Numerous studies support the effectiveness of online therapy (Backhaus et al., 2012; Bee et al., 2008), but little research has been conducted to determine whether computer-mediated communication (CMC) could impact crucial relational aspects of psychotherapy such as empathy (Terry & Cain, 2016). Empathy relates to our capacity to understand and, to some extent, feel what other individuals feel without experiencing distress or burden (Decety & Jackson, 2004). Interest in empathy in the context of CMC is important since the perception of empathy by therapists and clients during therapy is a relevant predictor of favourable outcomes at the conclusion of treatment (Elliott, Bohart, Watson, & Greenberg, 2011). Recognizing the need for greater understanding of this issue in online therapy, we surveyed the literature pertaining to empathy in online therapy and medicine and proposed a conceptual framework of empathy in computer-mediated interactions. Our motivations to establish such a framework were twofold. First, clinicians can greatly benefit from knowing how CMC can impact empathy in clinical sessions – and how they can adapt to better sustain empathy throughout online treatments. Second, researchers can employ this theoretical framework to investigate specific facets of the empathic process and design studies that attend to the specific features of CMC in online interactions.
The conceptual framework delineates four steps in the cycle of empathic interactions. This process begins when an individual (e.g., a client) displays an emotional state using both verbal (e.g., ‘I feel sad today.’) and nonverbal cues (e.g., having teary eyes, hunched body posture, etc.). Another individual (e.g., a therapist) then perceives those verbal and nonverbal cues and may feel a certain amount of empathy towards the client. The therapist can subsequently choose to convey his or her empathy through verbal and nonverbal cues. The final step of the empathic cycle consists of the client’s perception of the therapist’s empathy. This empathic cycle is often repeated multiple times during a given clinical session, providing socioemotional benefits to clients (Rimé, 2009)and strengthening the therapeutic alliance (Feller & Cottone, 2003).
So how does CMC impact the empathic interaction? Our conceptual framework argues that CMC filters out important communicational signals, most notably nonverbal cues. For example, text-based platforms do not allow the perception of visual or auditory cues. Other ‘richer’ media, videoconferencing for example, allow individuals to see and hear each other. Yet, even for videoconferencing, camera positioning and framing can restrict the perception of bodily posture and gestures during the interaction. The filtering effect of CMC is therefore inherent to most forms of CMC and impacts every exchange of information between individuals. This filtering makes it harder for therapists to assess emotional states in their clients and to effectively convey their empathy.
The framework carries implications for both clinicians and researchers. For clinicians, asking clients directly about their emotional states can help compensate for the lack of physical presence. Similarly, expressing empathy using explicit verbal statements can facilitate the clients’ perceptions of their therapists’ empathy (Trepal, Haberstroh, Duffey, & Evans, 2007). Therapists and clients can also agree to exaggerate nonverbal behaviors so as to make them more perceptible during the online session (Gifford, Niles, Rivkin, Koverola, & Polaha, 2012). For researchers, the framework lays the theoretical groundwork on which empirical results can be more easily interpreted and provides a valuable tool for future investigations of empathy and its constituent processes in the realm of CMC.
- How can we take advantage of the distinctive features of CMC to enhance empathy not only in online treatments, but in general social interactions as well?
- How could emerging technologies, such as affective computing and augmented reality, potentially help foster empathy beyond what is possible in face-to-face interactions?
Frédéric Grondin is a graduate student in psychology at Université Laval in Quebec City, Canada. In the context of his thesis, he investigates whether empathy is expressed and perceived in the same way when conducting teletherapy through videoconferencing compared to traditional, face-to-face modalities. Additionally, he is interested in how interacting in cyberspace by means of restricted communication channels impacts how we perceive and reach out to each other. Ultimately, his research aims to identify how empathy can be fostered when therapists and clients do not share the same physical space.
Anna Lomanowska, Ph.D. is a researcher in Cyberpsychology. She received her PhD in Biological Psychology from the University of Toronto and pursued postdoctoral research training in Cyberbehaviour at Université Laval. She directs the Digital Well-Being Lab which focuses on understanding how digital technologies can be used to foster positive social engagement and interpersonal well-being. Using a biopsychological framework, current research in the lab examines the exchange of nonverbal behaviour in digitally mediated social interactions, including cybertherapy.
Philip Jackson, Ph.D., is a professor at the School of Psychology at Université Laval, co-director of Consortium d’imagerie en neurosciences et santé mentale de Québec (CINQ), researcher at CIRRIS and CERVO research centers and member of the College of New Scholars, Artists and Scientists of the Royal Society of Canada. Professor Jackson is head of the Cognitive and Social Neuroscience Lab dedicated to the study of human empathy. Funding from the three main national agencies provides a unique multidisciplinary environment to study the physiological and neurophysiological signature of empathy, using the latest technology in brain imaging, non-invasive brain stimulation and virtual reality.
Grondin, F., & Lomanowska, A. M., Jackson, P. L. (2019). Empathy in Computer-Mediated Interactions: A Conceptual Framework for Research and Clinical Practice. Clinical Psychology: Science and Practice. e12298. https ://doi.org/10.1111/cpsp.12298
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