Saturday, February 15, 2014

More on the Brene Brown Empathy Video

My last post was about a brief video on expressing empathy that featured Brene Brown, PhD. You can find the video at:

Many liked the video, though some colleagues who are experts in clinician-patient communication felt that Dr. Brown was off target in her conceptualization of sympathy. Dr. Dennis Novack, Professor of Medicine and Associate Dean of Medical Education at Drexel University College of Medicine, wrote:
"I like what she says about empathy, but disagree completely with her definition of sympathy, which really undermines the value of the video for me. Sympathy is derived from the Greek sympatheia which means "feeling with." In one sense it might be empathy on steroids. We send a sympathy card to someone because we feel the loss as well. We feel sorrow for and with another, though maybe not as deeply, and in some ways identify with the other. 
The classic studies of Nightengale et al show that physicians who adopt a more sympathetic stance toward patients’ emotional situations do too many tests and perform CPR longer – they lose their objectivity (Nightengale, S.D., et al. JGIM:1991; 6:420-23.)
Empathy is conceived as a more objective process. All the actions you listed are components of the empathic process, that allow the physician to feel for patients and communicate that understanding, while still being able to make good decisions about their medical care free of the effects of the emotions elicited.By the way, a recent study Suely Grosseman and I and others recently did suggests that another component of the empathic process is checking to ensure that the patient got the empathic communication. We found that residents’ self-assessment of their empathic communication to standardized patients in 5 OSCE stations had zero correlation with SP assessments of their empathic communication."
Richard Frankel, Professor of Medicine, Indiana University School of Medicine noted the value of focusing on the interactional dynamics of empathy and referred interested folks to Jodi Halpern's use of the concept of "attunement" in her 2003 Journal of General Internal Medicine article (Halpern J. What is clinical empathy? Journal of general internal medicine. Aug 2003;18(8):670-674.) He added:
"Our group in Rochester also published a paper in 1997 in which we described the interactional dynamics of empathy, (Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA: the journal of the American Medical Association.1997;277(8):678-682.).
The model was later validated by Hilde Eide (Eide H, Frankel R, Haaversen AC, Vaupel KA, Graugaard PK, Finset A. Listening for feelings: identifying and coding empathic and potential empathic opportunities in medical dialogues. Patient education and counseling. Sep 2004;54(3):291-297)

Rich also endorsed the empathy video created by the Cleveland Clinic, featured in my March 23 2013 post:

I agree with both Dennis and Rich about the importance of both the cognitive and interactional aspects of emapthy and I, too, have found Jodi Halpern's conceptualization of clinical empathy quite helpful. Her thoughtful and erudite book, From Detached Concern to Empathy: Humanizing Medical Practice (Oxford University Press, New York, 2001) is highly recommended for all those interested in promoting and studying clinical empathy.
For those interested in learning more about clinical empathy, I also recommend the book, Empathy Reconsidered, New Directions in Psychotherapy (Eds: Arthur Bohart & Leslie Greenberg. American Psychological Association, Washington, 1997) which provides further perspectives on the role of empathy in clinical encounters, particularly in psychotherapy. I especially recommend the introductory chapter by the editors, in which they describe 3 different types of therapeutic empathy:
  1. "empathic rapport" - the clinician expresses understanding and acceptance of the client's feelings (this is closest to what Brene Brown was describing in the video);
  2. "experience - near understanding of the client's world" - a deeper understanding of the client's experience or "world". This usually results from exploration of the client's perceptions and reactions, including how the client's past experiences may have shaped their current emotional response; and
  3. "communicative attunement" - characterized by moment-moment attunement based on reflections or other attempts to understand what the client is trying to communicate.The therapist is actively trying to, not only understand what the client is saying, but also trying to "help the client make sense of their ever-emerging experience."
In a future post, I will share some simple strategies and approaches clinicians might use to enhance their capacity to develop empathic rapport.


  1. I don't like the video for two reasons. First, it cavalierly dismisses sympathy. To some extent this is a definitional issue. I think about sympathy as an "I" response to "your" situation. "I am sorry that....." Sometimes sympathy is sufficient and appropriate. This is often the case in brief encounters, public settings, and role determined relationships. Second, it focuses empathy on the negative end of human experience rather than across the entire range of experience. Empathically, I can inhale and celebrate with you your good fortune as well as your bad fortune. "You got straight "A's", wow!" Not being empathic with good fortune can be as damaging as a lack of empathy with misfortune.

  2. Thanks so much for your comments, Vaughn.

    I agree with you and others that the Brene Brown video is dismissive of sympathy, which as you point, can be a sufficient response. And I also agree that the video's focus on responses to "negative" emotional states limits it's usefulness. As you suggest, responding to positive emotions is also quite valuable and important to relationship building, especially in a therapeutic context.

    Though I only have limited familiarity with Brene Brown's work, she emphasizes the therapeutic value of focusing on, affirming and validating positive perceptions of self, including worthiness and courage. Her TED talk is about reframing "vulnerability" in a positive light.

    Check it out:

  3. Hi Michael, another resource about empathy that you may find helpful - Center for Building a Culture of Empathy

    1. Edwin, Thanks for your comment and link to the website. I have been exploring on the site - it is wonderful. So many resources across so many aspects of empathy! I will return again and again.


    2. hi Michael, let me know if you do more posts on empathy and I'll repost links to them to our site.

  4. Hi Michael, Thanks for the video links. I have been aware of Brene Brown's work for quite a while and was able to see her speak last year. I think she's appealing to so many people more for her vulnerability and connection work which derives from her research on shame. Dr. Brown makes these concepts accessible to a wide audience - however, that can also mean simplifying complex ideas down to a sound-bite... I disagree with her assertion of sympathy in that video... That's more like being dismissive to a person's suffering. I think the most powerful part of Dr. Brown's work is highlighting the differences in Shame and Guilt, the understanding of Blame, and the fact that in order for us to connect with one another, we have to be vulnerable and allow our vulnerability to be seen. The more "perfect" we try to come off - even in the medical profession - the less connection we have with others. Have you also studied Motivational Interviewing? There are some great micro skills that healthcare professionals can use in their practice to gain connection with patients that is tangible in its application - I dare say sometimes it seems almost too simple, yet the ideas behind it are pretty complex. Just wondering...

  5. Just realized I saw this post on the Motivational Interviewing networking group from LinkedIn... So yeah, you know about MI... duh.

    1. Salley, thanks for your comments. I am learning more and more about Brene and her work. Looking forward to learning more! And yes, I am very much aware of MI and am a member of MINT. I am helping to provide MI training to primary care clinicians within the Veterans Health Administration in the US.