Anyone who has ever had to deal with a healthcare professional with bad bedside manner, understands the importance of empathy. Just last week, a friend and I got into a discussion about why it’s so difficult for doctors to understand their patients. At one point I joked that maybe it should be mandatory that any doctor practicing a specialty should have to be afflicted with the very problem they are treating as a prerequisite to being able to practice that specialty. That way, there would be no doubt that your doctor has a very personal understanding of what you are going through. Admittedly, maybe my comment is a little unrealistic, but wouldn’t we all like to feel that understood? Does your doctor’s empathy really make a difference in your recovery? Is the difference a positive one? Just how much empathy is too much?

A recent article by Richard Friedman, MD, published in the September 26th issue of NY Times, tackles this very issue and how it relates to the treatment of depression. In the article Friedman recounts his treatment of a middle-aged man suffering from chronic depression. During initial consult, the patient, who had been going to therapy twice a week for a period of six years with another therapist, reveals to Friedman that his current therapist is “Warm, understanding and always available” but that he also doesn’t feel like he is getting better.

How can anyone attend therapy sessions twice a week for six years and not see any improvements?

Friedman suggests that the problem may lie in therapists exhibiting too much empathy toward their patients. Too much empathy paints a very bleak picture for some patients by implying to them that they have very little control of their future due to circumstances surrounding the source of their depression. While in a lot of cases, depression relates to circumstances having occurred in a persons’ past over which they had no control, it is important to realize that with depression, as any other health issue, a patient MUST take responsibility for their treatment in order to reap any benefits from therapy. Otherwise the patient is doomed to have, as Friedman puts it “chronic dissatisfaction” rather then chronic depression.

Friedman ends the article with a disclaimer stating “This is not to say that there aren’t lots of patients who haven’t experienced terrible trauma — sexual, physical, verbal and emotional — for whom empathy and understanding are critical and corrective” but that for “the majority who were not really traumatized, psychotherapy can become a sterile ritual of self-reflection without responsibility or action.”

The next time you have to deal with a doctor who you feel doesn’t have your best interests at heart; ask yourself if they are really a nasty person or they are just asking you to take responsibility for your treatment. As Friedman’s patient told him several months after his course of treatment had ended; “You weren’t nice, but I think you helped me.”