NOTE: Use this sheet only with people who have the capacity to empathize!


STAGE 1: A. REQUESTER: “Can I clear something with you?”



STAGE 2: A. REQUESTER: “I noticed that you…..” (Mention the fare facts about which there is no controversy. State the fact in a neutral voice, without accusations, judgments or criticsm.) For example, “You laughed when I spoke about _________.” “You didn’t call.” “You didn’t consult me before buying that item.” “You invited people without telling me.” “You left your towel on the floor.” “You ignored me when I walked into the room.” “You were _______ late.” “You refused to help.”

  1. EMPATHIZER: “I hear that I ….” (repeats what was stated.)


STAGE 3: A: REQUESTER: “The story I told myself when that happened was…..” (For example: “You don’t really love me.” “I’m fundamentally flawed.” “I’m a failure.” “I don’t belong.” “We’ll soon be impoverished and out on the street.” “No one cares about me.” “No one understands me.” “I can’t trust anyone. Everyone abandons, disappoints, hurts, betrays or neglects me.” “I’m not important.” “I don’t deserve better.” “I can’t cope.” ‘I’d be better off dead.” “I’m too_______ or not ________enough.” “I’m basically stupid, crazy, selfish, uncaring and bad.” “I should be able to handle anything/anybody and if I can’t, I’m ____________.” “People have to do what I want or it means ______________.”   “Hashem hates me.” “Hashem thinks I’m __________.” “Tears mean I’m weak, stupid, childish and crazy.”  

  1. EMPATHIZER: I hear that the story you told yourself is ______________.”


STAGE 4: A: REQUESTER: “When this happened, I felt ___________ angry, sad, scared, ashamed, guilty….”

B: EMPATHIZER: “I hear that you felt.”


STAGE 4A:  OPTIONAL: EMPATHIZER: Did this event arouse any painful memories from the past? (This is the empathizer’s opportunity to understand the requester more fully, to value his feelings and understand his fears and history.)


STAGE 5: A; REQUESTER: “What I need from you is ________________ 

(e.g., love, respect, understanding, space, help, privacy, communication, support, reassurance, predictability, stability, trust, money, security, etc.)

B: EMPATHIZER: “I hear that what you need is………” (NOTE: This does not mean that the empathizer has to change or give what the requester wants. The empathizer just can at least understand the feelings of the requester and the pain of not getting all s/he wants in the relationship.)


STAGE 6: A: REQUESTER: “Is there some way to keep this from happening again?” (NOTE: The answer may be “NO.”)

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