CULTIVATING EMPATHY: Inspiring Health Professionals to Communicate More Effectively

The first chapter of this textbook covered what is unique about this particular communications manual. Unlike many other books that focus primarily on communication strategies, this book presents empathy as the foundation for all therapeutic communication and teaches how to be empathic. The chosen methodology for this textbook was the examination of lived experience in conjunction with evidence informed practice. The underlying theoretical premise of this work was the ethic of care. The important connection between the ethic of care and empathy was explained. The concept of empathy was explored from a historical view point and from the perspective of both philosophy and psychology. Terms that are closely aligned with empathy such as benevolence and compassion were carefully delineated. The concept of empathy was further examined through recent evidence derived from social neuroscience. This discussion included: the role of mirror neurons; an explanation of how we come to know what another person is thinking and feeling; what leads us to respond with sensitivity to another’s suffering; and how we are able to differentiate between our own experience and that of the other person. In the case in point subjective perceptions of empathy in practice were shared by different helping professionals. A closing simulation exercise focused on practicing active listening, reflection and watching nonverbal cues, followed by mock scenarios on how to tell the difference between sympathy and empathy. The rules for confidentiality during simulation were introduced along with a sample simulation confidentiality form.

In this chapter narrative accounts were shared by persons who experienced or witnessed a lack of empathy. These stories were not intended to place blame on helpers. The goal was to assist practitioners with a better understanding of what it feels like to be treated with a lack of empathy and care in order to ultimately inform practice. In the case in point a nurse told her story of what it felt like to be a patient who was treated with indifference. At the end of the chapter reflective journaling was encouraged as a means to begin to increase self-awareness.

Chapter three reviewed the reasons why empathy is sometimes lacking. Levels or degrees of empathy were presented first ranging from a complete lack of empathy to very empathetic behaviour. It was then pointed out that, although empathy is located in the human gene code, the development and sustained experience of empathy requires a lifelong process of relational interaction that begins with early infancy. The evidence from orphanage studies revealed that the experience of empathy is often necessary for basic survival. The following circumstances were presented as hindering the development of empathy in children: lack of healthy emotions in primary caregiver; neglect and/or abuse; the de-emphasis of close family and/or social relationships in modern Western society; as well as various forms of stress. Bullying and evil were compared to empathy followed by the proposed notion of viewing evil, not as a permanent personality trait, but as a form of severe lack of empathy. Evil acts were presumed to occur as a result of complete empathy erosion and turning people into objects. Similarly, narcissistic behaviour was sometimes deemed to be due to a fear of being vulnerable. Specific reasons why some helping professionals lack skill in applying empathy in the clinical setting was also investigated, followed by suggested strategies for incorporating empathy training into educational programs. In the case in point a new nurse shares her story of not knowing how to be when confronted with a patient’s sadness. A simulation role play exercise is suggested to practice using nonverbal communication techniques to convey empathy.

Chapter four stressed the importance of understanding what it feels like to be the recipient of empathetic care. It was pointed out that, empathy requires that we resist the temptation to do for others. Instead helpers must make it their intention to learn to be and feel with others. For example, when directly confronted with another’s pain, the helping professional must learn to resist the temptation to give advice or reassurance, or to explain their own position or feelings. In the case in point a young student shares how an empathetic nurse helped her to choose life. In the section on something to ponder, the significance of being genuine and using silence was emphasized. A learning exercise was also suggested to discern between words and actions that demonstrate empathy and ones that do not.

Chapter five presented strategies on how to develop empathy as a lived skill. Becoming more self-aware was proposed as a means to that end through the use of the following techniques: reflective journaling; mindfulness; obtaining feedback from others; learning from lived experiences; and being more conscious of non-verbal messaging. Additional strategies to increase empathy were presented by enhancing other-awareness through: mindful listening; reading other people’s non-verbal cues; making use of open-ended questions and seeking clarification. Practicing kindness on purpose was recommended as another way to develop empathy. In the case in point a social worker revealed how her encounter with a stranger helped her to experience a change of heart. Because learning empathy is an active process and must come from experience, a role-play simulation on hearing voices was presented.

Chapter six taught us how to be empathetic when dealing with difficult people and situations. The first portion of the chapter specifically concentrated on strategies to empathize with people who are uncooperative or angry. Refraining from judging was advised and an acting out was presented as a desperate cry for help. Taking a step back when conflict does occur was also advised. The second part of the chapter focused on more effective ways to communicate care to people who are going through trying times, such as illness or dying. Care providers and patients were taught not to view sickness or death as a failure. Specific measures for communicating empathy in these circumstances were suggested. Two specific case study narratives of lived experiences were also presented. In the case in point a nursing student gained an understanding of what it is like to be stigmatized because of an addiction. An exercise on how to increase tolerance and acceptance was presented, followed by an additional teaching strategy on how to establish trust while still maintaining professional boundaries.

Although empathy is a crucial component in a helper’s capacity to communicate effectively with those under their care, there can be negative consequences associated with over identification with the suffering of others. For example, compassion fatigue can occur, where the caregiver stops being empathetic. Compassion fatigue was the focus of chapter seven. The difference between burnout and compassion fatigue was explained. The people who are at risk of developing burnout or compassion fatigue were identified, followed by an overview of the warning signs, and how to deal with these problems when they do occur. Strategies that may be helpful in preventing compassion fatigue were presented such as, critical incident and informal debriefing, exquisite empathy, and self-care. In the case in point, an emergency room nurse shared her story of how she developed compassion fatigue after being confronted with on-going suffering. In closing, caregivers were encouraged to develop a personal wellness plan.