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  • Writer's pictureBernard Beitman, MD

Physiological Empathy at a Distance During Psychotherapy

Distressing symptoms of patients may resonate physically with therapists.


Key Points

  • Research suggests closely bonded people may experience the pain or distress of the other at a distance.

  • A person empathically resonating with someone in a different location can be referred to as simulpathity.

  • Several case examples suggest simulpathity can occur between therapists and their patients.


An undercurrent flows between patients and therapists, fueled by a combination of patients’ words, their tones of voice, their facial expressions, and other nonverbals through which therapists can enter into their patients’ lives. Therapist and patient can become attuned to each other, to resonate together. Sometimes through that attunement therapists may experience the distress of the patient at a distance. Jungian therapist Robert Hopcke (1998) reported a disturbing dream the night an ex-patient was attempting an unsuccessful suicide. Psychologist Frank Pasciuti reported to me that he experienced an episode of atrial fibrillation around the time a patient of his was also in the act of a failed suicide attempt.

Jung’s headache—a mirror image simulpathity

Around midnight, Carl Jung had returned to his hotel after giving a lecture. About two o'clock he awoke with a start, feeling that someone had come into the room, but no one was there. It then occurred to him that he had been awakened by a dull pain, as though something had struck his forehead and then the back of his skull. The following day, he received a telegram saying that his patient had committed suicide. He had shot himself in his forehead. The bullet had come to rest in the back of his skull. The pattern of Jung’s headache resembled the path of the bullet through his patient’s skull. (Jung, 1989) While Hopke’s and Pasciuti’s experiences were contemporaneous with the distress of their patients, they do not illustrate the mirror image physiological responses at a distance like Jung’s. These mirror image simulpathities between therapist and patient are rarely reported.

Simulpathity research

There is systematic research about events like Hopke’s and Pasciuti’s involving closely bonded people. One person experiences unexplainable distressing emotional or physical sensations around the same time as the person at a distance experiences greater distress. (Coleman, Beitman, & Celebi, 2009). Twins are especially prone to simulpathity (Mann & Jaye, 2007) as are mothers and children, as well as other family members and close friends. (Stevenson, 1970). However, simulpathity research has yet to include therapists and patients.

A mirror image simulpathity between friends serves as an analogue to the therapist-patient ones. An illustrative example was reported by Jungian psychiatrist Jean Bolen (1979):

“Judy Vibberts was having a pleasantly relaxed afternoon in San Francisco’s Golden Gate Park, when precisely at 4:30 (she unaccountably noted the time) Judy was suddenly struck by excruciating, doubling-up abdominal pain, accompanied by a splitting headache. That evening, she found out that a good friend had been in a terrible accident. Her car had been smashed, causing severe abdominal and head injuries. She had been taken immediately to a hospital, needed emergency surgery to remove her ruptured spleen, and was on the critical list in the intensive care unit. The accident had occurred at exactly 4:30 p.m.”

A personal experience with mirror image simulpathity

I had seen Lew intermittently for over 10 years. We resonated well together each having become helping professionals, each having been captain of our respective college baseball teams and starring in football in high school. We liked each other. I helped him out of a loveless marriage and to manage a financially and emotionally disastrous divorce from his second wife. When he again returned to treatment, this time on Zoom, he felt lost and lonely without a woman in the house. I helped him manage the beautiful turmoil of his next relationship by normalizing several odd coincidences. (One of his favorite love songs kept popping up at just the right time.) He had never been happier. Each had found their perfect match. Lou was diagnosed with chronic kidney disease (CKD), and a few weeks later, so I was I. My numbers had been normal and then plummeted to below Lew’s. I wondered if there might have been a connection between his CKD and mine. Anyway, he was doing well and it was time for another separation. I wondered if being separated from him might help my kidney function. I worried that my deep empathy for him may have offered a vehicle for my registering his physiological dysfunction. A few months after suspending therapy with him, my nocturnal blood pressure skyrocketed, and I could not sleep. A week before I was to see my cardiologist, Lou texted me that he was having severe back pain that was not relieved by multiple injections. He couldn’t sleep. Could I help him with sleep? I suggested he temporarily return to alprazolam in the very low dose that had helped him before. My sleep problems began shortly after his sleep problems began. Might these paired events be mirror image simulpathities?

A few months after stopping with Lou, my CKD numbers returned to normal. Because CKD is estimated by high creatinine blood levels and creatinine comes from creatine which is only found in vertebrate muscle, I stopped eating meat. Was the explanation my diet restricting animal protein or the break with Lou or some combination of the two?


An anecdote may be just another story but a series of anecdotes suggests a pattern. Jung’s headache and my CKD and sleep problems hint at a subset of therapist-patient mirror simulpathity. If these anecdotes are coupled with Hopke’s disturbing dream and Pasciuti’s atrial fibrillation, then we may be bringing to awareness a mostly unrecognized challenge for therapists as part of our work. In certain corners of the psychanalytic literature, these possible dangers to therapists are recognized as “narcissistic transference." (Gilhooley & Toich, 2021) Anecdotal evidence suggests that patients may also find themselves with strange feelings or illnesses for which there is no clear explanation. They might be empathically resonating with a distressing problem of their therapists (Gilhooley & Toich, 2021; Stone, 2006).

Thank-you Dan Gilhooley for your deep and valuable insights into this intersubjective simulpathity.



  • Hopcke, R. (1998) There Are No Accidents: Synchronicity and the Stories of Our Lives New York: Riverhead Books, 97–98.

  • C. G. Jung (1989) Memories Dreams and Reflections (revised) Recorded And Edited By Aniela Jaffé New York: VINTAGE BOOKS Google docs PDF p. 171

  • Coleman, SL Beitman BD, & Celebi E, (2009). Weird Coincidences Commonly Occur Psychiatric Annals

  • Mann B & Jaye C, (2007) “‘Are We One Body?’ Body Boundaries in Telesomatic Experiences,” Anthropology & Medicine 14, no. 2 183–95

  • Stevenson, I (1970) Telepathic Impressions. New York: American Society for Psychical Research, 17–22.

  • Bolen J. (1979) The Tao of Psychology: Synchronicity and the Self. San Francisco: Harper 96–97

  • Gilhooley D. & Toich (2021) Intersubjective Writing, and a Postmaterialist Model of Mind: I Woke Up Dead. Abington: Routledge

  • Stone, M. (2006) The Analyst's Body as Tuning Fork: Embodied Resonance in Countertransference. Journal of Analytical Psychology 51:109-124

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