Counseling Psychology

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Taylor & Francis


Objective: We present a mixed methods systematic review of the effectiveness of therapist empathic reflections, which have been adopted by a range of approaches to communicate an understanding of client communications and experiences.

Methods: We begin with definitions and subtypes of empathic reflection, drawing on relevant research and theory, including conversation analysis. We distinguish between empathic reflections, reviewed here, and the relational quality of empathy (reviewed in previous meta-analyses). We look at how empathic reflections are assessed and present examples of successful and unsuccessful empathic reflections, also providing a framework of the different criteria used to assess their effectiveness (e.g., association with session or treatment outcome, or client next-turn good process).

Results: In our meta-analysis of 43 samples, we found virtually no relation between presence/absence of empathic reflection and effectiveness, both overall and separately within-session, post-session and post-treatment. Although not statistically significant, we did find weak support for reflections of change talk and summary reflections.

Conclusions: We argue for research looking more carefully at the quality of empathy sequences in which empathic reflections are ideally calibrated in response to empathic opportunities offered by clients and sensitively adjusted in response to client confirmation/disconfirmation. We conclude with training implications and recommended therapeutic practices.


This article is adapted, by special permission of Oxford University Press, by the same authors in C. E. Hill & J. C. Norcross (Eds.) (2023),Psychotherapy skills and methods that work. New York: Oxford University Press. The interorganizational Task Force on PsychotherapyMethods and Skills was cosponsored by the APA Division of Psychotherapy/Society for the Advancement of Psychotherapy. The authorsare grateful to Gerald Goodman and William Miller for useful discussions.

© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis GroupThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License(, which permits non-commercial re-use, distribution, and reproduction in any medium,provided the original work is properly cited, and is not altered, transformed, or built upon in any way.



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