The role of client empathy in treatment outcome in a sample of adolescents referred to forensic youth psychiatric services

Starting from the assumption that empathy is crucial in the therapeutic process, the current study explored whether client empathy before treatment relates to treatment outcome, whether client empathy is subject to change in the first six months of treatment, whether such change relates to treatment outcome and whether therapist factors relate to possible changes in client empathy. In total 90 adolescents treated by 31 therapists at forensic psychiatric services participated in the study. Client empathy was assessed with self-report questionnaires of affective and cognitive empathy at intake and again at six months of treatment. Therapeutic change was rated by their therapist. Client empathy before treatment was not systematically related to treatment outcome. Cognitive empathy tended to improve during treatment, stronger in girls than boys, and depending in part on the therapist's gender: Under conditions of a male (not female) therapist boys reported less improvement in cognitive empathy than girls. The most consistent study result was that improvement in cognitive empathy contributed positively to treatment outcome. The study provides new data on the role of client empathy in the treatment of forensic youth psychiatric patients. If replicated, these findings have important implications for treatment and training in juvenile forensic psychiatry.