A Structural Model for Predicting Empathy Based on Social Status, Horizontal–Vertical Individualism/Collectivism with the Mediating Role of Mentalization in Mental Health Therapists
Keywords:
Empathy, Mentalization, Social Status, Individualism, Collectivism, TherapistsAbstract
Objective: This study aimed to examine the structural model of empathy prediction based on social status and horizontal–vertical individualism/collectivism with the mediating role of mentalization among mental health therapists.
Methods and Materials: This basic research employed a descriptive–correlational design using structural equation modeling. The statistical population included 991 therapists in Tehran, from which 280 participants were selected via systematic random sampling. Data were collected using the Basic Empathy Scale, Horizontal–Vertical Individualism/Collectivism Questionnaire, Mentalization Questionnaire, and a researcher-made Social Status scale, and analyzed through descriptive statistics and SEM techniques.
Findings: Results indicated that social status (β=0.47, p<0.001), individualism/collectivism (β=0.45, p<0.001), and mentalization (β=0.36, p<0.001) had significant positive direct effects on empathy. Social status (β=0.52, p<0.001) and cultural orientations (β=0.58, p<0.001) significantly predicted mentalization. Indirect effects via mentalization were also significant (B=0.114, p=0.008; B=0.128, p=0.021). Model fit indices confirmed a good fit.
Conclusion: The findings highlight that socio-cultural factors combined with mentalization capacity significantly enhance therapists’ empathy, providing a foundation for designing educational and professional interventions in mental health settings.
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Aafjes-van Doorn, K., Cicconet, M., Bate, J., Cohn, J. F., & Aafjes, M. (2025). Development of an artificial intelligence-based measure of therapists' skills: A multimodal proof of concept. Psychotherapy. https://doi.org/10.1037/pst0000561
Avram, C. M. (2023). Theory as Behaviour: Why Empathy Research Needs Horizontal, Mutualistic Habits of Seeing. Theory & Psychology, 33(3), 330-345. https://doi.org/10.1177/09593543231159077
Baskin-Sommers, A., Krusemark, E., & Ronningstam, E. (2014). Empathy in narcissistic personality disorder: From clinical and empirical perspectives. Personality Disorders: Theory, Research, and Treatment, 5(3), 323-333. https://doi.org/10.1037/per0000061
Bernardo, G. A. D., Pecini, C., Tallone, B., Raguso, G., & Andrighetto, L. (2025). No Hard Feelings: The Role of Self-Objectification and Self-Dehumanization in Understanding Emotions and Mental States in Cisgender Heterosexual Women. Psychology of Women Quarterly, 49(3), 365-380. https://doi.org/10.1177/03616843251340962
Bolton, M. J. (2023). De-Centering Neuronormativity Is an Imperative in Humanistic Psychotherapy: Towards a Neurodiversity-Informed, Person-Centered Approach. https://doi.org/10.31234/osf.io/q2t8h
Chang, D. F., Najafabadi, M. O., & Dunn, J. J. (2023). Antioppressive Approaches to Alliance Rupture and Repair: A Critical–cultural–relational Model of Rupture Resolution. 21-52. https://doi.org/10.1037/0000306-002
Cheng, W. (2025). When Winning Costs Your Peace: How Does Vertical Individualism Hijack Relaxation Capacity? Network Analysis and Mediation Models. PLoS One, 20(11), e0335851. https://doi.org/10.1371/journal.pone.0335851
Cwinn, E., Bell, T., & Kirby, J. N. (2023). Theory and Interpersonal Processes in Compassion Focused Therapy. Obm Integrative and Complementary Medicine, 08(04), 1-36. https://doi.org/10.21926/obm.icm.2304056
Davì, D., Prestano, C., & Vegni, N. (2024). Exploring Therapeutic Responsiveness: A Comparative Textual Analysis Across Different Models. Frontiers in psychology, 15. https://doi.org/10.3389/fpsyg.2024.1412220
Diener, M. J., Hilsenroth, M. J., & Giannopoulos, E. (2025). Therapist affect focus and patient outcomes in psychodynamic therapy: An updated systematic review and meta-analysis. Psychotherapy. https://doi.org/10.1037/pst0000568
Domínguez, S., Matsuno, E., Adames, H. Y., Mosley, D. V., Richardson, J., Lee, J., Norton, M., & Budge, S. L. (2025). Building and Practicing Anticolonial Psychotherapy: Using the Psychology of Radical Healing to Address the Coloniality of Gender. American psychologist, 80(4), 603-617. https://doi.org/10.1037/amp0001430
Fischman, L. (2025). My Bad, You Got This: Witnessing, Therapist Attitude and the Synergy Between Psychedelics and Inner Healing Intelligence in the Treatment of Trauma. Frontiers in psychology, 16. https://doi.org/10.3389/fpsyg.2025.1469559
Franco, P., Tesio, V., Bertholet, J., Gasnier, A., Portillo, E. G., Spałek, M., Bibault, J. E., Borst, G. R., Elmpt, W. v., Thorwarth, D., Mullaney, L., Redalen, K. R., Dubois, L., Chargari, C., Perryck, S., Heukelom, J., Petit, S., Lybeer, M., & Castelli, L. (2020). The Role of Alexithymia and Empathy on Radiation Therapists’ Professional Quality of Life. Technical Innovations & Patient Support in Radiation Oncology, 15, 29-36. https://doi.org/10.1016/j.tipsro.2020.07.001
Hittner, E. F., & Haase, C. M. (2021). Empathy in context: Socioeconomic status as a moderator of the link between empathic accuracy and well-being in married couples. Journal of Social and Personal Relationships, 38(5), 1633-1654. https://doi.org/10.1177/0265407521990750
Hunt, M. G., Schmitz, T. M., Vail, W., & Opperman, K. (2024). Training, Skills, and Leadership Experience: The Need to Expand Clinical Psychology Training as Illustrated by Psychology Leadership Stories. Psychological Services, 21(4), 702-712. https://doi.org/10.1037/ser0000846
Jung, S., & Kim, E. (2023). Development and Initial Validation of the Multidimensional Empathy Scale for Adolescents. Asian Journal of Social Psychology, 26(4), 488-503. https://doi.org/10.1111/ajsp.12573
Lachance, V., Laverdière, O., Kealy, D., & Ogrodniczuk, J. S. (2024). Dispositional Empathy Among Psychotherapists: A Latent Profile Analysis. Clinical Psychology & Psychotherapy, 31(3). https://doi.org/10.1002/cpp.3016
Levitt, H. M., Collins, K. M., Rizo, J., & Hand, A. B. (2022). Rethinking Therapists’ Responsiveness to Center Clients’ Experiences of Psychotherapy. 265-294. https://doi.org/10.1037/0000303-010
Levitt, H. M., & Whelton, W. J. (2024). On the Need to Reconcile Cultural and Professional Power in Psychotherapy: Humanistic Principles That Are Foundational for Feminist Multicultural Practice. The Humanistic Psychologist, 52(2), 137-162. https://doi.org/10.1037/hum0000327
Lindegaard, T., Persson, L., Thorängen, M., & Rozental, A. (2024). Therapists' experiences of negative effects in intensive short-term dynamic psychotherapy: A qualitative interview study. Psychotherapy Research, 1-13. https://doi.org/10.1080/10503307.2024.2420717
Lindegaard, T., Persson, L., Thorängen, M., & Rozental, A. (2025). Therapists' Experiences of Negative Effects in Intensive Short-Term Dynamic Psychotherapy: A Qualitative Interview Study. Psychotherapy Research, 35(8), 1300-1312. https://doi.org/10.1080/10503307.2024.2420717
Moyers, T. B., & Miller, W. R. (2013). Is low therapist empathy toxic? Psychology of Addictive Behaviors, 27(3), 878. https://doi.org/10.1037/a0030274
Nissen‐Lie, H. A., Heinonen, E., & Delgadillo, J. (2023). Therapist Factors. 79-106. https://doi.org/10.1037/0000358-005
Park, D. Y., & Peteet, J. R. (2023). When Does Psychotherapy Encourage Selfishness? Religions, 15(1), 8. https://doi.org/10.3390/rel15010008
Pieterse, A. L., Austin, C. L., Nicolas, A. I., Martin, C. G., Agiliga, A. U., & Kirkinis, K. (2023). Essential Elements for Working With Racial Trauma: A Guide for Health Service Psychologists. Professional Psychology Research and Practice, 54(3), 213-220. https://doi.org/10.1037/pro0000512
Redding, R. E., & Cobb, C. L. (2023). Sociopolitical Values as the Deep Culture in Culturally-Competent Psychotherapy. Clinical Psychological Science, 11(4), 666-682. https://doi.org/10.1177/21677026221126688
Rubino, G., Barker, C., Roth, T., & Fearon, P. (2000). Therapist Empathy and Depth of Interpretation in Response to Potential Alliance Ruptures: The Role of Therapist and Patient Attachment Styles. Psychotherapy Research, 10(4), 408-420. https://doi.org/10.1093/ptr/10.4.408
Shammout, E., D’Alessandro, S., Small, F., & Nayeem, T. (2022). Lifting the Curtain on Cultural Values, Materialism and Luxury Consumption: Evidence From Jordan. Journal of Consumer Behaviour, 21(5), 987-1001. https://doi.org/10.1002/cb.2053
Søndergaard, A. A., Juul, S., Poulsen, S., & Simonsen, S. (2023). Mentalizing the therapist - Therapist experiences with short-term Mentalization-based therapy for borderline personality disorder: A qualitative study. Frontiers in Psychiatry, 14, 1088865. https://doi.org/10.3389/fpsyt.2023.1088865
Steindl, J., Gilbert, P., & McEwan, K. (2023). Therapists' perspectives on Compassion-Focused Therapy: Addressing resistance and emotional barriers in treatment. Clinical Psychology & Psychotherapy, 30(1), 72-86. https://onlinelibrary.wiley.com/doi/abs/10.1002/capr.12530
Stiegler, J. R., Schanche, E., Danielsen, Y. S., & Hjeltnes, A. (2024). Growth in challenging situations: A qualitative investigation of therapists' experience of delivering emotion-focused therapy. Psychotherapy Research, 1-13. https://doi.org/10.1080/10503307.2024.2432680
Whittenbury, K. J., & Ward, P. (2023). A Mixed-Method Study of Medical Students’ Perceptions of Social Accountability in Medical Education. Comparing the Roles of Equity Identities, Empathies, and Curriculum Regulation. https://doi.org/10.21203/rs.3.rs-3162735/v1
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Copyright (c) 2025 maryam Salmanzadeh (Author); Arezoo tarimoradi; Niloofar tahmouresi, Roqaieh shahani shalmani (Author)
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