Empathy ERP, July 31...Empathy Conveyance – July 2017 5 What often results is an environment where a trip to a healthcare organization ends up feeling like a trip to the DMV, only

Empathy Conveyance PRACTICAL TIPS FOR HEALTHCARE PROVIDERS

By Elizabeth Morrison LCSW, MAC

EmpathyConveyance–July2017

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Copyright©2017byElizabethMorrisonAllrightsreserved.Nopartofthispublicationmaybereproduced,distributed,ortransmittedinanyformorbyanymeans,includingphotocopying,recording,orotherelectronicormechanicalmethods,withoutthepriorwrittenpermissionofthepublisher,exceptinthecaseofbriefquotationsembodiedincriticalreviewsandcertainothernoncommercialusespermittedbycopyrightlaw.


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TableofContentsEmpathyinHealthcare................................................................................................................4TheStudyofEmpathy.................................................................................................................7Open-EndedQuestions...............................................................................................................9AQuickWordonClosedQuestions....................................................................................11ReflectiveListening...................................................................................................................12FocusonStrengths.....................................................................................................................16Eliciting...........................................................................................................................................19BodyLanguage............................................................................................................................22Normalizing..................................................................................................................................24AcknowledgingFeelings..........................................................................................................26PuttingitAllTogether..............................................................................................................2910TipsforEmpatheticCommunication..........................................................................31CitationsandAcknowledgements.......................................................................................33AbouttheAuthor........................................................................................................................34


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EmpathyinHealthcare

Wearehealthcareprofessionalsandwearealsopatients.Ourworkisinfluencedbyoureducationandprofessionalexperience,aswellasourown(andourloved-ones’)experiencesofbeingonthereceivingendofhealthcare.

Giventheenormouslypersonalnatureofhealthcareanditsimportanceinallofourlives,onemightthinkthatwewouldplacesignificantattentiononthescienceandartofcommunication.Afterall,communicationinandofitselfistreatment.Infact,itisperhapsthemostcommontreatmentprocedureweengageinashealthcareprofessionalseveryday.Despitethis,researchand,frequently,ourowninteractionswithhealthcareprovidersshowusthattheencounterswehaveinthehealthcaresettingaretoooftenmarkedbyalackofconnection,compassion,andrespect.Whileotherindustrieshavelongunderstoodthevalueofskilled,kind,authenticexchanges,thehealthcarefieldhasbeenslowtoacknowledgetheimportanceoffocusingonthehumanaspectsofreceivingcare.


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WhatoftenresultsisanenvironmentwhereatriptoahealthcareorganizationendsupfeelinglikeatriptotheDMV,onlythatitismadeworsebythesignificantlymorepersonalnatureofthevisit.Peoplemayfeelfear,pain,ordreadevenatthethoughtofgoingtoaclinicorhospital.Thecustomarygreetingof“doyouhaveanappointment”,spokenwithoutasmileoreyecontact,andadirective“haveaseat”inthecold,silent,interminablewaitingarea,whilebeinglargelyignoreduntilyournameisbellowedfromthedoor,allcontributetoadehumanizingexperiencethatmanyhavecometoacceptasnormal.Often,weworkinplaceswherewewouldn’treferourownfamilymembers,notbecauseofthetechnicalcaretheywouldreceive,butinsteadbecauseofhowtheywouldbetreatedpersonally.

Thecostofthissortofindifferentenvironmentforahealthcareorganizationishighandtheresearchdemonstratingthisisunequivocal.Alackofperceivedempathylessensapatient’sconfidenceincare,increasestheiranxiety,decreasestheirsatisfaction,andlowerstheiradherencetotreatmentrecommendationsandtreatmentplans,allofwhichleadtonegativehealthoutcomes.Alackofempathyalsohasnegativeimpactsonusashealthcareproviders.Researchshowsthatthebetterourcommunicationskillsare,thehigherourjobsatisfactionis.Onthecontrary,theworseourcommunicationskillsare,thelowerourjobsatisfactionis.

Ofcourse,rarelyisalackofempathypurposeful.Infact,oneofthemaindifficultieswithempathyisthatfeelingithaslittlecorrelationwithsuccessfullyconveyingit.Welikelyallhavearelativethatweknowwhocaresaboutusdeeply,yetrespondstousinawaythatdoesnotconveythatcare.Or,forthoseofuswithchildren,wecertainlyknowhowmuchwelovethem,butadmitthattherearetimeswhentheyexclaimtous,“Youarenotlisteningtome!”or“Youdon’tcareaboutme!”.Feelingempathyisdistinctfromeffectivelycommunicating,orconveyingempathy.Bridgingthisempathygapinhealthcareisthefocusofthisbook.

Oneofthemostupliftingfactsinthemidstofallofthisisthatwecanimproveourempathyandcommunicationskillswithpractice.Themoretimeandenergyweputintoit,themorewenotonlybenefitourpatientsand


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colleaguesatwork,butalsoourselvesandourlovedonesathome,aswecanusetheexactsametechniqueswithfriends,neighbors,partnersandchildrenaswedowiththoseinourprofessionalsetting.


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TheStudyofEmpathy

Researchonempathyanditseffectsonpatientexperienceandtreatmentoutcomesoriginatedinthefieldofpsychologyduringthe1950swiththeworkofCarlRogers,whocanlargelybecreditedforestablishingthefoundationalimportanceofempathyinthebehavioralhealthfield.Overthepastfifteenyearstherehasbeenanevengreaterexpansionofinterestinstudyingtheconnectionbetweenempathyandhealinginthemedicalfield,whichhasdemonstratedequallypositivefindings.

Theempathyliteratureisvariedandfascinating.Researchhasshownthatwhenmedicalproviders(andtheirteams)effectivelyconveyempathyithasthepotentialtolowerbloodsugarlevelsindiabetics,improvesuccessinweightloss,lessenthedurationandseverityofthecommoncold,increaseweightlossinthosewithobesity,andlowerself-reportedpainlevels,tonameonlyafewofthesignificantresearchfindings.Higherlevelsofempathycommunicationskillshaveevenbeenshowntodecreasemedicalerrorsandimprovediagnosticaccuracy.Ofparticularinteresttothebehavioralhealthfield,researchdemonstratesthatcommunicatingempathydecreasessymptomsofdepression,anxiety,andproblematicalcoholuse.Conversely,conveyingalackofempathy,oftenaccompaniedbyjudgment,hasbeenshowntoloweradherencetotreatmentrecommendations,increaseweightgainindiabetics,increaseselfreportedpainlevels,andworsenalcoholuse.Alackofempathyandincreaseinjudgmentalsodecreasesmeaningfulhealthdisclosures,resultinginmoreinaccuratediagnoses.Asaresult,theAmericanPsychologicalAssociationTaskForceonEvidence-BasedTherapyRelationshipshasdesignatedempathyasanevidence-basedelementofthetherapeuticrelationship.

Itisalsoimportanttonotethatitisnotonlytheempathyofmedicalprovidersthatimpactsapatient’shealth,butalsotheempathyconveyedbytheentireorganization.Empathyisfundamentaltotheworkofreceptions,nurses,medicalassistantsandbillingstaff.Researchhasshownthatempathyconveyedfromsupportstaffhasasignificantandmeasurableimpactonapatient’sexperienceandtheirsubsequenttreatmentadherenceandhealth


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outcomes.Notsurprisingly,successfullyconveyingempathyonalllevelsofanorganizationalsohasthefurtherbenefitofloweringpatientcomplaints,grievancesandlitigationrates.


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Open-EndedQuestions

Ingeneral,open-endedquestionsareconsideredtobethegoldstandardofassessmentandskilledinterpersonalinteractioninthemedicalandbehavioralhealthfields.Theyshowcuriosity,conveyaninterestinwhatothersthinkorfeel,andcanmakeapatientfeellessguardedsincetheyarelesslikelytoperceivetheconversationtobeboundbyarigidagenda.

Whenquestionsaretrulyopen,wedon’tknowwhatwewillhearnextorwherethingsmightgointheconversationandthatisokay!Inaskingopen-endedquestions,wearetellingthepatientthatwevaluetheirstoryandtheirperspective–notimpartingourownjudgmentoropinionsontheirexperience.Open-endedquestionsareaninvitationforthepatienttosharewhat’sontheirmind,allowingustoseethingsfromtheirpointofviewandcatchaglimpseoftheirbeliefs,values,andstrengths.


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Herearesomeopen-endedquestionstems:

ü “Tellmemoreabout….”

Eventhoughthisismoreofarequestthanaquestion,itisincrediblyeffective.“Tellmemore”isversatileandcanbeusedinfrontofanysubject.Itcanguidetheconversationtoaspecificplaceifweneedittogothere,whilestillkeepingthequestionopenand,thus,empathetic.

ü “Howdidyoudecide…?”ü “Whatareyourthoughtsabout…?”

Notethateventhough“why”isalsoanopen-endedquestionstem,itisn’tveryeffective.“Why”soundsjudgmental,evenwhenwedon’tmeanittobe.Ittendstoputpeopleonthedefenseandclosesthedoortoafullerconversation.Justthinkaboutwhathappenswhenwesay“why”toourkids.Watchhowquicklytheyfoldtheirarmsandshutdown.

Exampleatwork:

ü “Tellmeaboutyourmedicines”or“Whatareyourthoughtsaboutsmoking?”

Exampleathome:

ü “Howdidyoumakethatdecision?”or‘Tellmemoreaboutyourthoughtsonthat.”

Open-endedquestionsareconsideredtobethe‘goldstandard’ofcommunicationbytheInstituteof

Medicine.


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AQuickWordonClosedQuestions

Closedquestionsonlyallowfor“yes”and“no”orsimilarone-wordanswers.Theydemonstratethatwearereallyconcernedwithouragenda,narrowingtherecipient’sfocustowhatwefeelisimportant.Closedquestionssqueezeouttheotherperson’sfreedomtospeakaboutwhattheybelieveisreallyimportantconcerningagiventopicorsubject.

Herearesomeexamplesofclosedquestionsthattendtoleadtoone-wordanswers:

✗“Didyouhaveagoodday?”✗“Doyougetalongwithyourmom?”✗“Areyoutakingyourmedication?”✗ “Howoftenareyoutakingyourmedications?”✗“Whendidyoumeether?”

Narrowquestionsalsolimitdialogueandsquashrapport.Whiletheymayobtaintransactionalinformation,theyaren’tveryeffectiveatconveyingempathy.

Now,considertheseclosedquestions:

✗“Whatclassesareyoutakinginschool?”✗“Doyouthinkyou’rereadynow,ordoyouwanttowait?”✗“Isyourmedicationworking?”

Wecanobservehowmuchmoreempatheticthesamequestionssoundwhenframedasopenquestions:

ü “Tellmemoreaboutyourclasses.”ü “Howdoyoufeelaboutgoingnow?”ü “Whatareyourthoughtsabouthowthemedicationsareworking?”

Researchdemonstratesa

higherratioofopen-endedquestionsisrelatedtodiagnostic

accuracy.


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ReflectiveListening

Reflectivelisteninginvolvesrepeatingbackwhatwehaveheardtheotherpersonsay.Thisdemonstratesthatwearepayingattentionandthatwewanttomakesurewe’veheardsomeonecorrectly.Moreimportantly,itreflectsthathearingthemisimportanttous.

Inpractice,reflectivelisteningcantaketheplaceofaquestion,promptingsomeonetotalkfurther,withouthavingtoposeaninquiry.Reflectivelisteningalsoreplacesevaluativejudgments.Thesearestatementslike“that’sgreat!”or“howhorrible”.Reflecting,insteadofevaluating,givestheotherpersonthefreedomtoevaluatewhattheyfeelandthinkforthemselves.Byreflectingbackwhatwe’veheard,wearesignalingthatweare“with”thepersonandthatwearewillingtosuspendourownreactionstohearmoreabouttheirs.

Researchdemonstratesthatusingreflectivelisteningactuallysavestimeduring

appointments.Whenothersfeelheard,theytendnotto

dwellonthingsandrepeatthemselves.


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Repeatingbackselectedpiecesofwhatanotherpersonhassaidmightseemcounter-intuitiveandoften,reflectivelisteningisoneoftheempathyconveyancetechniquesthatpeoplefindmostchallenging.Thisisforgoodreason!Whileweweregrowingup,othersrarelyusedreflectivelisteningwithus,andsometimeswhenitisunskillfullyusedinprofessionalsettings,itcansoundinsultingordisingenuous.However,withpractice,reflectivelisteningcanbeapowerfulempathyconveyancetechnique-perhapstheonewiththebiggestpayoffforpatientcareoutcomes(andourownpersonalrelationships!).

Exampleatwork-MedicalAssistantspeakingtoapatient:ü “Youwanttomakesurethedoctorknowsthemedicationisn’tworking.Youalsowanttoaskaboutyourlabresultsandtofindoutthestatusofthereferralforyourfoot.”

Thisisan“exactwordreflection”.Thepatientfeelsconfidentthey’vebeenheardandreassuredthattheirissueswillbeaddressed.Thepatientlikelywillnotfeeltheneedtorepeatthesethings.

Exampleathome-Spousespeakingtopartnerwhohasdisclosedmultipleeventsatworkthatweredistressingtoday:

ü “Wow,thatsoundslikeareallytoughday’

Thisisa“summaryreflection”.Summaryreflectionsattempttocapturethegeneralnatureofwhatwasshared,insteadofreflectingbackthespecificlistofitemsthatwereshared.

Exampleathomeorwork:

“It’sbeenreallytoughformetoloseallthisweightthisyear.”

ü “It’sbeentough….”(Selectedexactwordreflection)ü “Soundslikeithasbeenhardforyou.”(Summarywithastem.Stemsarephraseslike‘Soundslike…’and‘Ihearyousaying….’)


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Unfortunately,insteadofreflecting,weoftenuseineffectiveresponses:

“It’sbeenreallytoughformetoloseallthisweightthisyear.”

✗ “Don’tlosetoomuchtooquickly!”(Advice)✗ “It’swonderfulthatyou’velostweight!”(Cheerleading)✗“Idon’tthinkthat’snecessarilyagoodthing”(Judging)✗“Don’tworry,itistoughforeveryone”(Reassuranceanddismissing)✗“Youneedtotakebettercareofyourself”(Correcting)

Alloftheseresponsesblockthepersonmakingthestatementfromdescribinghowtheyfeelaboutlosingsomuchweight.


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Anothercommonmistakeismakingthereflectionintoaquestion:✗ “So,you’refeelingsad?”Instead,try:ü “Ihearyou’resad…”

Restassuredthatifyouareincorrectinyourreflection,theotherpersonwillletyouknow,andthereflectionwillstillhavetheimpactofconveyingempathy.

Parentspeakingtochild:

Parent:“Ihearyou’resad”

Child:“No,notsad,justfrustrated”

ü Parent:“Justfrustrated….”


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FocusonStrengths

Orientingourcommunicationinawaythatrecognizesandvalidatesanotherperson’sstrengthsbenefitstherelationshipthatwehavewiththem.Itindicatesthatweseethattheotherpersonasfundamentallygoodandwhole.Itshowsthemthatwearefocusedandattunedtowhatisbestaboutthemandthatweareawareoftheirinherentworthanduniqueabilities.Thisstrengthsperspectiverepresentsaparadigmshiftinthefieldofhealthcare.Itisamoveawayfromtraditionaldeficitandpathology-basedcommunicationmodelsandtowardstrulywhole-personcare.

Focusingonstrengths,however,ismuchharderthanitsounds.Itrequiresnotfollowingthe‘problem’andinsteadhighlightingthegoodnessthatliesbeneaththeconcern.

Examplesatwork:

“Idon’tsmokeinthecarwhenmykidsarewithme.”

ü “Youreallycareaboutthehealthofyourchildren.”

✗ Insteadof:“Thereislikelystillsecondhandsmokeexposure”(Problemfocused)

Or:

“Ican’tseemtosticktoadiet,orexercise.It’shopeless.”

ü “Youreallywanttobeabletomakehealthychangestoyourlifestyle.”

✗ Insteadof:“HaveyoutriedthePaleodiet?”(Advice)

Focusingonaperson’sstrengths

islinkedtoincreased

motivationforpositivebehavior

changes.


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Or:

“I’msickofwaitingfor2hourseverytimeIcomehere.”

ü “Isureappreciatehowhonestyouareaboutyourfeelings.IknowI’dfeelthesameway.”

✗ Insteadof:“Thedoctorhadadeliveryatthehospitalthismorning”(Explaining)

Examplesathome:

“Ihatemath!”

ü “I’mamazedthatyoucancontinuetoworkoniteventhoughyoucan’tstandit.That’srealgrit.”


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Or:

“Idon’tknowwhyEthanismadatmeagain.Wehadanotherargumentatschool.”

ü “Youreallyvalueharmonyinyourfriendshipwithhim.”

Or:

“Ifeelbadaboutthis,butsometimesIdon’twanttobearoundGrandma.”

ü “I’mimpressedyouwerewillingtotellme.It’softenhardtotalkaboutfeelingswefeelbadabout.”


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Eliciting

Whensomeoneasksforadvice,itisquitetemptingtojumprightinandtellthemwhattodo.Instead,weshouldtakeastepbackandstartbyaskingthemwhattheythink.Askingothersfortheirthoughtsbeforeweshareourownoftentakespracticeandafairamountofdiscipline,butitisimportantsothatwecandiscoverwhatthepersonthinksabouttheirproblemfirst.


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Examplesofeliciting:

“Imean,whatamIsupposedtodoafterhearingsomethinglikethat?”

ü “Yes,wow.Whatareyourinitialthoughts?”

Or:

“Andnowmysisterissayingthatmymomshouldmoveinwithus!Howisthatpossible?”

ü “Whatareyourthoughtsaboutthat?”

Or:

“Whatdoyouthinkiscausingthesepanicattacks?”

ü “I’dlovetohearyourthoughtsonthat.Whatcomestoyouwhenyou’veaskedyourselfthatquestion?”

Often,wedoneedtoprovideinformationtopatients(ortofamilyandfriends).Wemaywanttoletapatientknowabouttheeffectsoffailingtoloseweightorquittingdrinking.Wemightwanttoletourchildknowwhattheconsequenceswillbeifhe/shedoesn’tcleantheirroom.

However,thereisadifferencebetweengivinginformationandgivingadvice.Givinginformationisnottellingsomeonewhattheyshoulddo.Rather,itisofferingdatatoinformtheirdecision.Theskillfulgivingofinformationischaracterizedbyaskingpermission(“canIgiveyousomeinformation?”),makingsureyouaren’ttellingsomeonewhattheyalreadyknow(“whatdoyoualreadyknowaboutsmokingduringpregnancy?”),andusingpronounsthatavoid‘you’statements(“whatweknowaboutsmokingduringpregnancy,isthatitcancause….”).Finally,itisaboutaskinghowtheinformationwasreceived(“whatareyourthoughtsaboutthat?”).

Whenwegiveadvicetoothers,the

mostcommonresponseisa

defensivedefiancetoprotectourautonomyand

personaldecision-making.


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Whengivinginformation,aneasywaytoremembertheseskillfulstepsisAATAorAskAskTellAsk.

Askwhattheyalreadyknowaboutthesubjectinwhichyouwanttogiveinformation.

Askpermissiontogiveinformationtheydon’talreadyhave.

Tellthemtheinformation,keepingitshortandavoidingthe‘you’pronounwhenpossible.

Askthemwhattheirthoughtsareonwhatyoushared.


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BodyLanguage

Researchshowsthatwetendtobelievewhatweseeinsomeone’sbodylanguageandhearintheirtoneofvoicemorethantheiractualwords.An“I’msorry”withagenuinelookofconcernandaslightleaninginisbelievable.An“I’msorry”withasurlytoneandarchedeyebrowsisreceivedentirelydifferent.Tothisend,itisimportanttorememberthatourbodylanguageandtoneofvoicecannaturallyconveyempathywhenwearefeelingopenandcaringofothers.However,whenwearetired,irritable,judgmental,fearful,ordistractedittakessomeextraconsciousthinkingtomanageourbodylanguageandtone.

Weknowquiteabitaboutwhattypesofbodylanguageandtoneofvoiceconveyempathy(whetherwearefeelingitthatdayornot)fromcrossculturalresearch.

Studieshavefoundthatwhenweare

communicatingwithsomeone,wordsonlyaccountfor7%oftheoverallmessage.Toneofvoiceaccountsfor

38%andbodylanguageaccountsfortheremaining55%.


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Eyecontactprovidesthemostpowerfulnon-verbalwaytoconveyempathy.Maintainingeyecontactbecomesmoredifficultaswebecomemorefamiliarwithothers.Asaresult,ourfamiliesoftengettheleastamountofeyecontactofall.Initialeyecontactwhenapatientwalksuptoreception,orwhenaproviderwalksintoaroom,musthappenwithinthefirstfewsecondsforittobeeffective.

Smilingisoneoftheonlywayswecanconveygoodwilltosomeonenon-verbally.Smilingisincrediblypowerfulinconveyingempathyandhasbeenresearchedextensively.Ithasbeenwrittenaboutbymanyspiritualleadersofdifferenttraditions.Itissometimesreferredtoas“holdinghands”withouttouching.

Openbodyposturethatis“squared”totheotherpersonconveysengagementandcare.Crossedarmsorsidepositioningcanindicatedisengagementorjudgment.Likewise,leaningslightlyforward,whensittingorstanding,conveysempathy.Ontheotherhand,leaningbackconveysalackofengagementand,insomecircumstances,judgment,aswell.

“Weshallneverknowallthegoodthatasinglesmilecando.”

-MotherTeresa


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Normalizing

Normalizingistheoppositeofmakingsomethingbad,wrong,orpathological.Itislettingothersknowthatthey’renottheonlyonestohaveeverfeltthisway,donethis,orhadthishappentothem.Maybethesamethinghasevenhappenedtous.Normalizingstrengthenstherelationship,increasesself-disclosureandencouragestheotherpersontotellusmore.

Theseexamplesillustratethedifferencebetweenpathologizingandnormalizing:

“IknowIshouldn’t,butIactuallystartedtalkingtomyex-boyfriendagain.”

ü “Gosh,we’vealldonethingsweknowweshouldn’t.Tellmemore.”(Normalizing)

✗Insteadof:“Youknowwherethatleads-thesameplaceeverytime”(Judgment).

Or:

“I’vebeenyellingatmykidsalotlately.”

ü “Whenwearestressed,itseemstocomeoutonthoseclosesttous.”(Normalizing)

✗Insteadof:“Youcan’ttakeyourstressoutonthem.”(Judgment)

Or:

“Ipickedupcigarettesagainlastweek.”

ü “Gosh,cigarettesaresotough.Weallhavethosethingswestrugglewith.Howareyoufeelingaboutit?”(Normalizing)

✗ Insteadof:“Again?You’vegottostarttakingcareofyourself”(Pathologizing,Advice).


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Or:

“Iendedupdroppingoutofschoolthissemester,itwasjusttoomuch.”

ü “I’vehadtodropcommitmentsbeforewhenIwasoverwhelmedtoo.Tellmemoreaboutit”.(Normalizing)

✗ Insteadof:“WhenIwasinschool,IhadtwokidsandIwasworking.”(Shaming)


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AcknowledgingFeelings

“Nevermeetafeelingwithafact”isaphraseweoftenusetotalkaboutacknowledgingfeelings.Acknowledgingfeelingsisoneofthefundamentalcornerstonesofeffectivehumaninteraction,althoughdependingonourupbringing,itcanbeexceedinglydifficulttodoinitially.Manyofusdidn’thaveourfeelingacknowledgedwhenweweregrowingup.Rememberhearingcommentslikethese?

✗“Youdon’thaveanythingtocryabout.”✗“Youshouldn’tbeangryaboutthis,it’snothing.”✗“Don’tbeembarrassed.”✗“Youshouldbehappyabout….”

Hearingsuchremarksaskidsoftenledustobelievethatwhatwewerefeelingwasn’t“real”orimportant.Asaresult,today,wemayfinditdifficulttoacknowledgeourfeelings,muchlessthefeelingsofothers.Wemaycontinuesayingsimilarphrasestopatientsandourlovedonesoutofhabitorroutine.

Acknowledginganotherperson’sfeelingsshowscareandconcernfortheirexperiences.Often,themereactofacknowledgingsomeone’sfeelingsbyrepeatingtheir“feelingwords”helpsthemfeelbetter.Itcanincreasetheirtoleranceforadifficultfeelingandlessenthefeeling’sintensity.Simplyput,whenourfeelingsareacknowledged,wefeelvaluedandcaredabout.Dismissinganotherperson’sfeelingsdoesexactlytheopposite.Itcanmakesomeonefeelalone,ignored,orshamed.Ignoringfeelingsalsoincreasestheirintensity.Psychologistsoftenusethephrase‘nameittotameit’whendescribingacknowledgement.Thisappliestoothersfeelingsaswellasourown.Thisdoesn’tmeanthatwediscussallfeelingsdeeply,orthatweneedto“process”allfeelings,itonlymeansthatweacknowledgethefeeling.


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Herearesomewaystoacknowledgeothers’feelings:

“I’msonervousaboutsurgery.’”

ü “Soundslikeyouhavesomeworriesaboutit.”(Reflectionofastatedfeeling)ü “You’refeelingreallynervous.”(Reflectionofastatedfeeling)

✗Insteadof:“There’snoreasontobescared.Thesurgeonhasdonethisprocedure100times.”(Dismissing)


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Or:

“EverytimeIcomehere,Ihavetowaitfortwohoursinthiswaitingroom!”

ü “Ihearyourfrustrationwiththewaittime.”(Reflectionofastatedfeeling)ü “Youmustbereallyfrustrated.”(Reflectionofastatedfeeling)

✗ Insteadof:“HaveaseatandIwillchecktoseewhenyouwillbecalled”(Ignoringthefeeling,fixing)

Acknowledgingthefeelingsoffriendsandfamilyisequallyimportantinmaintaingoodrelationshipsandconveyingempathy.Thesearealsothethingswecanregularlythinkaboutsayingtoourselves.

Examplesathome:

“I’mtooembarrassed!”

ü “Youfeelreallyembarrassed”(reflectingastatedfeeling)ü “Thisistoughforyou.”(reflectingademonstratedfeeling)

✗Insteadof:“Don’tbeembarrassed!Nooneevennotices!”(Dismissing/Reassuring)

Or:

“Ifeelsohopeless.”

ü “Youarereallyfeelingdown…”(Reflectionofanexpressedfeeling)ü “You’vehadahardtimelately.”(Reflectionofanexpressedfeeling)

✗ Insteadof:Youdon’thaveanyreasontobedepressed,yourlifeisgreat.”(Judging/Dismissing)


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PuttingitAllTogether

Empathyconveyanceisatreatmentinandofitself.Whencombinedwithothertreatments,itincreasestheirefficacy,improvingtreatmentoutcomes.Thoseofusinhealthcareenteredtheprofessiontohelpandwetypicallygotogreatlengthstocontinuallylearnandgrowinourskillsashelpers.Spendingtimelearning,enhancingandpracticingourempatheticcommunicationskillsisaninvestmentinourprofessionaleffectiveness,aswellasinourmostcherishedpersonalrelationships.Hereareafewadditionalexamplesthattietogethereverythingwehavecovered.

Example1

“Sometimesinthemorning,IlookinthemirrorandIjusthatemyself.”

ü “(Withempathetictoneofvoiceandbodylanguage)Ah,yousoundangryatyourself(Acknowledgement).Manyofushavefeltthatwaybefore(Normalizing).Iappreciateyourwillingnesstosharethiswithme(Strengthsfocus).Tellmemoreabouthowyoufeel(Open-endedquestion).”

Example2

“Ican’tstandcheckingmybloodsugar!”

ü “Youreallydislikeit(Acknowledgement,reflection).Itmustbesuchachoretohavetodoiteveryday(Acknowledgment).I’msoimpressedthatyouactuallycontinuetodoit.Yourhealthmustbereallyimportanttoyou(Strengthsfocus).Tellmemoreaboutyourexperiencewithit(Open-endedquestion).”


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Example3

“Ican’tloseweight.I’vetriedeverything,andnothingworks.”

ü “(Withempathetictoneofvoiceandbodylanguage)You’vetriedeverything(Reflection).Itmustbesofrustratingthatnothinghasworked(Acknowledgment).I’mamazedyou’vecontinuedtotrysomanythings(Strengthsfocus).Whatareyourthoughtsaboutyourweightnow(Open-endedquestion)?”

Example4

“Igotajobinterview!”

ü “Yougotaninterview!(Reflection).Youmusthavedonealotoffootworktomakethathappen!(Strengthsfocus).Howareyoufeeling?(Open-endedquestion).”

Respondingempathicallytogoodnewscorrelatestohappinessinintimate

relationships.


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10TipsforEmpatheticCommunication

1. Useadviceandreassurancesparingly.Althoughbothusuallycomefromaplaceofcaring,bothcanalsoconveythatwedon’twanttohearanymorefromtheotherperson;thatweinsteadwantto“fix”theirfeelings,tellthemwhattodo,andbedonewithit.

2. Useopen-endedquestions,encouragingtheotherpersontosharetheirthoughtsandfeelings.Closedquestionstendtoshuttheconversationdown.

3. Usecheerleadingsparingly.Cheerleading(“thatisgreat!”or“howawesome!”)iswell-meaning,andmostofusareinthehabitofusingitquiteabit.Cheerleading,however,doesn’tinviteotherstosharewithushowtheyfeelabouttheiraccomplishments.Whenwedofeelthedesiretogivepositivefeedback,wecanprovideotherswithspecificpraise,suchas“I’msoimpressedbytheeffortandtimeyouputintoyourhomework.”

4. Acknowledgetheotherperson’sfeelingsbeforetryingto‘fix’anything.Thiscreatesapositivebond,andoftenifwedothiswell,wedon’tneedto“fix”anything!

5. Avoid“controlwords”,like“should”,“must”,“haveto”,“needto”.Ashumanbeings,wehaveanaturaltendencytoprotectourautonomy.Whenwehearwordsthattelluswhatwe‘must’do,wetendtoresist.

6. Practicefocusingonthestrengththatunderliestheotherperson’sdisclosure.Focusingonstrengthsbeforeaddressingthedifficultythathasbeensharedisaveryimpactfulwayofshowingempathyandgoodwill.

7. Avoidqualifyingresponseswitha“but”asthiswilloftensignifyashiftfromanempatheticresponsetojudgmentoradvice-giving.Forexample,resist“You’vedonesowellonyourweightlossthisyear,butyoustillneedtoworkonthesmoking.”


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8. Consciouslyusebodylanguagetoconveyempathy.Rememberthatsomuchofwhatwearecommunicatingisbeingconveyedthroughbodylanguageandtoneofvoice.

9. Engageinreflectivelistening.Thisallowstheotherpersontoknowthattheirthoughtsandfeelingsareimportanttous,andthatwearetrulyhearingthem.

10. Practice,repairandpracticeagain!Enhancingempatheticcommunicationisenrichingforourpatients,ourlovedones,andourselves!


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CitationsandAcknowledgements

Anannotatedbibliographyonempathy’simpactonallaspectsofhealthcarefromtheInstituteforHealthcareCommunicationcanbefoundathttp://healthcarecomm.org/wp-content/uploads/2011/05/Empathy-Effect-bibliography_3-22-17.pdf

ThankyoutoEricaPalmer,MSWforprovidingessentialfeedbackandskillfullyeditingthisbook.


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AbouttheAuthor

Anaccomplishedtrainer,therapistandconsultant,ElizabethMorrisonspecializesinhelpinghealthcareorganizationsenhancehumanconnectionsincareprovision.Herareasofexpertiseandpassionarebuildingeffectiveandsustainableintegratedbehavioralhealth(IBH)services,developingpatient-centeredcomplexcareprograms,andprovidingresearch-basedtraininginempatheticcommunicationforhealthcareprofessionals.OriginallyinspiredbyCarlRogers’researchontheprimaryroleofempathyinhealing,sheusesevidence-basedstrategiestodesigntrainingsandconsultationstailoredtomeettheneedsofawiderangeoforganizations.

MoreinformationaboutElizabethandherworkcanbefoundonherwebsite,http://www.emorrisontraining.com.Elizabethcanalsobereachedviaemailatemorrisontraining@icloud.com.

Documents

Empathy ERP, July 31...Empathy Conveyance – July 2017 5 What often results is an environment where a trip to a healthcare organization ends up feeling like a trip to the DMV, only