Interpersonal Neurobiology: Why a Therapist’s Empathy Matters

One person empathetically holds another person's hands in their own.There is nothing more satisfying for me than hearing, “I have been in therapy for years talking about this and today with you is the first time I felt like someone really believed me.” The individual comes to this relief when they sense my intention and ability to hear their story, be emotionally present, and be impacted emotionally by them. Possibly for the first time, the person is “seen” without judgment. And I let them know that I appreciate that willingness to let me in on something that is so personal and sacred.

People occasionally ask me, “How can you stand to listen to problems and complaints all day?” With this attitude a person would never feel emotionally safe and experience my believing them. I tell them, “It is not like that at all. I am so grateful that I can be with people who can open up their hearts and let me in. It is an honor for me that they trust me so much.”

With either child or adult trauma, even if the person has people who genuinely care in their life, they are often left with feelings of loneliness since very few people (therapists included) are able to go to that deep emotional place. This is more than understanding details, the listener must obviously demonstrate that they are emotionally and physically impacted by what they are seeing, sensing, and hearing. Their eyes could moisten, tears could flow, face may soften, and the body language and voice intonation somehow must genuinely show caring.

This is the power and miracle of Interpersonal Neurobiology (IPNB)—that we can influence each others neurology in a significant way. Unfortunately, many of our parents did not know how to give us this gift of being seen, since they never experienced this themselves. As an IPNB therapist we must first find a way to experience this emotional resonance for ourselves with a partner, therapist, friend, lover, or someone else. Unless we know this emotionally, not intellectually, then we cannot possibly give it to another or participate in this exchange.

Making the implicit explicit—not simply that a person exists in the mind and heart of the therapist, but exploring how they exist—gives weight and staying power to the new experience, to balance the pervasiveness of the defenses marshaled against the pain and disappointment associated with intimacy. Moreover, such therapeutic work promotes and intensifies, even accelerates, the process that primes the Reflective Self Function (Fosha, 2000). A therapist’s task is to assist a person in bringing to the surface what is implicit, the unconscious mind. The therapist must enter a person’s world, not as an invader, but as a trustworthy ally willing to fight the enemy. “The enemy of healing is not only trauma; the even more subversive enemy of healing is detachment, trivialization, stagnation, and the loss of feeling and meaning” (Fosha Trauma, Resilience p. 3).

When a person knows that the therapist is truly present with them in the loneliness, this changes their world, their inner reality. For the first time the person is not isolated with the pain. As a result, toward the end of the session when each shares their experience of the session, this person is not alone with the joy, relief, and appreciation. One adult individual once took me to her “torture chamber,” the place where her father raped and threatened her life many times. As a result of that session, she was later able to take a shower without having a 15 minute panic attack. When she saw how touched I was by her progress, and she saw my tears, she believed this had a greater impact on her than the previous “torture chamber” session.

She could see and sense my feelings for her healing and this changed her brain. It reduced her cortisol and adrenaline levels and generated oxytocin. The oxytocin promotes emotional resonance and the resonance generates oxytocin. They feed each other. This exchange is sacred, healing, and spiritual.


  1. Fosha, Diana. (2000). The Transforming Power of Affect. Jackson, TN: Basic Books. pp. 219
  2. Fosha, Diana, Trauma Reveals the Roots of Resilience. Constructivism in the Human Sciences

© Copyright 2010 by Christopher Diggins, MA, LMHC. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • anna

    January 28th, 2010 at 7:48 PM

    Thnaks for the article.I always feraed that the psychatrist dont really bother about our feelings.But after reading the article i feel secure about my feelings in a safe hands.

  • catherine

    January 28th, 2010 at 7:50 PM

    I totally agree with anna.

  • Miley A.

    January 29th, 2010 at 3:15 AM

    I just think it is extremely important for a therapist to convince his clients that their inputs are in safe hands…otherwise they would never be comfortable in telling the whole story, thereby preventing adequate treatment.

  • Eric

    January 29th, 2010 at 5:54 AM

    Therapy was such an eye opener for me, it let me see who I really was inside and the feelings I had kept covered up for too long. My relationship with my therapist is sacred because she is the one who helped me get to that point. Without her I would not be where I am today and for that I am so grateful.

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