Episode 258: Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons

By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Other Places to listen: iTunes , Spotify Connect with Dr. Flemons: contextconsultants.com Empathic Engagement in Clinical Practice: A Deep Conversation with Dr. Douglas Flemons (00:00) Puder: Welcome back to the podcast. I am joined today by Dr. Douglas Flemons . He is a marriage and family therapist who later got his PhD. He taught marriage and family therapy for 30 years. He has worked actively with topics like suicide, and today we're going to be talking about a recent book he wrote, Empathic Engagement in Clinical Practice (2026). So yeah, welcome to the podcast. Flemons: Thanks for inviting me. Delighted to be here. Puder: So I understand you're in North Carolina now? Flemons: Yes. At the moment, I'm in south Florida because it's very cold in North Carolina. But yes, I live in Nashville. Puder: Okay. Where in south Florida are you? Flemons: In Fort Lauderdale. Oh, when I was teaching at the university, we lived here. So we're just back visiting friends and getting work. Puder: Wonderful. So yes, tell me some misconceptions on what empathy is and how you define it. Maybe we could start there. Common Misconceptions About Empathy vs Sympathy in Therapy (00:56) Flemons: A lot of people conflate empathy and sympathy, and that's not just run of the mill lay people, but researchers, the theoreticians. They don't have any clear way of distinguishing between them and so they use them interchangeably, often. And that runs you into some trouble when it comes to trying to engage empathically with your clients. If you approach it from a sympathetic mindset, you can find yourself in a world of, I don't know about world of hurt, but a world of complication. Puder: I feel sorry for people that find themselves in a world of hurt. Flemons: “Feeling sorry for” is a sympathetic response. You feel bad and you feel bad along with them, and then you then feel bad for the fact that they feel that way. So that lands you in the world of sympathy. And it's something that comes to us naturally. As humans, we're wired in such a way that if you're demonstrating pain and I'm close with you, or I care about you, or you're important to me, then my brain's going to fire in very similar ways to what's happening to you. And that's just automatic. That's sympathy. But that's not empathy. Empathy doesn't happen to you. Empathy is something you pursue. Why Sympathy Creates a Ricochet Effect, Victimhood, and Loss of Agency (02:24) Puder: Yes. I think that often when people experience sympathy from others, they're experiencing it from friends. It can feel almost weighty for me sometimes to have sympathy from friends because then I feel like, “Oh, I'm making them feel bad and sorry.” I'm then feeling bad for their experience. Flemons: Yes. So it can become sort of this ricochet effect. You feel bad, they feel bad for you, now you feel bad that they feel bad, now they feel bad that you feel bad about them feeling bad about you, feeling bad. So that can get pretty twisted. But it's also,... there's a quality… I don't know if this happens to you, but if somebody feels bad for me, it somehow diminishes me. Puder: Hmm. Flemons: Oh, you poor thing. Puder: It kind of puts me in the victim. Flemons: Yes. Puder: Exactly. I'm a victim. Flemons: And I think that happens kind of naturally because we have a sympathetic response for people who have had unfortunate experiences. So if you're helpless or hapless, it's easier for the person to have sympathy for you than if they think that you're responsible for whatever negative experience you're having at the moment. So the feeling of sympathy automatically imbues the person with some quality of helplessness. Puder: Subtly. Flemons: Subtly. Puder: Yes. Flemons: And so that if you're the recipient of that, you mentioned the victim, victims have no agency. So if you're the subject or the receiving end of sympathy, there's a quality that your agency has been diminished or stolen from you in that quality of emotional connection. Puder: Yes. But what if the person's empathic experience of themself, or the experience that they're having is one of a victim and, I feel like I am a victim. The world is all against me. Flemons: So, I can have a sympathetic response, “Oh, David, you poor thing for feeling like a victim.” So that's certainly possible, but an empathic understanding of that doesn't have me feeling bad for you. It has me exploring the intricacies and the complexities of how it is that you're orienting to the world with that kind of belief system. Cognitive vs Affective Empathy Debate and Lisa Feldman Barrett’s Insights (05:03) Puder: Do you think it's helpful to split empathy up into cognitive empathy or affective empathy? I see these kinds of differentiations in the research, compassion and empathy being the third one. Flemons: Yes. It's a very common division in research, cognitive and affective. I'm a big fan of Lisa Feldman Barrett's work on constructive theory of emotion (2017). And she makes the point in a bunch of different writings that there's no such thing in the brain as an affectless cognition. You can't have pure rationality in logic. It lives there. In philosophy, there's this idea of, if we're going to champion rationality over emotionality, but at the level of brain function, she says, you can't locate a thought that doesn't have an affective connection to it. And an emotion, she says, is a category of experience. So it's feeling. It's affect. But there's a cognitive spin that is placed on that affect in order for it to be recognized and felt as an emotion. So that division between affect and cognitive empathy is an after effect, a downstream after effect, of that kind of split. But if the brain doesn't operate that way in the first place, then I think the division doesn't make as much sense. So I think of it as, instead of affect of empathy, cognitive attenuated empathy. That is, there's not a hell of a lot of cognition going on, but it's not absent. And same thing, cognitive empathy being affective attenuated empathy. There's still an affective quality in it. So I don't find it an incredibly useful distinction. Puder: Okay. So when you kind of

You can listen to Episode 258: Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons online on Radio and Podcast. Open the player on this page to stream the available audio.

Episode 258: Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons is an episode from Psychiatry & Psychotherapy Podcast.

The episode duration depends on the source podcast feed and may not always be available.

This episode was published on Feb 20, 2026.

Yes. Use the heart button on the episode page to add it to your favorite episodes list.

Yes. This page shows related episodes from Psychiatry & Psychotherapy Podcast when more episodes are available from the podcast feed.