, Fogassi L. Premotor cortex and the recognition of motor actions. Cognitive Brain Research. 1996; 3(2):131-141.

3. Gallese V, Ferrari PF, Umilta MA. The mirror matching system: A shared manifold for intersubjectivity. Behavioral and Brain Sciences, 2002; 25(1):35-36.

4. Ramachandran VS. Mirror neurons and imitation learning as the driving force behind 'the great leap forward' in human evolution. Edge [On-line]. 2000; 69. www.edge.org/documents/archive/edge69.html

5. Hatfield E, Cacioppo JT, Rapson RL. Emotional Contagion: Studies in Emotion and Social Interaction. Cambridge, UK: Cambridge University Press; 1994.

6. Rothschild B. (in press). Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma. New York: W.W. Norton.