The Dual Nature of Empathy: Exploring Its Role in PTSD Symptoms Among Psychotherapists Following a Mass Casualty Event

Objective: Psychotherapists face a risk of posttraumatic stress disorder (PTSD) due to exposure to appalling details in therapy. Such risk is elevated during mass casualty events, which increase therapists’ workload and ratio of trauma survivors. While therapists’ empathic capacities are vital for therapy outcomes, empathy may increase their vulnerability to PTSD. We examined empathy’s role in the relationship between therapy-related traumatic exposure and PTSD symptoms following the October 7, 2023, terrorist attack in Israel. Method: Seventy-three Israeli therapists (88% females) who were not directly exposed to the attacks were included. PTSD symptoms, empathy, and exposure to traumatic content in therapy were examined. Empathy was assessed using the Interpersonal Reactivity Index, which evaluates four components: perspective-taking, fantasy, empathic concern, and personal distress. Moderation analyses were performed to assess moderation by the components of empathy on the relationship between therapy-related traumatic exposure and PTSD symptoms. Results: Eighteen percent of participants scored above the threshold, indicating probable PTSD. Empathic concern and fantasy each moderated the relationship between exposure in therapy and PTSD symptoms. Specifically, higher levels of empathic concern and fantasy amplified the association between exposure and PTSD symptoms, with participants showing greater empathic concern or fantasy tendencies experiencing more pronounced PTSD symptoms when exposed to trauma in therapy. Conclusions: While providing care to victims of mass casualty events, therapist’s tendency for empathic concern and fantasy, which may contribute to treatment success, may also increase the therapist’s vulnerability to PTSD. The results highlight the importance of adequate training and supervisory support for therapists in disaster contexts.