How Helpers Empathize may Affect Their Personal Well-being

Researchers distinguish between two different forms of perspective taking and examine their impact on helpers’ wellbeing


Recent findings on how helpers respond to the distress of others challenges existing notions that “walking in one’s shoes” is the best way to empathize and provide help. A study conducted by Buffone and researchers, published in the Journal of Experimental Social Psychology, argues that there are two distinct forms of perspective taking that have measurably different effects on the helper.

“No research has examined consequences on the helper while the helper is actively engaged in a helping task. This is particularly noteworthy because the act of helping itself poses distinct emotional burdens on helpers, such as the strain of performing a difficult task on someone else’s behalf and it also poses distinct emotional rewards, such relief of distress in response to another’s suffering.”

Empathy Sensitivity Meet Head Face Friendliness

Engaging in helping behaviors has been shown to have both positive and negative effects on the helper. Buffone and a team of researchers were interested in understanding whether these effects were a result of how people go about helping. More specifically, they examined different styles of perspective taking.

Some studies point to two distinct forms of perspective taking referred to as imagine-self perspective taking (ISPT) and imagine-other perspective taking (IOPT). While both forms involve compassionate and empathic feelings for the person struggling, they differ in how helpers are able to separate their own experience and the experiences of those they are seeking to help. Those engaging in imagine-self help are more likely to display greater self-related thoughts and fewer other-related thoughts, demonstrating that they were merging the other person’s experience with their own. Imagine-other perspective taking involved greater self-other distinction overall and did not result in the same heightening of personal distress that has been seen to be taken on by ISPT helpers, who personally experience that distress and other negative emotions.

The differences between these two forms of perspective taking have been supported by fMRI (functional magnetic resonance imaging) research, according to the authors. Findings from fMRI studies also suggest that the experience of “putting oneself in another’s shoes” (ISPT) may occur automatically or unintentionally while maintaining a clearer distinction between self and other (IOPT) is a more deliberate process.

In seeking to further understand the different consequences of engaging in imagine-self versus imagine-other perspective taking on helpers, Buffone and researchers investigated three primary questions and accompanying hypotheses. Based on the already existing literature, their team expected that helpers engaging in imagine-self perspective taking, who experience the target’s struggle as their own, would experience stronger negative emotions. This form of perspective taking, they hypothesized, would also result in the helper experiencing the situation as more demanding and physiologically threatening in comparison to helpers who used imagine-other perspective taking and to helpers who simply remained entirely objective.

They also sought to examine whether helpers’ perception of the situation as more or less demanding determines how perspective taking results in helpers experiencing the situation as a threat or as a challenge. Finally, the researchers wanted to find out whether further evidence would support that feeling one’s pain as one’s own (ISPT) leads to debilitating personal distress in contrast to separating oneself in the dilemma (IOPT), which is said to involve other-focused, benign distress.

Participants (N=202) were asked to respond, through a video recording, to a written account of a person facing a conflict. They were told that they were tasked with helping a fellow participant when in actuality, the story was of a fictional person. Participants, who were mostly comprised of undergraduate psychology students, were randomly assigned to imagine-self, imagine-other, and objective reading conditions. Their recording consisted of their recounting of the person’s dilemma and their response to the problem. During the course of this process, data was gathered through multiple assessments of self-report and physiological monitoring.

“This study is the first one that assessed effects of perspective taking on physiology during pursuit of a helping task and therefore the first study to our knowledge that directly tested whether different forms of perspective taking could modulate the effects of helping behavior on helper’s health and well-being,” state the authors.

The findings supported the idea that imagining another’s struggle as one’s own leads to a greater state of physiological threat, which may be arousing enough to be debilitating, versus maintaining an emotional distance while engaging in helping. Additionally, as helpers perceived the situation as more demanding, they were more likely to experience it as a threat rather than a challenge. Finally, participants who self-reported their distress in response to the dilemma were those that experienced physiological threat in the imagine-self condition.

In some ways, these findings counter previous research or colloquial suggestions that “affective empathy” results in better help. The authors write:

“The current research, however, may shed doubt on the ability to imagine oneself in another person’s shoes without such emotional resonance, suggesting that such cognitions may naturally induce vicarious distress.”

Buffone and team comment that such vicarious distress may even lead to helpers abandoning the pursuit of their goals to assist, and therefore, further research should look into how the experience imagine-self vs imagine-other perspective taking might impact the likelihood and quality of helping. The current study is limited, they add, in that it reflects responses to one scenario at one point in time, a condition that may not be reflective of real-world helping circumstances.

“We hope that this research may help generate new insights into the interplay of perspective taking, and its underlying states, namely self-other overlap, contagion, empathic concern and distress, in individuals’ health and well-being, and ultimately on targets of help, as well.”



Buffone, A. E., Poulin, M., DeLury, S., Ministero, L., Morrisson, C., & Scalco, M. (2017). Don’t walk in her shoes! Different forms of perspective taking affect stress physiology. Journal of Experimental Social Psychology. (Link)


  1. This completely meshes with my personal experience in helping situations. I find that I am much less emotionally effected by volunteering at the food bank for example than I am when I am moved to give money to a homeless person on the street. The former is somewhat removed from the person in need of help and I I feel a reward for “doing my part”, so to speak, and the latter results in a feeling like I’m not doing enough to help in someone’s immediate time of need.

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  2. Zenobia,

    as a helper, this is an interesting study…I think this area, the occurrence of distress in the helper, is one of the greatest areas in which a good therapist/counselor could help because there were so many things in my wife’s healing that NO counselor/therapist could ever do in my place because I was in the trenches 24/7 with her. But if I had had someone to help me sort thru all the distress that the process brought my way, it would have helped a lot.

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  3. When a helper takes on the experience of the “helpee,” they generally set up a situation where the “helpee” feels like they have to take care of the helper because of their distress. I’ve always felt the best approach is to put oneself into the helpee’s shoes long enough to get a sense of what is going on, but then backing away and looking at the situation from a more removed perspective. That way, I can ask relevant questions and suggest options without being invested in whether the person I’m helping agrees with me or not about my assessment. This is critical to the person feeling empowered, and empowerment is at the core of any kind of healing, IMHO.

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  4. An important study done incorrectly!

    We are talking about a relationship here, right? It’s about helper/helpee.

    When you tease this apart and artificially look at just one part, and with a story that is not real, how can you expect to determine something valid and useful?

    This is the problem with reductionist science looking at a wholistic problem.

    Perhaps it might be better to look at this in a peer support group setting and monitor individual responses to one person’s pain, and how the group setting helps out all of the members.

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  5. the author might find this interesting –

    Comments included – “This is not “rare.” It’s called being an empath and medical intuitive. The doctor is one and the medical model is trying to make it a big scientific deal. It’snot. He needs a spiritual teacher to show him how to disconnect it and turn it into insights about the diagnosis instead of feeling the physical pain. I had to learn how to do this myself after feeling the significant physical pain of several clients.”

    and “When I was a doula I would feel when my clients were going into labour before they even paged me. When I was with them I felt their labour contractions and this would guide me very well to understand what to do to help. I often knew weeks ahead of the birth how things would go. Luckily for me I experienced this without the actual pain. But with my children it is different. I DO often hurt where they hurt and get their symptoms but not as dramatically.

    and “when I was active in Therapeutic Touch I would know when my clients needed a bedpan in the middle of the night – and when the nurses were not responding to them. I also knew when people were about to take their own lives – i.e. attempt suicide.”

    William Bengston has done a lot of fMRI research on healing – when he is in ‘healing’ mode the same site in his brain lights up as does the site in the healee’s brain.

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  6. Lordy:

    This summary was not written for a layperson. I was searching for the ‘nugget’ in the hopes that there is some take away from this study that could be applied to my own situation with my daughter, especially because as Steve McCrea pointed out, caregivers can inadvertently cause a role reversal in which care receivers must nurse the caregivers emotionally)

    My frustration with this summary is that the nomenclature used is not the language of real life. Don’s comment captured the spirit of frustration I feel around this study because it was based on fictional relationships. The heavy use psycho babble made it inaccessible.

    For family members who are caregivers for a loved one in distress, what are real-life techniques for avoiding compounding the distress felt by a loved one? Not sure if this study offers anything practical to the body of knowledge already in existence, such as that accrued, as Don points out to the efficacy of peer support.

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    • The very first thing I had to do was work thru my own issues. Part of staying in a dysfunctional relationship for me was ‘owning’ the decision to do so. Until then I had a LOT of anger issues because I did NOT sign up for this in my mind! Who signs up to essentially raise his wife with a lot of littles(young ‘alters’) ruling the house 95% of the time at home? So I did a lot of journaling to deal with my issues and also understand why I was choosing, again, to stay in the relationship. Once I did that I was able to accept the fact that emotional pain would be a regular part of the relationship. And once I had made an informed decision, I rarely lashed out at my wife after that.

      Now I can share my distress with my wife…and leave it at that. If she is in a place to help, that’s great. If not, I understand it’s part of the healing journey and I hold on to the hope that someday as she heals, the relationship will become more healthy for both of us.

      Another important way that helped me deal with the distress of my situation was finding ‘safe people’ for me to share with outside our marriage. My family of origin was NOT safe. I think they essentially wanted me to get rid of my wife like my older brother got rid of his wife who had issues. However, my uncle who lived in town was a safe person. He could listen to me pour out my distress without trying to turn me against my wife. And even though he was ignorant at first of what I was going thru, over time, he became more understanding and so he could ask informed questions and be excited as my wife healed and progressed.

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  7. Then again, it occurs to me, what harm is it really, if a care receiver emotionally nurses a caregiver at times? Isn’t this the normal give and take of people in relationships? Why would we expect that a person, even one in the deep throes of distress, is incapable of emotionally supporting and/or nurturing others?

    A person who is already reeling from a lack of identity an a severely battered self esteem stemming from the “ceremony of degradation”–not sure who gets the credit for that term–represented by psychiatric diagnosis and psychiatric harm–may actually benefit from such a dynamic. People who have the resilience to rebound emotionally from the harm inflicted by them by well intended treatment providers and family caregivers have an amazing ability to offer appropriate insight and emotional support to other non-psychiatrized individuals. It may well be that such a role reversal from care receiver to care giver is the means to find the ‘way back home.’

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    • I agree with you, when we’re talking about a lay person being a caregiver. When it is a paid staff person, however, the client should be the focal point and the caregiver’s goal should be to be as helpful as they can to the client without letting their own immediate feelings drive their decisions. Not saying that having and sharing feelings in a therapeutic setting is always a bad thing (I do it a lot) but it needs to be done because it’s good for the client, not because it makes the professional feel better. And I’m speaking from very direct experience here. Happy to share an example or two if need be.

      Always a pleasure to hear from you!

      —- Steve

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      • Steve, this goes to the heart of the question, why have professionals in the field of mental health in the first place? Why not teach regular people like me practical skills like non violent communication and emotional CPR?

        I think professionals fool themselves into thinking they can remain objective while struggling to meet the standards of conduct dictated by their
        particular guild.

        I think the best qualities that any caregiver or treatment provider can bring to the table for people in distress: a sense of curiosity, an ability to suspend judgement, and the ability to maintain perspective. I’m not sure how much of this professionals can learn in school. In fact, many of these qualities may actually be considered suspect and individuals who exhibit such qualities may actually flunk or wash out.

        When Dr. Mosher established the Soteria house, they experienced enormous success by hiring staff who did not have training in psychology and other traditional precursors to counseling. That having been said, I do regularly seek the services of therapists and counselors.

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        • I agree 100%. There is no training for the kind of ability to be present and non-judgmental and patient yet firm that is needed to be a true helper. I started out in the field by the back door, and had only a three-hour group processing class under my belt. I think this worked hugely to my advantage, because I knew I didn’t know anything and I also knew the only source of the information I needed to figure out what to do was the clients themselves. So I asked them questions and learned from them and I developed my own “theories” based on what actually seemed to work.

          I had one other advantage: I had already had some very good therapy and worked through a lot of my childhood issues, so I knew what good therapy looked like, and I also knew how to separate what was my emotional reaction from what was the client’s need. This is the real “training” for therapy, the only training that will really help – learning to understand and respect how your own life was shaped by your childhood and adult experiences and how to change your perspective on your own life. Absent that, 20 years of “clinical training” will do little besides make you feel like you should know something that you really don’t.

          — Steve

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          • Steve, I kind of had a similar start with my wife. The first couple of girls to come out BEGGED me NOT to read the literature out there on d.i.d. because they liked what I was doing ‘naturally.’ And so I made a point of asking lots and lots of questions, learning to see things from their perspective, and dealing with my own issues, and it really seemed to work. Only a few years later did I think I should become ‘educated’ on the subject when I started blogging and then I realized how ‘wrong’ I was doing everything…until I started reading about attachment theory…and it was like a blueprint of what I had done to help them heal.

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    • Madmom,
      I believe I may have suggested to you before to find literature on attachment theory for adult relationships. There’s not nearly as much out there as for children, but there is a growing body of works. And attachment theory makes clear that adult attachment relationships SHOULD be reciprocal in nature. In fact, that’s been the most painful part of my 29-year marriage: the lack of reciprocity. However, as my wife has healed, she has naturally become more attentive to my needs and feelings…and that’s as it should be. It should be NO different in an adult, parent/child relationship. And I would argue that to keep it asymmetrical would be a bigger problem than to encourage your daughter to ‘give back’ to you like you do to her: that’s a sign of healing, growth and maturity.

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      • I can identify so much with your feelings. Yes, the most painful part of my 19-year-old marriage has been the lack of reciprocity. Even when my husband starts to look like he is feeling empathy toward someone else, he just ends up turning the focus back to his own distress. Because the victim role is very hard to let go of, and so there is always the temptation to stress that he is the bigger victim – the other person isn’t suffering nearly as much as he is.
        But I know that I also have to look at my own codependency issues when it comes to being vulnerable and showing my own distress, rather than continuing in the “rescuer” role.
        That’s why healing has to happen within relationships, and none more productive than marriage. And I also wish that there was more help and concrete advice for people in my situation, who end up de facto being therapists 24/7 without the knowledge or tools. If anyone can recommend any good books I would be very grateful. Thank you

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        • I read a lot of marriage books the first 20 years of my marriage: most of them weren’t very helpful. I finally decided to work on myself, and as I did, my wife began to see her own issues and realized she was NOT treating me well. At that point she finally told me she needed to get help…and then began our journey thru her d.i.d. which stirred up all kinds of other issues that I thought I had dealt with and so I spent another couple years figuring out why I was still in the marriage. For me the best thing I ever did was begin a daily journal so I could figure out who I was and what was important to me. Once I was settled on that, then I could help my wife heal because her issues no longer triggered mine. Not saying her issues still don’t cause me considerable, daily pain, but I now understand what staying in this marriage with her means and my goal is for a win/win situation for both of us.

          As far as specific books, I really can’t recommend any, I’m sorry, but once I learned about attachment theory, it helped me become more purposeful in the way I interact with her so that we are in the healing journey together rather than ‘combatants’. Now I see her issues as the enemy and not her, and that was a huge distinction in my mind.

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          • Thank you so much for this. I’ve gained a lot from your insightful comments and experience. I’m sure others have too.
            “Seeing the issues as the enemy, not the person.” I have to keep that one at the forefront of my mind. And yes, to work on my own stuff so that I don’t keep getting triggered.
            Thank you also, madinamerica, for providing this forum. It’s the only place where I feel among the like-minded who understand what it’s really like.

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          • I think for further clarification… another reason it was important that I deal with my issues first, is it made my wife feel secure in our relationship. For years we had argued about who had issues, and she always quipped that I was the one with the problems…and yes, it is true that we all have issues, but the bigger issue was for her as an early, childhood trauma victim, she never knew what it was to be ‘healthy’ and so she had no baseline from which to understand ‘healthy’ adult relationships because of her own trauma and her parents were no more healthy than she. Thus, when I began to work on my own issues, not only did it make hers more glaring in her own sight, but more importantly, it was no longer a combative situation of me trying to force her to change…now I was leading by example and willing to become a better man for her without trying to manipulate her to do the same…

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          • Sam

            You sound like an amazing person who has found the most unique perspective and way of looking at things I have ever read. I wish I had met you many years ago. I who am a PHD biopsychologist know and believe what I have read in so many books and articles which change from day to day many of which I now believe are very blaming and critical and contribute to the voices which I believe you have said are just repetition of what we are told. It seems you have learned from lived experience that can’t be taught in books.

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          • Sam

            As I read your posts about your wife I wonder if d.i.d is possible in males. In my life I have had many diagnoses including schizophrenic, depression, manic depressive, OCD, panic disorder, generalized anxiety disorder, being co-dependent, considered extremely self absorbed. At times fiercely independent and at other times feeling helpless to the point of rocking and trying to sooth myself and feeling unbelievably frantic and panicked when stressed and alone, extremely self critical, and judgemental. Having extreme patience and empathy and then at other times feeling and acting sadistic and rageful. I am unable to sustain healthy female intimate relationships. I gravitate toward abusive or cold detached women for intimate relationships.

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          • Hi Helpstillneeded,
            as Steve has already said, yes, d.i.d. is most definitely possible in males, too, because it’s basically childhood, trauma-based dissociation that becomes systemic over time: something that easily touches both sexes. And it’s one of those sliding scale things, so I see a lot of evidence of bits and pieces of it even in people who are generally considered ‘healthy’. So even if a person wouldn’t be considered to have full-blown d.i.d. they could still show a lot aspects of it, like the dis-integration you feel and see in your own life…could be milder forms of dissociation even if they don’t rise to the level of the complete dissociation my wife experienced…or they could be full d.i.d. My wife appeared VERY normal and healthy much of her adult life to everyone except me: she couldn’t hide her issues within the intimate areas of our marriage, but I was too ignorant and naïve at that point to understand what was going on since she is the only woman I have ever been with.

            Thank you for the compliments, too. My experience and understanding were forged in the fires I walked with my wife. It’s not that I’m so great, but I love my wife and couldn’t leave her in this mess and so I HAD to figure out how to help her…and ISSTD really doesn’t understand what they are talking about in all their protocols and guidelines they put out concerning d.i.d. If you look at their guidelines on their website (, it’s kind of sadly funny, but so much of what I do is the exact opposite of what they tell the world is the ‘best’ methods of helping someone with d.i.d. Attachment theory is the foundation of most of what I do with her, but I also use other concepts like neural plasticity and then things I learned along the way which are specific to d.i.d.

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  8. There is a question if both of these forms may be called empathy, as the two forms can be experienced as having much in common with the distinction between empathy and induced suffering: “When we suffer contagiously over another’s pain, it is tempting to call it empathy. It makes our reactions seem noble. But induced suffering instead can make us withdrawn, angry, and even dangerous” (Breggin, 1997, p. 45).

    From my own experience of written victim narratives I have become aware of at least two possible ways of reading them. One of them is to seeing the beauty in it, the values of another’s humanity as a person and their rights to respect and social support. In this kind of response the reader come forward with deeply respect for the other and his/her way of trying to do something active about his/her situation, and become empowered to join the journey of the other for the support of the other. In contrast to this, there is a way to read it that looks rather negative and angry, as if the victim narratives adds to a collective suffering that become lesser being buried and hidden. In this kind of response the reader come forward with criticism of the other for writing about the negative experiences of his/her life, and sometimes also an assumption about the other’s own emotional and cognitive response to his/her story that may as likely be totally wrong as correct; like an assumption that the other suffer more in writing the narratives when the truth may be that writing them is a process of healing.

    My experience from written victim narratives are confirmed in Diana T. Meyers (2016) book: Victims’ Stories and the Advancement of Human Rights, and it point to the crucial distinction between empathy and other reactions that looks like empathy but is different and maybe also absolutely opposite to empathy. In being helpful, this distinction, either if it is seen as different forms of empathy as ISPT and IOPT, or as different kind of reactions, is import to acknowledge and be aware of. But this acknowledge and awareness may not be enough, as they pose the question: “What is it behind that make one respond with ISPT rather than IOPT?”

    Breggin, P. R. (1997). The Heart of Being Helpful: Empathy and the Creation of a Healing Presence. (Kindle Edition). New York: Springer Publishing Company Inc.

    Meyers, D. T. (2016). Victims’ Stories and the Advancement of Human Rights. (Kindle Edition). Oxford: Oxford University Press.

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