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Wash and Where

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Submitted By mroche
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Facultad de artes liberales y ciencias de la educación

Escuela de psicología

LA EMPATIA EN EL TERAPEUTA:

Teorías y aplicación en las distintas terapias.

Autor: María José Roche

Practicas progresivas

Andrea Garibaldi

Samborondón, Mayo de 2012.

La empatía humana ha resultado de enorme interés tanto en el ámbito de la psicopatología, como en el estudio de la conducta social. La capacidad humana para empalizar se ha venido estudiando desde hace tiempo, ha habido confrontaciones teóricas y no hay pleno acuerdo sobre su definición. Hay discusiones sobre si la empatía consiste en ponerse mentalmente en el lugar del otro o a sentir la emoción del otro. Es un constructo muy amplio, que abarca diferentes componentes. En este ensayo se va describir las teorías y definiciones más relevantes en la historia sobre la empatía, luego se verá su utilidad en la clínica, no solo a nivel de diagnóstico sino como habilidad del terapeuta en beneficio del proceso terapéutico, sus usos de acuerdo al modelo terapéutico que se siga y que ocurre cuando el terapeuta muestra falta de empatía en la terapia.

La empatía desde un enfoque cognitivo ha tenido estudios diferenciando las que se referían a imaginarse a sí mismo en una situación e imaginarse al otro en una situación. Stotland (1969) empezó a realizar estos estudios, y encontró que mientras en el primer conjunto de instrucciones la gente podía llegar a sentir ansiedad, no ocurría lo mismo en el segundo, la consideraban una disposición del individuo. La empatía desde un enfoque afectivo tiene una propuesta de Batson (1991), quien entiende la empatía como una emoción vicaria congruente con el estado emocional del otro, como sentimientos de interés y compasión orientados hacia la otra persona que resultan de tener conciencia del sufrimiento de ésta. La entiende como una emoción que se surge ante la presencia de estímulos situacionales concretos. Hay una visión integradora de la empatía, Salo-vey y Mayer (1990) afirman que la empatía requiere la adecuada identificación de las respuestas emocionales en otras personas e implica no sólo actitudes sino también habilidades o competencias bien definidas.

Eisenberg (Eisenberg y Strayer, 1987) establece la distinción formal entre la adopción de perspectiva perceptual, cognitiva, y afectiva. Según esta autora, la adopción de perspectiva perceptual se ha entendido como la capacidad de representarse la visión que tiene el otro en función de su localización. La capacidad de representarse los pensamientos y motivos del otro ha sido recogida en la noción de adopción de perspectiva cognitiva. Por último la adopción de perspectiva afectiva se refiere a la inferencia de los estados emocionales ajenos (Davis, 1996). Davis (1980) establece que la empatía es un constructo multidimensional que incluye cuatro componentes diferentes aunque relacionados entre sí. Dentro de la dimensión cognitiva distingue: Fantasía, que se refiere a la tendencia a identificarse con personajes de ficción y Adopción de perspectivas, definida previamente como adopción de perspectiva cognitiva. En relación a la dimensión afectiva Davis propone dos escalas: Angustia empática, que es la tendencia a experimentar sentimientos de compasión y preocupación por el otro y Aflicción Personal, que se refiere a la ansiedad que se experimenta al ser testigo de un suceso desagradable para otro.

Desde un punto de vista clínico, la evaluación de la empatía no resulta útil solamente para el diagnostico de enfermedades mentales, sino también para evaluar la empatía de los propios psicólogos, ya que esta capacidad es una de las principales habilidades que debe presentar un buen terapeuta. Como señalan Ruiz y Villalobos (1994) Un terapeuta empático ha de ser capaz de entender adecuadamente no sólo los pensamientos y sentimientos que el paciente está expresando, reconociendo su significado, sino también las implicaciones emocionales, conductuales y cognitivas que tienen en su vida. Su importancia en el desarrollo terapéutico se plasma de diferentes formas, ayudando su presencia en los distintos momentos de la intervención, de la misma manera que la carencia por parte del terapeuta de dicha habilidad puede dificultar y entorpecer el proceso de intervención. Safran (1994, en Romero, Bejarano & Álvarez, 2000), realizó un análisis concluyendo que sólo el 15% del cambio psicológico en terapia es atribuible a factores específicos, mientras que un 45% se atribuiría a factores de la relación terapéutica. Dentro de estas variables inespecíficas, se ha encontrado que la relación terapéutica, y particularmente la alianza terapéutica, tiene una gran influencia sobre el resultado del proceso de psicoterapia (Orlinsky, Grawe & Parks, 1994).

La comprensión empática del terapeuta afectará el proceso terapéutico desde sus inicios. En la primera entrevista va a facilitar la colaboración del paciente al sentirse comprendido y entendido colabora de forma activa en el proceso proporcionando información relevante que ayuda a la evaluación, realizando los registros y comprometiéndose en la terapia, queriendo regresar. Se requiere la participación del cliente en el cumplimiento de tareas para alcanzar los resultados terapéuticos ya que es fuera de la sesión donde se ponen en práctica y ejercitan las estrategias y recursos enseñados en la consulta. Ayuda a establecer una alianza terapéutica que permitirá que el terapeuta y el paciente estén de acuerdo sobre los objetivos y prioridades de la intervención. La presentación de la información de forma clara, cercana al problema que presenta la persona mediante ejemplos tomados de su vida facilitará la comprensión y el acuerdo que se intensificará si el terapeuta respeta las críticas, objeciones o reservas que en un primer momento puede plantear el cliente.

La comprensión de la visión del paciente facilitara la selección de estrategia, adaptando el proceso a su propio ritmo, hará que los pequeños logros sirvan de aliciente para resolver dificultades, se buscara ser flexible para que el paciente se perciba tomando decisiones que incrementen su responsabilidad en el proceso y evitara el abandono de la terapia. Por último la empatía del terapeuta va a facilitar el abordaje de resistencias, al explorar los sentimientos y percepciones del paciente que pueden estar en la base de sus dificultades. La superación de estas situaciones problemáticas depende en gran medida de la forma que tienen los terapeutas de abordarlas. Las personas se suelen mostrar más dispuestas a seguir indicaciones cuando se encuentran en un entorno terapéutico cooperativo y no controlador.

Las habilidades empáticas del terapeuta se utilizan diferentes de acuerdo al modelo terapéutico que se siga. La terapia humanista rogeriana o centrada en el cliente, habla de dos tipos de comprensión empática en la relación terapéutica: la empatía cognitiva que consiste en percibir el mundo desde el punto de vista del cliente, y la empatía afectiva, que hace referencia a sentir con el cliente conservando la distancia emocional necesaria para mantener la objetividad. También tiene tres condiciones que deben estar presentes durante la sesión para que se pueda producir el cambio terapéutico en el cliente: autenticidad o congruencia del terapeuta, aceptación positiva incondicional de éste hacia el cliente, y comprensión empática del mismo (Giordani, 1997). En la terapia conductual tradicional la empatía es contemplada como un elemento facilitador del cambio y se encuentra al servicio de las técnicas, en modelos como la terapia dialéctica conductual se convierte en uno de los ingredientes esenciales de la terapia y, por tanto, algo clave e imprescindible para que se produzca la mejoría clínica; además, para la terapia de aceptación y compromiso, es un elemento básico no sólo con el fin de acompañar y comprender al paciente, sino para ponerse en su mismo nivel y estar alerta para que uno mismo no caiga en los problemas de fusión y literalidad que trata de desterrar en el paciente.

Un terapeuta que no muestre empatía hacia el paciente puede provocar el abandono de la terapia o retrasará la probabilidad de obtener resultados terapéuticos beneficiosos para el cliente. El terapeuta interesado más en conseguir información relevante para la evaluación que en escuchar al cliente, puede dificultar la comunicación con el paciente, al cortar su discurso de manera reiterada, ya que el paciente percibe desinterés en sus cuestiones que él vive como más significativas. La búsqueda de información es un proceso progresivo y continuado que comienza utilizando preguntas abiertas y amplias, para ir paulatinamente centrando el discurso a través de preguntas más concretas y específicas. Los terapeutas interesados en poner de relieve su experiencia, conocimiento y autoridad suelen proponer pautas de acción de forma prematura, sin haber dejado el tiempo suficiente para que la persona trasmita todos aquellos aspectos que le preocupan y que desde su perspectiva son relevantes para la comprensión de su problema. El paciente no siente que las pautas que se le proponen se ajusten a su circunstancia pudiendo valorar la intervención como un procedimiento estándar, ajeno a su problema.

También se puede ver cuando el terapeuta tiene excesiva preocupación por su competencia, hace un énfasis excesivo en la consecución de resultados y se plantea un ritmo terapéutico inadecuado, que no se ajusta a las circunstancias personales del paciente. En estas circunstancias es frecuente que aparezcan los no cumplimientos de las tareas programadas, las dudas para seguir las instrucciones y las anulaciones de las citas programadas para finalizar en el abandono de la terapia. Es importante señalar la enorme importancia que tiene para la motivación del paciente el reforzamiento de su trabajo y la valoración de sus esfuerzos. Una evaluación superficial del trabajo entre sesiones puede en ocasiones incrementar las situaciones de fracaso al planificar actividades que requieren recursos que no están disponibles en el repertorio de la persona. Lograr que las personas sigan las instrucciones y se involucren en el proceso terapéutico dependerá en gran medida de las habilidades terapéuticas y personales.

En conclusión se puede decir que la empatía es una habilidad esencial que debe tener el terapeuta, es indispensable para establecer la alianza terapéutica y conseguir buenos resultados para el paciente en la terapia. Aunque ha habido discordias en la definición de empatía anteriormente, ahora en las teorías actuales unifican la empatía cognitiva y la afectiva, dándole la importancia a que el psicólogo analice los sentimientos que experimenta en la terapia y los trabaje usándolos para el beneficio de ésta y no sea indiferente a ellos, ya que al evitar tener sentimientos en la terapia y querer ser frio y distante, no hay empatía y entonces la terapia se ve entorpecida y se corre el riesgo de abandono de la terapia por parte del paciente. En fin la empatía no se aprende en los salones sino que es una habilidad que se desarrolla y puede ser mejorada con la práctica.

BIBLIOGRAFIA

Arango, A. Moreno, F. (2009). Más allá de la relación terapéutica: un recorrido histórico y teórico. Acta Colombiana de Psicología. 12 (2), 135-145
Barraca, J. (2009). Habilidades Clínicas en la Terapia Conductual Tercera Generación. Clínica y salud. 20 (2), xx.
Carrasco, M. (2006). La empatía en la terapia cognitivo-conductual. Manuscrito no publicado

Fernández, I. y Márquez, M. (2008). Empatía: Medidas, teorías y aplicaciones en revisión. Anales de Psicología. 24 (2), 284-298

Oceja, L. y Jiménez, I. (2007). Más allá del Egoísmo y de la Identidad Grupal: Empatía hacia el Otro y Conciencia de Otros en un Dilema Social. The Spanish Journal of Social Psychology. 10 (1), 369-380
Santibáñez, P. Román, M. y chenevard, C. ( 2008). Variables inespecíficas en psicoterapia. Terapia psicológica. 26 (1), 89-98.

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