FIGURE 4-1 The Process of Listening and Empathic Response
A common way of responding that gets in the way of listening is trying to fix a problem the other person is describing. When people present us with a problem or are having a difficult time emotionally, we often become anxious. We believe we must do something immediately. We want to quickly fix or minimize whatever is wrong in order to reduce our own anxiety. Usually the problem does not get solved this way, and the patient ends up feeling even less understood.
One of the primary reasons for listening and empathic responding is to help the patient feel less alone or isolated. As Carl Rogers3 states, “For the moment, at least, the recipient finds himself or herself a connected part of the human race…. If someone else knows what I am talking about, what I mean, then to this degree I am not so strange, or alien, or set apart. I make sense to another human being. So I am in touch with, even in relationship with, others. I am no longer an isolate.” To put this another way, when we feel alone in a problem, hopelessness often goes with that. If no one else understands, the problem seems unsolvable. If someone can express understanding at an emotional level, then the person is not alone. If someone else can understand, then the problem must be solvable. At least, so it seems. Therefore, listening and empathic responding offer hope. The next time a patient presents a problem and you feel anxious, use that anxiety as a trigger to demonstrate your understanding, rather than trying to escape your anxiety by minimizing the problem.
EMPATHIC RESPONDING
Empathic responding is crucial in building an effective therapeutic alliance. The word empathy is derived from the German word Einfuhlung. This word means that we can actually share the experience of another. It is different from sympathy. Sympathy is feeling sorry for another. Empathy is feeling or experiencing affectively with another. It is a neutral process. This means there is no judgment or evaluation of the person or feelings involved. Sympathy is not neutral. Empathy has been defined as an objective identification with the affective state of an individual.4
To better understand empathy, several concepts must be understood: identification, imitation, and affective communication. Before an empathic response can be made, one must experience the affective state of the other. Empathy involves identification with the affective experience of the other. It does not involve identifying with the other person in total, nor does it mean that you have shared the same experience in actuality. It is not necessary to have experienced the loss of a loved one to experience the grief that the person standing before you is experiencing. Too often people believe that one must have had the same experience to be empathic. But this can simply get in the way, because a subjective component is now added: your experience of a similar event. This may interfere with your capacity to identify with the unique affective state of the other. Empathy takes courage, because it means you must be open to the affective experience of another. Often this experience is painful. (Of course, we should also be empathic with the joy and happiness of others.) There is a tendency to avoid the experience rather than be with the experience and be truly useful and available to the other.
Imitation is also part of the empathic process. Often, without realizing it, we imitate or mimic the facial expressions or body posture of the other, particularly when a painful experience is recounted. This is a form of identification with the affective state and signals some empathic understanding. This is affective communication. This form of communication cannot be accomplished if one is distracted or interrupted—a key reason why giving total attention is important.
The empathic process always results in the acquisition of knowledge by both parties—in coming to know one another. It does not involve like or dislike, good or bad, but is a neutral process. Behavior is not prescribed, and the other’s feelings are not evaluated. You simply come to know more fully how this other person relates to a problem or a situation.
Reflecting this understanding back to the other is always transforming or growth producing. If it is not, then we are not dealing with the process of empathy. A few cautions are in order here. First, although empathic understanding is always transforming, it is not always soothing. It may, in fact, be painful at times.
This leads to my second caution about empathy. Empathy does not mean giving in or giving up. Empathy is with a person’s affective state or situation, not with the person’s demands. For example, a company sales representative enters a pharmacy and asks the owner to purchase some of his company’s products. The owner does not carry that line of products and has no desire to start doing so. The company representative states sincerely, “This would really help me out. I’m having a tough month and could use the business. My boss is pushing me about meeting quotas. How about a small order?” The owner responds, “You sound worried. I really hope you make your quota, but I don’t carry your product line and don’t want to at this time.” The owner responds empathically to the concern of the salesperson but does not give in to the request. It should be noted that empathy cannot be conveyed in a clichéd manner. If the owner had said what he did without sincerity or caring, his response would not be empathic.
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