Bill Miller's Book, "Listening Well" is Worth a Post, and Read

It's been about a year and a half since I last posted here. I can't tell you why I have lapsed, though I have been preoccupied with work, my family and current events. All have contributed to the challenge of staying "posted" on developments in the world of empathy.

Plus, Ed Rutsch and his sites, Center for Building a Culture for Empathy, and Empathy and HealthCare are both awesome and comprehensive sources for posts and developments.

It was actually a post by Ed on Culture for Empathy that featured Bill Miller and his new book, Listening Well: The Art of Empathic Understanding that stimulated me to resume blogging and write this post.

Bill Miller is the primary force behind Motivational Interviewing, a highly effective motivational counseling method that features an empathic patient-centered style. I highly recommend Bill's little new book, which serves as a primer on the core empathic listening skills that are central elements of MI. There is so much wisdom in this little book, as well as great examples of empathic listening and valuable suggestions for skill practice.

Enjoy!

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:https://www.youtube.com/watch?v=1Evwgu369Jw

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:

http://empathyworks.blogspot.com/2013/03/watch-this-wonderful-video-empathy.html

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.

A Short Video on Empathy Featuring Brené Brown

Sue Raffa, PhD, a colleague at Alpert Medical School, Brown University,  recently shared a wonderful animated video on empathy with me. The brief video was created by the Royal Society of the Arts (RSA) and features Brene Brown, PhD, LMSW, a research professor at the University of Houston Graduate Colleage of Social Work.

You can find the video at: https://www.youtube.com/watch?v=1Evwgu369Jw

The video offers a wonderful, quick,and amusing lesson on empathy and how if differs from sympathy. 

I particularly like Dr. Brown's  reference to the 4 key qualities of empathy:

1. perspective taking
2. staying out of judgement
3. recognizing emotion; and
4. communicating what you notice

I also like her idea that empathy "fuels connection", contrasted with sympathy, which "drives disconnection". Empathy, she states, can be operationalized as "feeling with" other and requires a "vulnerable choice". She adds, "To connect with you, I have to connect with something in myself that knows that feeling", which can be painful. Empathy, she notes, is not about trying to make things better, it's about being present and expressing understanding to a person who is struggling>

"Rarely can a response make something better....what makes something better is connection."

Awesome! 

Does Empathy Produce Poor Moral Decisions? I Think Not!

In the May 20th issue of the New Yorker, Paul Bloom argues that empathy can lead to irrational decisions that are "parochial" and "narrow-minded". He concludes that, "a reasoned, even counter-empathetic analysis of moral obligation and likely consequences is a better guide to planning for the future than the gut wrench of empathy."

However, I agree with the point of view expressed by Michael Zakaras in his blog post, The Case Against the Case Against Empathy, which appeared on the Huff Post World on May 16th. Zakaras reminds us that empathy is more than just a gut reaction; empathy involves cognitive processes similar to imagining and perspective taking.  As Zakaras notes, empathy "requires careful thought, self-awareness, and real listening."

Zakaras continues, "But to truly empathize is not easy. In this sense Bloom is right: we're more likely to do so with those who look and think like we do. So rather than dismiss empathy, why not commit ourselves to practicing it more deliberately and more often, and expanding our spheres of empathy to those who are not just different but who challenge some of our very own moral foundations?"

I agree strongly with Zakaras. We need to practice and deepen our capacity for empathy. And, we must also use the understanding gained from empathy to choose and act wisely. As my colleague Vaughn Keller taught me, compassion is empathy in action.

Watch this Wonderful Video: "Empathy: The Human Connection to Patient Care"

Empathy is an essential element of quality health care. This video (Empathy: The Human Connection to Patient Care) simply, and beautifully, illustrates the value of seeking to understand others' experience. Listening, noticing, exploring and responding helps us to build healing connections with patients, family members and  caregivers. Empathy also helps those of us who are privileged to work in health care settings to know and support each other.

The video was published on YouTube on February 27, 2013 with the following information:

Patient care is more than just healing -- it's building a connection that encompasses mind, body and soul.

If you could stand in someone else's shoes . . . hear what they hear. See what they see. Feel what they feel. Would you treat them differently?

CEO Toby Cosgrove, MD, shared this video, titled "Empathy," with the Cleveland Clinic staff during his 2012 State of the Clinic address on Feb. 27, 2013.

 

Empathy Works for Business Too!

See the link below for an article on the value of empathy in the workplace that appeared in the online magazine Smart Business.

The importance of empathy in the workplace | Smart Business

The Empathy Gap - Obama vs. Romney

Empathy, or the lack of it, is an important and perhaps crucial issue in the US Presidential campaign. Results of a CBS News poll released earlier this week shows that half of registered voters think that Mitt Romney does not understand their problems, reflecting an empathy gap with President Obama. See: CBS News Empathy Gap Poll

In an interview that appeared in the online magazine, Slate, noted British author Marin Amis predicts an Obama victory because he sees a “disastrous lack of empathy” in Mitt Romney. See: Slate interview with Martin Amis

Too much talking | QReview

Follow this link Too much talking | QReview to a blog post about the importance of  eliciting understanding, concerns and beliefs and listening, rather than just telling.

The author, Dr. Susan Shaw, is Chair, Health Quality Council and Department Head, Adult Critical Care, for the Saskatoon Health Region in Canada.

The post originally appeared on Q Review, a blog published by theThe Health Quality Council (HQC). HQC is an independent agency that measures and reports on quality of care in Saskatchewan, promotes improvement, and engages its partners in building a better health system.