The Power of Empathy in

Effective Dietetic Counselling
Issue 4
March 2014
G'day! It seems that Issue 3 really struck a chord with many of you. I had some great feedback which is always very welcome. To underscore the importance of the therapeutic relationship in quality Dietetic work I would like to share with you a message I received from Joanne Ikeda:

'I very much appreciate Issue 3 of your newsletter.  For over 20 years, I taught nutrition education and counseling to dietetics majors at the University of California, Berkeley.  The very first thing I taught my students was the importance of establishing an effective helping relationship with clients.  I am glad to see this reinforced in your newsletter.' 
Joanne Ikeda, MA, RD, Nutritionist Emeritus, University of California, Berkeley

In this Issue of Practice Pavestones I am going to be focusing in on one of the core attributes underpinning the formation of this effective helping relationship - Empathy. How does empathy play a role in practicing effective Dietetic counselling?

If this question interests you ………read on and be sure to send me feedback and questions.
Remember! If you are short on time - scroll down to the Pavestone for this issue

Ever wondered about undertaking Supervision ?
One of the most effective ways to enhance your learning and adoption of new skills is to receive mentoring/supervision for your work. If you would like to learn more about this you are welcome to have a look at my service. If you'd like to make an enquiry please feel free to email me. You could consider booking a session with a colleague and practice together between sessions.



 HAES Workshop for APDs 

It is so exciting to be supporting my colleagues Fiona Willer and Fiona Sutherland as they take the HAES message to our profession so I am running this notice again for a second month for new subscribers! They have a workshop coming up in Melbourne May 7th and a date to be announced for Sydney in June.

Here is what they say about the training:
This will be a day of learning about the non-diet approach, extending your counselling skills and how to apply these skills in your practice.  This practical workshop is perfect for dietitians working in private practice, weight management clinics and hospital outpatient services.

For more info go here.


HAES Article Of The Month

Judith Matz, author of 'Beyond A Shadow Of A Diet' (essential reading for working with eating behaviours) has written a very thought provoking article in Psychotherapy Networker this month. Titled 'Beyond Lip Service: Confronting Our Prejudices Against Higher-Weight Clients' it addresses the very current issue of weight stigmatisation in helping professions.

There is much in this article that bears relevance to this issue's topic of empathy. Judith comments on the importance of practicing empathy not just for the benefit of our clients but for our own growth as practitioners - particularly with reference to challenging our own preconceptions. Judith writes:

'In my own journey, I've spent countless hours listening to the challenges and victories of people of higher weights. Witnessing the transformation that occurs when people learn to let go of the shame and treat themselves with respect has transformed me'.

I highly recommend the article. Take a look here.

Shout Out Of the Month!

Goes to my dear friend and colleague Susan Hamilton CMCAPA, RMPACFA.  Thank you Susan for introducing me all those years ago to the power of attending with opennes to 'what is' and encouraging me to 'just be there'.

Susan is an accomplished, professional Counsellor and Psychotherapist and runs a private practice in Sydney's eastern suburbs. You can visit her service here.

'First of all' he said, 'if you can learn a simple trick, Scout, you'll get along a lot better with all kinds of folks. You'll never really understand a person until you consider things from his point of view...........'
'...........until you climb into his skin and
walk around in it'

Harper Lee. To Kill a Mocking Bird. 1960

'A prerequisite to empathy is simply paying attention to the person in pain'

Daniel Goleman

I'd like to start this exploration of the power of empathy by considering a recent real life scenario:

Dietitian: 'Mary, I'm wondering as we near the end of your session today how it was for you to share with me the story of your ups and downs with eating so far?'

Mary: 'It was good -...'

Dietitian: ..(gently) ......'Good?'

Mary: 'Yeah you really understood where I was coming from. I think you can help me'

What Mary is really saying here is that the experience of being understood left her feeling that she could be helped. 

This is the power of empathy in a nutshell. It enables a connection which sits in direct contrast to the sense of isolation that comes with a difficult problem. It is this isolation that often drives despair, shame and entrenchment of behaviours.

With empathy, it is in our power to give our clients a new experience of relating to their problems. If we are able to communicate our understanding of their situation we start to remove the isolation, we increase accepatnce and importantly I believe, motivation. Can you hear the subtle motivational edge in Mary's observation above? This was afforded to her simply by giving her the experience of being understood and accepted. In Carl Rogers' well referenced quote below, the importance of acceptance in the change process is beautifully encapsulated for our consideration:
The curious paradox is that when I can accept myself,
just as I am, then I can change.

Carl Rogers

The evidence base for the effectiveness of empathy as a key change process is well established in the therapeutic setting (Norcross 2011 p132 introduced in Issue 3) and there is no reason to anticipate that Dietetics would be an exception to this established data.

What is Empathy?

Cartoon Source

You may recall from Issue 3 that empathy sits in the hub of our therapeutic work as an essential core attribute but what does 'empathy' really mean? If you read about empathy in depth it quickly becomes apparent that it is a complex construct with many different components and expressions.

For this discussion, I particularly like the simplicity of this definition quoted in Philip Burnard's book 'Teaching Interpersonal Skills" (1989) from an author on nursing skills:
 [Empathy is] The ability to perceive accurately the feelings of another person and communicate this understanding to him'  BJ Kalisch

What I particularly like about this definition is the second part. Entering the perceptual world of another person can have profound power in a helping relationship but our empathic perception needs to be communicated back to our client to really have benefit. This can be done through words, emotions and our bodies. This communication back to the client is where I believe the transmission of acceptance can occur that is so central to insight and the change process.

I also really like what Molly Kellogg RD LCSW  had to say in a recent newsletter of hers about empathy for Dietitians:
'Empathy can be seen as a resonating that occurs in us when we are in the presence of a person experiencing a certain emotion or state. It allows us to recognize and understand what that person is going through. Empathy is what allows us to then feel compassion'.

Resonating - that is a great match for how I personally experience empathy with clients in my work - it's like a sort of embodied 'hum'.

Perhaps take a moment to reflect how you experience a sense of really 'getting' what your client is trying to say.

How do we 'DO' empathy?

Back in my 'Trecky' days this woman was my Hero.

Source Dianna Troy

For those of you too young or just too sophisticated to know who this is I take great pleasure introducing you to Counsellor Dianna Troy - a Betazoid Alien on staff of the Star Ship Enterprize. Betazoids are blessed with a powerful empathic skill (or so the story goes). I used to marvel at the majesty of Dianna's ability to quickly and correctly intuit the lived experience of 'the other' and stay so solid in herself. She was blessed with an alien capacity beyond my human ken and I so wished to be a Betazoid - and look that impressive in a onesy! 

Of course as humans we do posses empathic capacity to varying degrees. Empathic ability can also be developed by practicing active listening and reflective skills in the context of a willingness to allow the client to express themselves fully.

Brene Brown Ph.D LMSW is a research professor at the Univeristy of Houston Graduate School of Social Work and I am a great fan of her work on vulnerability and shame. She discusses four essential components of empathic communication identified in a study researching a diverse range of professions in which empathy is important. She summarises these components as:
  1. Perspective taking - recognising the client's perspective as their truth
  2. Staying out of judgment
  3. Recognising emotion in other people
  4. Communicating that recognition.

There is a popular animation available on line here which brings Brene Brown's views on empathy to life in a very entertaining way. Whilst she is talking particularly about empathy in personal relationships it bears relevance to how we may consider empathic communication in professional relationships. I really encourage you to have a look. I particularly enjoy her observation that when appreciating the power of empathy  'rarely can a response [solution] make something better - what makes something better is connection'

There are a couple of points in Brene's clip that in my opinion could lead us astray when practicing empathic communication in professional relationships. I think they are important to discuss without wanting to detract from Dr Brown's powerful work.

Firstly, if we have a client sitting down the bottom of a deep dark hole, I would NOT be recommending that we climb right down into the hole and sit there with them! Empathy is not being exactly where our client is - it is understanding their experience of being where they are and communicating acceptance of their reality. Joining with our clients too closely runs the risk that we lose perspective and potentially get stuck ourselves.

The second point I want to comment on in Brene's animation is that I am not sure it is entirely helpful to say directly to our clients 'I know what it is like down here [to be you] - You're not alone'. The ideal outcome of empathic communication is to imply this through our active listening and reflective responses. It is not enough to simply say 'I hear you'. For the client to have the true benefit of being heard they must experience the process of our skillful listening and reflective sensitivity as this models the all important acceptance process. It also provides opportunity for the client to clarify and fine tune their own understanding of what they think they 'know'.

I will be writing more in future Newsletters about active listening and reflective responses but wanted to provide a short exchange as a demonstration to bring some of the empathic concepts together. Lets take a snippet of conversation from what may have preceded the exchange at the beginning of the newsletter with Mary and her Dietitian:

Mary: I have been dieting for 25 years and all I seem to get is bigger. It is miserable for me now (tears in eyes) I have no idea what to feed myself and eating has become a constant battle

Dietitian: 'Hmmmm... I hear that dieting has taken a real toll on you over many years and if I am getting things right Mary, it leaves you confused and in conflict with yourself.............(sensitively) I get a real sense of your sadness about that'.

Mary: 'Yes I am very.....very .. unhappy about where things are at,...(deep breath and quiet tears). The worst of it is the sense that I have done this to myself'.

Dietitian: ' mmm uhu......., that you are somehow to blame. (pause, hands tissues). It saddens you deeply'

Mary : 'Yes,......   thank you (taking tissue)'. It is a total mess and I am ready to stop this crazy business'

Dietitian: '..(tentatively) .....the time has come for something new, something better for you'

Mary: 'mmmm...........(considers) ... maybe not new, maybe something that I used to do, I used to know how to eat well!'

Dietitian:  'uha -so finding that again in yourself, your knowledge of how to eat well'

Mary: 'Yes! Absolutely'

Dietitian: 'yeah, wow..... there is something really powerful in that idea for you'

You might like to reflect on this exchange. What stands out to you? Is there something in the Dietitian's capacity that you see in your own work or anything you would like to develop and introduce more of?


There was lots of competition for this months soundtrack - there is so much empathy in music. I have chosen R.E.M.'s 'Everybody Hurts' for its beautiful truth about our shared humanity and also the wonderfully creative film clip featuring the glimpses of our inner experiences. Have a look and enjoy a little time out. 

Issue 4 Pavestone: The Power of Empathy in Effective Dietetic Counselling


Nutrition is a science. Eating is a behaviour.

Behaviour change is difficult.

Empathy is an evidence based, key component of the therapeutic relationship and human change process

Empathy is the ability to accurately perceive the lived experience of another, emotionally, cognitively and bodily and reflect that understanding back to the other 

Empathy requires a sensitive perception and a willingness to put our agenda to one side as we appreciate the reality of another

Empathy relies on the skills of active listening and reflective responding

For empathy to be safe and therapeutically valuable it is important for the clinician to maintain a solid definition of themselves as separate to the client

Suggestions for Reflection:

What do my most effective client interactions tell me about the importance of empathy?

What do my most challenging client interactions suggest are my barriers to empathy or my learning edges?

What are my innate qualities that facilitate my empathic ability?

What skills would I define as important to practice to continue to develop my empathic ability?


Enjoy experimenting!
Keep reflecting!


I'd love to hear your thoughts, curiosities, insights. Please email me to let me know!

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About Tara MacGregor
Tara MacGregor is a dual qualified Accredited Practising Dietitian and Counsellor & Psychotherapist in private practice. Graduating from Sydney University in 1991 she has worked in a broad spectrum of clinical areas in public and private hospitals until specialising in disordered eating in 2004. Tara works exclusively in the non-diet paradigm and is passionate about teaching and promoting the Health At Every Size (R) philosophy. Tara provides skills training and mentoring in the form of clinical supervision for Dietitians and enjoys tremendously the exciting opportunities, insights and growth this offers both herself and supervisees.

Make an enquiry about supervision and mentoring with Tara