What empathy is

Empathy is the act of communicating to our fellow human beings that we understand something about their world (Dunne, 2005). As a nurse, your practice reflects your understanding of human behavior. How you listen, how you talk, and how you demonstrate empathy and concern are powerful ways to connect with another person (Gallagher, 2009). You are always being observed as a role model, as a communicator . . . you are “on” all the time (Keefe, 2006). In your education and experience you grow in self-awareness, build self-confidence, sharpen listening skills, and work on developing nonjudgmental attitudes (Davis, 1990). It is important to note that nurses may become more task oriented than client centered and patients experience this as a lack of empathy (McCabe, 2004). Taking time to inquire about how the patient is doing, appearing relaxed, and not constantly looking at your watch may demonstrate empathy (McCabe, 2004). You may have the experience of learning and working alongside role models of compassion and empathic communication and negotiate to work with nurses and in settings to foster such ideals. It has been theorized that the ability to experience empathy is the result of a developmental and maturational process (Davis, 1990; Alligood and May, 2000; Olsen, 2001). As a student and novice, you assume the responsibility to work on any problem behaviors such as “prejudice, self-preoccupation, excessive nervous talking, poor listening and poor assertiveness skills, and low self-esteem . . . that block empathy and interfere with healing” (Davis, 1990). As your own sense of self-identity, personal values, and boundaries develops, it is easier to retain your own identity in interactions with clients and thus to feel at one with others without judgment. You move to the highest level of empathy, in which you recognize the other’s humanity and personhood regardless of the illness, its circumstance, or stigma. Empathy is more complex than the other interpersonal communication behaviors you have mastered so far. By the end of this chapter you will understand what empathy is and be able to explain its importance in interpersonal communication. A number of exercises provide you with the opportunity to practice demonstrating empathy with supervised feedback. Such rehearsal begins the journey to the empathic maturity that benefits clients and colleagues.

Think of empathy as occurring in three overlapping stages. The first, self-transposition, occurs when we listen carefully and seek to put ourselves in the client’s place. The second, a crossing over, is an emotional shift from thinking to feeling, a deepening of our understanding, and an awareness of the client’s experience. This has been called the I–Thou relationship (Buber, 1955), dialogue, or a “shared moment of meaning” (Davis, 1990). The Moments of Connection in this textbook are examples of interventions that occurred at this level of connection with clients, family, or colleagues. The third stage, getting our “self” back, is when we stand side by side with the other in heartfelt understanding about the experience just shared (Davis, 1990).

American psychologist Carl Rogers contributed immensely to defining the meaning and significance of empathy for helping professionals. He died in 1987, and in honor of his gifts to us, his direct words are quoted to expand your understanding of the meaning of empathy. This passage is from his book A Way of Being (1980):

A synonym for empathy is communicated understanding. When we are convinced that others fully understand us, without judging us for how we are feeling, questioning why we are reacting that way, or advising us to feel differently, we experience a wonderful sense of acceptance. The process of empathy involves the unconditional acceptance of the individual in need of help; judgments and evaluation of feelings are never offered (Pike, 1990).

This nonjudgmental reception by our fellow human beings is accompanied by feelings of relief and freedom. Once we know we have been understood and accepted, we do not have to struggle to get our point across, nor do we have to justify our reactions to others. When we receive empathic responses, we can relax because we no longer fear being misunderstood or rejected. Acknowledgment of our feelings reassures us that we have a right to be who we are. We may wish to change, and we might change our feelings and reactions in the future, but there is nothing so accepting as having others verbally acknowledge that they understand our feelings.

Another skill associated with empathy is active listening. We can listen passively or actively. Listening passively includes attending nonverbally to our clients or colleagues with eye contact, head nodding, and verbally encouraging phrases such as “uh huh,” “mm-hmm,” “I see,” “yeah,” or “I hear you.” It is easy to delude ourselves into thinking that when we listen passively, we truly communicate that we understand. Passive listening, however, does not include an actual articulation of others’ feelings, so it lacks the conviction and reassurance of active listening. The receivers of passive listening have to assume, hope, or pretend that they are being understood. Active listening removes this guesswork. It specifically provides speakers with the knowledge that we know how they are feeling—and understand why. Receivers of active listening know that they have been understood.

Natural empathy has been described as a natural and instinctive trait, an intrinsic ability to understand the feelings of others. It contrasts with clinical empathy, a tool or skill that is consciously and deliberately employed to achieve a therapeutic intervention (LaRocco, 2010; Pike, 1990). The goal of empathy is to aid in the establishment of a helping relationship. It is not empathy by itself that is beneficial, but the intention of the giver and the perception of the receiver. An empathetic nurse helps meet the client’s basic need to be understood, an important part of establishing a healthy nurse–client relationship (Davis, 2009).

If empathy is truly a curative factor, it must somehow be both communicated to and received by our clients. It is more than a state of mind or attitude. As a concept, empathy is a value-neutral tool that can be used for destructive or manipulative purposes. To be used in a therapeutic or curative way, it must be used to accept, confirm, and validate the total experiences of others. It must be used with the intention of helping.

As nurses in the changing healthcare climate come to accept that the business and caring aspects of patient care must be linked, patients’ satisfaction with their caregivers becomes essential. Customer service has become another way to look at delivery of excellent patient care. Patten (1994), in an article about therapeutic hospitality, concludes that “staff interaction skills correlate more highly with patient satisfaction than technical skills.” She discusses the ancient practice of hospitality, which has evolved into three levels: public, private, and therapeutic. Therapeutic hospitality involves a high degree of intimacy with a deep personal connection that is the therapeutic use of self. Empathy is an important part of this therapeutic use of self in service recovery when customers’ expectations are not met.

How to communicate empathically

Empathy includes the ability to reflect, accurately and specifically, in words what our clients or colleagues are experiencing, drawing on the nonverbal behaviors of warmth and genuineness.

When to communicate empathically

Rogers (1980) asserts that in some situations empathy has the highest priority of the attitudinal elements and makes for growth-promoting human relationships. When clients or colleagues are hurting, confused, troubled, anxious, alienated, terrified, doubtful of self-worth, or uncertain as to identity, then understanding is called for.

Every day nurses encounter clients who are in this kind of pain. Nurses have many opportunities to know their clients’ most intimate thoughts and feelings. Dicers (1990) warns that empathy is intrusive and cautions nurses to ask themselves, “How far should I go?” She reminds us that there is a tremendous amount of freedom related to empathy. “Empathy is a concept by intellection, like ‘justice’ or ‘love,’ as opposed to a concept by observation like ‘chair’ or ‘bottle.’ Such concepts are seductive because there is so much room to play around.” It is the clinical and ethical judgment of nurses that guides them in deciding when to verbalize empathy. Follow this advice: “Whenever we enter another’s mind, we must remember to be respectful and take off our shoes.”

We nurses know that we have as much responsibility for clients’ needs to express their feelings on intimate matters as we do for their privacy. We might ask ourselves: “How much should I encourage my clients to tell me? Am I at risk of crossing the line between facilitating communication (with my empathy) and aggressively pursuing their private reactions?” Being empathic can be helpful or invading, and as nurses we must strive to use our empathic skills with the intent of being helpful.

Dicers (1990) argues: “Empathy is a dangerous notion if it is thought to be mindless, experiential, existential connectedness. Surely every patient encounter requires an openness to the other’s experience, for only when one is open to another can one perceive needs. But surely, not every encounter will benefit from empathy; some will require theory, or applied experience, or even translation or consultation.”

It is helpful to be empathic any time people share their thoughts and feelings with you. An empathic reply can be used on its own or with another message or communication strategy. For example, empathy can be used with the following:

Missing opportunities to convey empathy can create a gulf between speakers and listeners, and make speakers feel ignored. When we do not hear others, a new struggle is created for them. They are disappointed at not being understood and in turn either withdraw with wounded feelings or fight to convince us of their feelings. When empathy is not offered, our clients and colleagues feel cheated, frustrated, and ignored. Including empathy with other communication strategies lets our clients and colleagues know beyond a doubt that they have been heard and understood.

In any therapeutic relationship it is important that our partners feel cared for. Client–nurse relationships are ones in which we have established ourselves as helpers. That label means that we acknowledge and make public our desire to support others. Empathy is one concrete way to show our caring.

Sometimes when stress levels are high we get lost in our own concerns and forget that our colleagues have concerns of their own. Simple acts help get us back on track.