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The Art of Empathic Confrontation: Fortifying the Therapy Relationship 

by Wendy Behary

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When postured in a sturdy (healthy adult mode we are better able to effectively address complex issues and confront the patient who may be unrelentingly avoidant of emotion-focused work in treatment, or to set limits with a patient who has escalated into an angry, highly critical, or demanding/entitled mode.  

Anxious patients may utilize distraction to avoid engaging vulnerability—fearful of  emotional experiences, consequential rejection or loss of control—through the use of content-loaded, detailed storytelling or they may report an inability to recall emotional experiences.  Other clients (especially narcissistic types) may avoid painful emotional material for fear of exposing shame and insecurity. They can become supremely intellectual, defiantly detached, and may even become critical when asked to make a commitment to the therapy relationship, i.e., respectfulness, timeliness, payment, and participation. 

In order to secure the therapy relationship for healing and adaptive change, we begin with a stance of curiosity and discovery, imagining ourselves stepping into the patient’s skin-felt experience; an attempt to resonate with their emotional reactions and behaviors vis-à-vis their personal narratives, early life experiences, unmet emotional needs, the onset of the activation of early maladaptive schemas, and prevailing conditions that continue to trigger schemas and modes.     

This collaborative sense making of the client’s experiences and habituated maladaptive coping styles and modes, as well as the moment-to-moment events in the therapy relationship, readies us to artfully apply the strategy of empathic confrontation.  The use of an empathic prelude when initiating a confrontation can be very effective in calling the patient’s attention toward you as they start to drift into defensive, detached, or interruptive counter-reactions.  

When we start with genuine empathic statements like: “Of course you’re upset about...” or “I know how much you value… “ or “I understand this is a difficult thing to hear… must be especially hard given what you learned from your father…” or “I know you didn't mean to be hurtful...” we have a greater chance to inspire, in the patient, a sense of feeling “known”, “gotten”, “seen”, “understood”, and a greater chance of being heard by us as we follow it with a needs-based confrontation.   

The opportunity for cultivating a heightened awareness and for reducing the intensity of schemas and modes appear to be the essence of a needs-based confrontation, one that follows an empathic prelude; one specifically designed to target the unmet needs of the patient’s vulnerable child, by confronting the presenting mode.  The empathic prelude can dilute and evacuate the intensity of defensive reactions related to schema activation, while the use of the term “but” targets the presenting mode and the patient’s outstanding problem –  the unacceptable and maladaptive reactions, the impact of offensive behaviors on others, the obstacles we are facing together in the healing process. The use of the term “but” also aims to predict the known trajectory of self-defeating life themes like, “You are so competent, Joe, and your ideas can be an asset to your team. It’s not your fault that you rush in with your one-sided decisions, it’s what you learned you must do—to compete, control, and prove yourself worthy of status and recognition.  But, when you just take over the project without discussion or collaboration, your good intentions and capacities become overshadowed by that nagging old need to control and to perform and all they see is a bully.”

Empathic confrontation allows for the patient to receive benefit-of-the-doubt while asking them to take stock of their behaviors and to appreciate the impact on others as well as themselves. With narcissistic patients – this can be quite effective in promoting accountability, especially when setting a limit where the patient’s insults, criticisms, or anger cross a line and present a threat: “I know you may not intend to be threatening, but right now I’m feeling uncomfortable and this is unacceptable. I have rights and you have rights. And this feels like a violation of my right to feel safe and respected.”

The empathic alliance with the patient’s underlying suffering and intended message can fortify the therapy relationship and promote a greater sense of trust and secure the connection while addressing the most challenging obstacles in treatment, and for weakening self-defeating schema content and coping modes.

About the Presenter:

Wendy Behary, LCSW

With 25+ years of professional experience and advanced level certifications, Wendy Behary is the founder and director of The Cognitive Therapy Center of New Jersey and The Schema Therapy Institutes of NJ-NYC-DC. She has been treating clients, training professionals and supervising psychotherapists for more than 20 years. Wendy was on the faculty of the Cognitive Therapy Center and Schema Therapy Institute of New York (until the Institutes merged in 2012), where she trained and worked with Dr. Jeffrey Young since 1989. She is a founding fellow and consulting supervisor for The Academy of Cognitive Therapy (Aaron T. Beck’s Institute).  Wendy served as the President of the Executive Board of the International Society of Schema Therapy (ISST) from 2010-2014 and served as the Training and Certification Coordinator for the ISST Executive Board from 2008-2010. She is currently the chair of the Schema Therapy Development Programs Sub-Committee for the ISST.

Wendy Behary has co-authored several chapters and articles on Schema Therapy and Cognitive Therapy. She is the author of an international bestselling book, "Disarming the Narcissist...”  translated in 15 languages. The Third Edition was released on October 1, 2021.  Wendy has a specialty in treating narcissists and the people who live with and deal with them. As an author and an expert on the subject of narcissism, she is a contributing chapter author of several chapters on schema therapy for narcissism for professional readers. She lectures both nationally and internationally to professional and general audiences on schema therapy, narcissism, interpersonal relationships, anger, and dealing with difficult people. She receives consistent high praise for her clear and articulate teaching style and her ability to bring the therapy to life through dramatic demonstrations of client interactions in the treatment room.

Her work industry business speaking engagements focus on interpersonal conflict resolution. Her private practice is primarily devoted to treating narcissists, partners/people dealing with them, and couples experiencing relationship problems.

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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