As a therapist, I have often wondered how my clients could treat people they love with meanness and disdain. For example, Mark and Annie had been married for twenty years and yet when they would come in for counseling, they reported having vicious and hurtful arguments on a weekly basis. Or there was Terri, a 17-year-old girl who had been very close to her mother as a child and yet didn’t seem to care at all about how her excessive drinking and drug experimentation affected her. She’d tell me, “I can’t be responsible for her problems with me.  Let her live her own life.”

Having researched how empathy develops in children for my books on emotional intelligence (How to Raise a Child with a High EQ: A Parents’ Guide to Emotional Intelligence, Learning to Listen Learning to Care, and others), I understood that most of us are born with empathy, and we show empathic responses and compassionate behaviors very early in life. When a baby sees another baby crying in distress, she will most likely start crying, too. Toddlers in daycare have been observed comforting children who are clearly upset, stroking their arms, or even fetching a box of band-aids.

Yet for some reason, as we grow older, many people seem to lose their capacity for empathy – or at least behave in ways that show a lack of understanding of others.

When we try to help clients improve their relationships at home, at school, and at work by tapping into their natural empathy, we must acknowledge that empathy is not a simple construct, and there are different points of intervention. Researchers who explore the effects of emotional intelligence tell us there are three different types of empathy; affective empathy, where people actually feel the emotions of others; cognitive empathy, where people can see the perspective of others, and compassionate empathy, where people not only understand and feel the distress of others, but they have the desire to behave in ways that can relieve that distress.

In incorporating empathy training into a treatment plan, it can also be useful to understand the neuroscience of empathy. Various aspects of empathy appear to be related to at least five different brain structures:

Mirror neurons fire when a person performs certain physical movements and when another person is observed doing the same. They underlie imitative action, awareness, and understanding of another person’s behavior, intention, or emotion. Mirror neurons are thought to be important for understanding the actions and intentions of others, and they seem to play a key role in cognitive empathy. Some people believe there are correlations between reduced mirror neuron area activity and the severity of autism, and that some social deficits might be ameliorated with activities like imitating facial expressions.

The amygdala, a small almond-shaped structure located deep in the brain, is involved in the processing of emotions, and it is believed to play a role in emotional empathy by allowing individuals to share and respond to the emotions of others. Since the amygdala also plays an important role in other emotions, including the fight or flight response, we can speculate that intense emotions such as ones triggered by traumatic events can interfere with a person’s ability to feel and understand the feelings of others.

The insula, a region of the cerebral cortex, is involved in the perception of emotions and physical sensations, and it is thought to be important for somatic empathy, the ability to understand and share the physical sensations and experiences of others. Proprioceptive exercises may be useful in helping clients understand the physical sensations experienced by others.

The anterior cingulate cortex (ACC) is involved in the regulation of emotions, and it is thought to play a role by allowing individuals to regulate their own emotions in response to the emotions of others. This suggests that teaching your clients emotional regulation skills can also have an impact on their ability to empathize with others.

Finally, we should consider the role of the prefrontal cortex (PFC) in helping people with cognitive functions like decision-making, planning, and problem-solving that can aid clients in understanding the thoughts and intentions of others. For example, deciding to practice in a “random acts of kindness” program can stimulate compassionate empathy, which can lead to a greater awareness of the importance of helping others.

Incorporating Empathy Training into Your Therapy and Counseling

Nearly every therapy plan includes explicit or implicit goals designed to help clients better understand their own feelings and the feelings of others. To find out if a client lacks empathy, you may wish to administer the 20-question Perth Empathy Scale (see below for this free download).

Therapists can use in-session strategies to promote a discussion of empathy and they should also use therapeutic assignments to help clients learn specific skills in the areas of affective, cognitive, and compassionate empathy.

Examples of in-session strategies include:

Introduce discussion topics that focus on empathy, such as how people express themselves differently and why it’s important to listen to different perspectives. Talking about how everyone has a unique experience and asking clients to imagine what it would feel like if they were in someone else’s shoes can also help promote understanding.

Role-playing activities are another way to foster empathy. This can involve having the client take on the role of someone else, such as a loved one, and expressing themselves from that perspective. It can also involve practicing active listening skills. By listening to someone with the intent to understand, instead of just responding, clients learn to focus on bringing empathy into their relationships.

Mirroring exercises. This involves having clients watch the nonverbal cues and facial expressions of another person and mirroring those gestures themselves. This exercise helps increase the understanding between two people and strengthens empathy.

Problem-solving activities. This involves helping clients find solutions to real-life issues by considering the needs of others. This helps build empathy, as well as collaboration and compromise.

Examples of between sessions activities include:

Practicing active listening to address relationship problems.

Practicing a daily Loving Kindness meditation, where clients focus on compassionate feelings toward themselves and others.

Practicing daily acts of kindness for an entire month.

Doing forgiveness exercises.

Find many more worksheets on the various aspects of teaching empathy with a free trial at, where you will also have access to our Virtual Counseling Room “Understanding Others.”