You entered into your profession as a health professional because you have a calling to help others using knowledge and skills in communication, healing, listening, physical manipulation, technical or clinical skills.
Helping takes many forms. Patients value health professionals who listen to them and communicate in ways that are easily understood. This shows an interest in connecting, respect and courtesy. It increases their trust and confidence in your ability to support them. To know how to really help someone requires empathy.
NB: What I’m about to share here is for 1:1 and 1: many therapeutic relationships, not in emergency situations that have specific protocols.
What is empathy?
Empathy is an innate quality and a learned skill that we access when we feel interested, curious and a desire to connect with others.
- is the ability to tune into the emotional frequency of another person
- allows us to directly perceive the feelings of another person, realise their circumstances, learn how they feel about it and appreciate how they’re living with it.
- is essential to establish and maintain relationships that vary in intimacy
- is involved in the creation of groups and the formation & transmission of attitudes, values & group identities (i.e. groupthink or collective consciousness)
Each human quality or virtue exists on a spectrum. We can go too far into either extreme due to poor boundaries between Self and other. Too little empathy (fortress) is expressed as sympathy, pity, antipathy, cynicism or indifference. Too much empathy (broken or no fence) results in feeling overwhelmed, emotional and physical pain or mental distress, and other symptoms that highly sensitive people (HSP) also exhibit. Entering into a receptive state with another is a choice and maintaining connection with another is a skill.
The risks of empathy
The table below lists the pros and cons of empathy. Research tells us empathy is so important as it helps people feel at ease, validated, witnessed and safe to be vulnerable, honest and open.
Empathy is also a double-edged sword. It’s the workplace hazard needed to be effective in any therapeutic relationship.
Extremes of empathy results in symptoms of compassion fatigue which ironically, is due to an absence of compassion.
Compassion and the wrongly termed compassion fatigue will have their own blog post shortly!
Some of the symptoms include:
- reduction to loss of empathy
- decreased pleasure
- decreased libido
- stress and anxiety
- pervasive negative attitude
This impacts on professional and personal satisfaction, productivity, focus, self-confidence and patient or client safety.
Some of these symptoms sound a lot like burnout. Burnout is a different beast that results from actions becoming out of sync with personal values and purpose, ignoring intuition and neglect of emotional needs rather than emotional over or underinvestment in therapeuetic relationships. These burnout-inducing actions are exacerbated in workplace settings that stifle creativity, agency, autonomy, safety and interconnectedness. These conditions also reduce empathic capacity as people verging on burnout operate in survival mode.
By now you might be thinking:
So let me get this straight — I’m here in service to my patients who I love to work with (on my good days) and I know I’m helping them, yet I’m feeling drained. This feels like an unfair exchange. How do I know that I’ve gone too far in either extreme?
Basically, empathic extremism can also be described as compromised empathy which occurs when you’re no longer able to be where the patient or client is at because you’re focused on Self and what the interaction is making you think and feel.
How empathy gets compromised within a therapeutic relationship
- identifying with a client or patient experience because something similar happened to you, instead of remaining curious & objective with fresh eyes and ears
- you’re drawn into the content of a patient’s story and you feel sorry for them (pity)
- ruminating or worrying about them
- believing that you know what a patient needs based on perceived familiarity with their issue (I’ve heard this before)
- finishing their thoughts or sentences because ‘you know’ what they’re going to say
- responding based on assumptions instead of observation
- feeling judgmental toward their lifestyle choices, behaviours, decisions and philosophies
- belief that you know what a client needs because you’re the one with expertise/knowledge/experience, not them
- guiding their healing process (trying to control outcomes)
- allowing your client to dictate or drive the process (they’re trying to control outcomes)
- fear-driven persuasion or influence on their decisions (coercive tactics to fulfil an agenda)
- rushing through a consultation while thinking about the time and the queue of patients waiting
- unconscious bias
- unclear about your role, purpose and boundaries with patients
- overconfidence in your approach, experience or methods (lacking humility)
- following a protocol instead of what’s needed for their unique context
- wondering if you’re actually helping
- believing that the patient needs you
- feeling/being disturbed by emotions triggered by client
- lack of interest or curiosity about a patient’s experience
- excessive emotional investment to provide specific results for clients
- attachment to specific outcomes
- using the therapeutic relationship to meet your emotional needs.
This list is not exhaustive yet highlights some of the ways working with others can be exhausting. Not only is (unintentional) interference with empathic connection tiring, it can hinder the ability to truly fulfil the purpose of the therapeutic relationship, which sucks for everyone.
Signs that your empathy is compromised:
- you feel tired after seeing 1 to a few patients or clients
- you feel drained at the end of your day
- you feel a bit bored with your work
- you feel irritated by some of your patient’s problems
- you want to love your work but can’t
There are a few things happening that destabilise an existing therapeutic connection or that prevent empathic engagement in the first place.
- Shifting focus from being present and WITH the patient to being in your head, thinking about the next steps, your own problems and anything other than what’s being revealed in the moment.
- Investing too much of your own emotional energy or an agenda into your work instead of allowing a process to unfold together to fulfil a purpose
- Your own educational and training conditioning that reduces patients to a set of symptoms and problems that need solving.
There is a healthy empathic range where you remain anchored in your own Self and your emotional centre is not disturbed by what’s going on for your patient or their behaviour.
Many people think empathy is being in someone else’s shoes.
Stay in your own shoes while taking a look into what’s going on in someone else’s world, while they remain in their own shoes. Empathy is maintaining an Other focus and the desire to be of benefit to them without getting lost in their world or wearing their shoes.
If you recognise yourself in the descriptions above and you want to move out of the cycle of empathic disengagement that happens to EVERYONE (including me!), there are things you can do about it.
Hitting the empathy sweet spot
- remain connected to your breath as often as possible
- define your role(s) & responsibilities
- remember your purpose
- park your problems using meditation techniques and debrief via brain dump onto paper, voice recording or speaking to a trusted peer
- exude warmth, openness and kindness, even when the patient is not showing you those qualities
- avoid trying to do all the things or tricks with clients or patients — focus on what’s enough and what’s needed in that moment
- define your boundaries of knowledge, experience & expertise. Knowing something isn’t the same as mastering something — be honest about where you’re at in your professional development.
- know your triggers and learn strategies to comfort yourself in the moment
- use pauses and silence as a strategy to feel, listen to your inner voice or intuitively perceive what’s going on for your patient beyond their words and body language
- focus on the process of change/transformation/transition your client or patient is going through, not just the content of their story/problems
- exercise compassion for yourself (you’re doing your best!) and others, not sympathy (aw that’s too bad) or pity (poor you)
- let your patients know what they can expect from you and what you won’t be able to do for/with them
- negotiate an agenda with your patient for what you will realistically cover in your time together
- ask questions if you’re unsure of anything
- be ok with doing enough
- pray, ask for higher guidance, inspiration or connect with feelings of compassion before you start your day. As a healer, you’re more than your technical skills and knowledge. Your calm presence, empathy & desire to be of benefit transforms you into an instrument that can facilitate a healing process, whether a problem gets solved or not.
- create space between one patient and the next through any ritual that makes a clean break between sessions and at the end of your work day
- debrief with a professional empathic listener, journal about your experiences at the end of a work day and engage in group learning & reflective practice.
- maintain perspective about your patient as they don’t exist in a vacuum but within an ecological context. Strive to discover what matters to them, what connections comfort them and hinder their wellbeing.
Bronfenbrenner’s Ecological Model. This is a great tool to use to explore a patient’s life and world to discover what matters to them, the connections that can provide support to enhance skills and those that can help them grow and heal.
You might also want to increase the support you get for yourself to help you identify and understand any tendencies to disengage the empathic connection, what needs you’re trying to meet through your work, how you take on other people’s energy, emotions, stories and trauma, WHY you do it and WHAT to do to about it.
I also recommend any group learning activity — reflective practice, Balint groups, therapy groups or Schwartz rounds are excellent options to participate in on a regular basis.
Like anyone who wants to excel in their profession, everyone needs a coach to monitor and support skill development. We cannot deepen and master our capacity for empathy without understanding how our life experiences, beliefs, knowledge or ignorance can be barriers or helpers to developing and maintaining stable and effective therapeutic connections.
Healers need healers too.
I invite you to reflect on your own experience as a health professional or someone in a helping role to discover what you might be doing/not doing that’s interfering with your ability to more deeply connect with another for the purpose of helping or healing.
This is a pretty long article. If you’ve made it this far, I’d love to know if this resonated with you, what didn’t, what stands out and what you’d like to know more about.
NOTE: This content is a result of consulting, shadowing, observing and facilitating reflective practice & debriefing sessions with diverse health professionals for the last 7 years. This is intended to be a practical article of how our own natural tendencies, conditioning and an unruly mind hinders our ability to maintain empathic connections with others.
Barrett, S., Komaromy, C., Robb, M., & Rogers, A. (Eds.). (2004). Communication, relationships and care: a reader. Routledge.
Charon, R. (2001). Narrative medicine: a model for empathy, reflection, profession, and trust. Jama, 286(15), 1897–1902.
Davis, H. & Day, C. (2010). Working in Partnership: The Family Partnership Model. London: Pearson (my bible).
Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring.
Kelm, Z., Womer, J., Walter, J. K., & Feudtner, C. (2014). Interventions to cultivate physician empathy: a systematic review. BMC medical education, 14(1), 219.
Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., … & Scheffer, C. (2011). Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic medicine, 86(8), 996–1009.
Plack, M. M., & Greenberg, L. (2005). The reflective practitioner: reaching for excellence in practice. Pediatrics, 116(6), 1546–1552.
Rivera, Luis de. (2004). Empatia y Ecpatia. Psiquis, 25: 243–245.
Singer, T & Klimecki, O.M. (2014). Empathy and Compassion. Current Biology, 24(18), R875-R878.
Skovholt & Trotter-Mathison (2010). The Resilient Practitioner. p. 23.
de Zulueta PC (2015). Suffering, ethics and doing good medical ethics. J Med Ethics, 41, 87–90.
This article was first published on Safe Space Health. Please check it out and other resources.