February 2022 Article of the Month
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA
van Dijke, J., Duyndam, J., van Nistelrooij, I. and Bos, P. "'We need to talk about empathy': Dutch Humanist chaplains' perspectives on empathy's functions, downsides, and limitations in chaplaincy care." Journal of Pastoral Care and Counseling (2022): online ahead of print, 1/24/22.
[Editor's Note: Because this article is available ahead of print, no final page numbers can be cited. References are to manuscript [MS] page numbers.]
SUMMARY and COMMENT: The opening phrase of this month's title should resonate with virtually all chaplains, but its draw may be undercut in the minds of some readers who light upon the particularity of the source group for this study, wondering how the experience of "Dutch Humanist Chaplains" might be broadly generalizable. The authors hold that this specific group is able to provide special insights, because empathy is an explicitly highlighted concept in their professional practice: in essence, this is a group with good authority from their intentional and practical emphasis on this "key notion" [MS p. 1]. The article contains a great deal to stir discussion about empathy, over and above the insights it provides into humanist chaplaincy, and to generate further research and theory development around a topic that needs more critical exploration both because it may often be taken for granted in chaplaincy circles or because chaplains may feel disinclined to talk openly about how empathy can at times be problematic [--see MS p. 10].
Semi-structured interviews lasting 90-120 minutes were conducted with 20 chaplains (11 working in health care, 5 in the military, and 4 in prisons), with the purpose of "gather[ing] rich, detailed, and in-depth insights into participants' understandings and experiences of empathy in their daily care practices [MS p. 3]. Data collection took place between January 2017 and January 2019 [--information from a personal communication from the author]. Methodology was driven by grounded theory, but alongside of the usual coding process for the transcribed interviews the authors developed memos, tables, concept maps and visual representations to help them in their analysis [--see MS p. 4] and in building their own theoretical model.
Among the results, one set of findings addresses 7 identified functions of empathy that substantiate its importance but also acknowledge downsides and limitations:
- To Connect --
- "The data yield three ways in which empathy may support the connection or relationship between client and chaplain. First, participants point out that the quality of being empathetic may attract people. ...Second, empathy is a way to connect with people, as it is a form of contact in itself.... ...Third, empathy contributes to a trusting relationship, as engaging with the client's experiences promotes trust and sharing...." However, this function is limited when chaplains either "relate too much" or "relate too little" to the other person. "Chaplains self-observe that they tend to empathize more easily with people that they experience as relatable," but when they experience others "as 'far away,' 'miles apart' or different, they find it more difficult to relate and to empathize with their clients' experiences. In these situations, participants concede that they must 'work hard' and actively search for common ground to enable empathy." [MS p. 6]
- To Understand --
- "Chaplains draw on empathy to gain insight into clients' experiences and into the meaning of these experiences. ...This helps chaplains to understand what is at stake and to determine their clients' existential and spiritual needs. At the same time, the practice of empathy may help clients to better understand themselves as well. ...Chaplains emphasize, however, that empathic understanding is inherently imperfect and that one cannot assume to fully understand what the other experiences.... Chaplains consider making assumptions or jumping to conclusions a serious risk. ...This happens when chaplains project or when they overestimate their empathic abilities and the potential of empathy to know the other." [MS p. 6] As a result, they "need to be constantly aware of their quick judgments and interpretations." [MS p. 7]
- To Guide --
- "First, empathy gives direction to the conversation. It helps chaplains to understand what is important in the eyes of the client and needs to be addressed. ...Second, [because chaplaincy practice] "encourage[es] clients to focus on their inner world and verbalize their experiences, ...[e]mpathy helps chaplains to sense whether a certain word or metaphor is 'right' or appropriate. ...Third, empathy helps chaplains to attune and finetune their actions and responses.... ...[However,] one of the main risks of empathy is that of losing touch with one's own (moral) position and perspective. This may happen, for example, when chaplains are compliant and 'move endlessly along' with their clients. ...Several participants, particularly those working in the military or in prisons, mention[ed] that their clients are not interested in a chaplain who only listens and is a 'yes-person.' These clients value chaplains for their unique and independent outlook and perspective...." [MS p. 7]
- To Acknowledge --
- "Being acknowledged as a unique and valuable human being is an important, existential function of empathy and emerges as one of its major humanizing qualities. Chaplains work with clients who are often vulnerable and marginalized and who may feel lonely, unacknowledged, or misunderstood. ...According to the participants, feeling acknowledged is valuable in itself and may improve clients' sense of existential well-being. ...Experiencing the chaplain's commitment to truly listen, to empathize and to be genuinely affected by the other's situation may be a form of acknowledgment in itself. ...[However], [o]ne of the potential problems of empathy in relation to the acknowledgment function is that chaplains may be tempted to feign empathy in some situations. ...Participants note that vulnerable clients are particularly sensitive to insincerity and feigned empathy." [MS p. 7]
- To Motivate --
- "Participants explicitly mention that empathy helps to motivate them to be in a caring relationship, to act in a caring way, and to be fully present for their clients. When chaplains empathize with their clients, being present and providing care feels less like an obligation and comes more naturally. ...Chaplains observe that they tend to keep conversations shorter or more superficial when empathy is absent. ...[Nevertheless], [c]lients may use empathy to 'move' chaplains, to influence their behavior. Some chaplains mention that they feel manipulated when clients try to deliberately appeal to their empathy to 'get things done' or to gain their attention.... ...Chaplains confide, however, that they usually give their clients the benefit of the doubt and that manipulation appears to be a rare occurrence." [MS p. 8]
- To Inspire --
- "Empathy may inspire and energize chaplains and clients. According to the participants, experiencing empathy is a source of joy and inspiration, which contributes to personal meaning-giving and happiness. ...Chaplains emphasize that sharing in joyous moments...can be as important and meaningful as sharing in their clients' hardship. ...On the downside, empathy can be energy-intensive and overwhelming. This is the case when empathy is challenged or concerns experiences of hardship, suffering, and hopelessness...." [MS p. 8]
- To Humanize --
- "On an individual level, empathy has an innate humanizing quality... [and]...helps chaplains to be aware of the humanity of the other and to acknowledge the other as a fellow human being. On an interpersonal level, chaplains draw on empathy to encourage mutual understanding and to connect people. ...On an institutional level, chaplains draw on empathy in several ways to help promote humanization processes [in their work with staff]. ...[However], attempt[s] to contribute to a more empathic and humane environment can be burdensome if chaplains have little or no 'empathy allies.'" [MS pp. 8-9]
The authors parlay such findings into in a proposal of "three topics for reflection and discussion that we consider to be particularly relevant and urgent for the professional practice of empathy" [MS p. 10].
These questions, are intended to serve as "building blocks" rooted in the study findings that may help "give empathy a more prominent place on the agenda of those occupied with chaplaincy research and with the practice, education, and professionalization of chaplains" [MS p. 10], and lead to further investigation and discussion.
- Personal Empathy Strengths and Pitfalls and how to Address Them. What does empathy mean to me, how do I practice empathy and what are my empathy strengths and personal pitfalls or limits?
- Challenged Empathy and Challenging Behavior. Which clients do I find difficult to empathize with and for what reasons? How does challenged empathy or challenging behavior affect me and my care and in what ways do I respond to these challenges?
- The Cost of Empathy: Burnout and Empathy Fatigue. What do I need from the organization and from colleagues to practice empathy and how do I address the risk of empathy fatigue?
This study works out of data from a group of chaplains who should be well-placed to speak about empathy in general, but their perspective is also particularly significant in offering insight into the practice of humanist chaplaincy. Another set of findings is prominent in the article pertains to "three pillars of humanist chaplaincy that emerge[ed] from the interview data and that represent the core of the profession" [MS p. 4].
- Establishing a Caring Relationship Based on Trust and on Being Faithfully Present --
- "Chaplaincy care emerges as relational care. The participants explain[ed] that they aim to make 'real contact' or a 'real connection' and, if possible, to build an authentic and durable caring relationship.... Being faithfully present as a fellow human being is a vital part of their profession.... Many participants explicitly mention the so-called 'presence approach' as a core and a foundation of their work..., [this being]...a relational approach that centers around 'being attentively there' for clients, particularly for those who are vulnerable, marginalized and who may be experienced as challenging or difficult people by caregivers. The participants also mention[ed] the importance of being genuine and trustworthy. In their experience, vulnerable clients are particularly sensitive to these qualities." [MS p. 4]
- Supporting Meaning-Giving and Guiding Transformation Processes --
- "When questioned about the core of their profession, the participants mention[ed] meaning-giving as their primary concern: 'The aim of the conversation is meaning-giving (...), helping people to articulate their thoughts, to put into words what they consider to be important.' ...In addition..., several participants mention[ed] guiding transformation and acceptance processes as the main concern as well: 'Transformation takes time (...) my goal is to help people find peace of mind.' Chaplains provide existential or spiritual care for clients who have lost their sense of meaning and purpose, often because of life-changing experiences. Some participants use[d] the metaphor of 'journeying together' or of 'walking alongside' the other to characterize their professional role.... [MS pp. 4-5]
- Humanization on an Individual, Interpersonal, and Institutional Level --
- Here the authors note the individual-, interpersonal-, and institutional-level processes by which chaplains work to make a difference. [See the theme of To Humanize, above.]
The importance of empathy to humanist chaplaincy, in particular, is addressed at various points throughout the article. For example, regarding empathy's function To Guide, the authors comment that "humanist chaplains do not have religious texts or an extensive tradition of rituals, metaphors, and images to turn to and they do not work according to a specific methodology" [MS p. 7], so empathy is crucial to their ability to work fully and successfully from the present moment with another person. The authors also translate their findings into a model of empathy that integrates the "pillars of humanist chaplaincy" with the 7 functions of empathy [--see MS p. 9] and illustrates the interconnectedness of the constituent concepts. While this model may be illustrative of humanist chaplaincy, readers beyond that tradition should able to relate well to it.
Other findings of interest from this study include the participants' characterization of "the main existential and spiritual concerns of clients...: (1) Existential struggles, particularly those concerning death, grief, and a variety of losses such as the loss of health, independence, or future perspective; (2) Relational challenges include family issues such as a divorce, family disputes, or estrangement; (3) Emotional issues such as anxiety, loneliness, sadness, or anger; and (4) Spiritual and religious struggles such as fear of a punishing god or a loss of faith" [MS p. 5]. This enumeration of concerns may have come from a group of humanist chaplains in The Netherlands, but it seems noteworthy for its articulation of quite universal issues. Chaplain readers might muse about how this list relates to their own experience.
The functions and limitations of empathy have been researched before, but "[t]he originality of the present study lies in providing new and more detailed insights into these empathy functions" and how they operate "within the context of humanist chaplaincy care" [MS p. 9]. The same can also be said of the various "disadvantages and limitations" [MS p. 9] of the concept and practice. The authors state in closing: "We hope that our research findings, the theoretical model, and the three reflection topics presented in this paper can inspire and structure [ongoing] discussion" [MS p. 10]. It is clear that the participants of the study are open to the challenges as well as the value of empathy. Their expressed commitment to "'work hard' ...to overcome empathy challenges and to deal with empathy drawbacks and limitations" [MS p. 10] may be taken as a call from a small group of chaplains in The Netherlands to the larger profession internationally, to talk more about empathy and delve further into its praxis.
One more comment: This study predates the COVID-19 pandemic, which of course not only brought a new tragic disease into the landscape of chaplaincy but the additional hurdles of Personal Protective Equipment and social distancing in clinical interaction. The pandemic hardly devalues the findings here, but it does suggest that we are presently in time when chaplains are necessarily exploring novel ways work with empathy in practice --novel ways that themselves deserve discussion and research.
The quite extensive bibliography of 81 references covers up through 2020 and provides many avenues for further reading.
Suggestions for Use of the Article for Student Discussion:
This article is given to at least three different approaches for discussion. First, depending upon how empathy has been a topic in the CPE group up to this point, there could be some general sharing about students' basic understanding of the concept and experience in chaplaincy practice. Then, the group could look carefully at the findings around the 7 functions of empathy and their limitations [MS pp. 2 and 5-9]. Are the students open to both the upsides and downsides of empathy in chaplaincy? Which functions stand out to them? Perhaps one or more people could offer examples of how they have been challenged in their empathic work with patients, or say how they personally have received empathic care in their own lives. This alone could easily take up the whole session time, but it may be prudent to allow for some time to look at other sections of the article. A second approach would be for discussion to move quickly from some initial impressions of the article to the authors' three proposed topics of discussion [MS pp. 10-11]. This would be a fairly straightforward tack on the material and would logically back into the 7 functions of empathy and their limitations. It might be worth monitoring how the discussion of empathy may favor either a cognitive or affective track in the group. A third approach would be to discuss the article with an initial focus on humanist chaplaincy. Here, the session could begin with the Pillars of Humanist Chaplaincy section [MS pp. 4-5] and move into the rest of the article from there. Are students who do not identify as humanists still able to identify with aspects of humanist chaplaincy as described in the study? The authors comment that humanist chaplains may function as "empathy ambassadors" in an organization [MS p. 9]. Do the students imagine that they could be looked upon by healthcare staff as "ambassadors" of empathy in the institution? What does the group think about the diagrammed model of the functions of empathy [MS p. 9]? Regardless of the approach to the discussion, however, the group could be asked what the article leads them to want to know more about: empathy; humanist chaplaincy; chaplaincy in The Netherlands? And finally, this article urges a discussion of empathy in part because that is believed to be lacking in the field, possibly with the positive side of empathy being taken for granted and the downsides of empathic practice being somewhat "taboo" [MS p. 10]. Does this seem accurate to the group? Also, are there other aspects of chaplaincy for which the same might be said about a lack of open discussion and study?
Related Items of Interest:
I. For more on the subject of humanist chaplaincy, the Chaplaincy Innovation Lab site hosted a webinar in May 2021 on "International Perspectives on Humanist Chaplaincy," in collaboration with University of Humanistic Studies (Utrech, The Netherlands) and the Center for Spirituality and Health at the Icahn School of Medicine at Mount Sinai (New York), available freely online. (By the way, the Chaplaincy Innovation Lab also has a basic, general information page about Humanist Chaplaincy.) For more specifically on research related to humanist chaplaincy, especially out of The Netherlands, see the page for Humanist Chaplaincy Studies for a Plural Society from the University of Humanistic Studies (Utrech, The Netherlands). And, see the following recent articles:
de Vos, J. and Braam, A. W. "An empirical study on the nature of the verbal responses of humanist chaplains." Religions 12, no. 12 (2021): 1080 [electronic journal article designation]. [(Abstract:) There has been a limited amount of empirical research conducted in the past on how chaplains, and humanist chaplains in particular, actually interact with their clients during conversations as a part of spiritual care and counselling. The aim of the current study was to gain insight into the extent to which the verbal responses of humanist chaplains corresponded to Rogers' nondirective approach during conversations with clients. Rogers' approach has been commonly embraced since the beginning of the professionalization of humanist chaplains in the Netherlands. The study focused on humanist chaplains working at a general hospital in the Netherlands. Ten humanist chaplains took part in the study by audio recording their conversations with clients. The audio recordings were transcribed and analysed, and the verbal responses of humanist chaplains were compared to Rogers' approach. Subsequently, the verbal responses were analysed via conversation analysis, which also provided insight into how the humanist chaplains actually conversed with clients. Most of the verbal responses (73%) were consistent with Rogers' nondirective approach, though the ways in which some of the verbal responses were expressed were different; they were more compassionate and comforting. The remaining 27% of the verbal responses were directive and did not correspond to Rogers' approach. The study shows that, compared to Rogers' nondirective approach, the approach of the humanist chaplains was more direct and comforting.] This article is online at available online.]
Schuhmann, C. M., Wojtkowiak, J., van Lierop, R. and Pitstra, F. "Humanist chaplaincy according to Northwestern European humanist chaplains: towards a framework for understanding chaplaincy in secular societies." Journal of Health Care Chaplaincy 27, no. 4 (October-December 2021): 207-221. [(Abstract:) In this article, views on humanist chaplaincy of Northwestern European humanist chaplains are explored with a view to the question of how to understand chaplaincy in secular societies. Seventeen questionnaires were analyzed, filled in by humanist chaplains from Belgium, the UK, Ireland, and Denmark, who attended an international conference on humanist chaplaincy organized in 2015 in the Netherlands. In the Netherlands, humanist chaplaincy has a history of several decades and is meanwhile firmly integrated in public institutions; a brief overview over this history is presented. Using thematic analysis, respondents' understandings of 'humanist' in humanist chaplaincy were explored, yielding 4 key themes: humanist chaplaincy as a calling, caring for all fellow human beings, belief in (inter)personal potential, and struggling with a non-supportive environment. On the basis of these themes, building blocks are proposed for a future-oriented perspective on chaplaincy that allows for open dialogue between all chaplains and identification of common ground.]
II. For more on empathy that may be of general interest to chaplains, see Stephen Dietrich's article in the APC Forum [vol. 20, no. 6 (September 2018)], "Empathy: how it helps and how it hurts," available online. This piece is not a report of research, though the author is certainly research informed. For additional articles that report research, see the following that are not cited in our featured study this month:
Hamouda, M. A., Emanuel, L. L. and Padela, A. I.
"Empathy and attending to patient religion/spirituality: findings from a national survey of Muslim physicians." Journal of Health Care Chaplaincy 27, no. 2 (April-June 2021): 84-104. [(Abstract:) Attending to patient religion and spirituality (R/S) generates controversy. Some worry that because physicians lack formal religious training they may overstep their expertise, while others argue that physicians who are attentive to patient R/S provide higher quality of care. We aimed to describe American Muslim physicians' perspectives and practices regarding R/S discussions, and how physician characteristics correlate with these. A questionnaire including measures of religiosity, empathy, and attitudes and behaviors toward R/S, was randomly administered to Islamic Medical Association of North America members. More empathetic physicians were more likely to inquire about patients' R/S, share their own religious ideas and experiences, and encourage patients in their own R/S beliefs and practices (beta = .44, p < .01). More empathetic physicians also had greater odds of encouraging discontinuation of futile life-sustaining interventions (OR 1.90, p < .05). Additionally, respondents with higher empathy had greater odds of encouraging patients at the end-of-life to seek reconciliation with God (OR 3.27, p < .001), and seek the forgiveness of those they have wronged (OR 2.48, p < .001). In the context of R/S diversity among the patient and provider population, enhancing physician empathy may be key to attending to the health-related R/S needs of patients.]
Taylor, E. J. and Mamier, I. "Nurse responses to patient expressions of spiritual distress." Holistic Nursing Practice 27, no. 4 (July/August 2013): 217-224. [This study, featured as our ACPE Research Article-of-the-Month in August 2013, utilized a 5-item Response Empathy Scale, which may be of particular interest to chaplains.]
III. The following recent article may be useful for CPE purposes, through an adaptation of a tool developed for medical students.
Cairns, P., Pinker, I., Ward, A., Watson, E. and Laidlaw, A.
"Empathy maps in communication skills training." The Clinical Teacher 18, no. 2 (April 2021): 142-146. [(Abstract:) BACKGROUND: Empathy is a cornerstone of patient-centred care. However, empathy levels among health care professionals and medical students are currently suboptimal. An empathy map is a tool which aids in understanding another person's perspective. Empathy maps have up until now not been used in a medical education setting. OBJECTIVE: To assess the attitudes towards, applicability and usefulness of empathy maps as part of medical student's communication skills training. METHODS: Empathy map training was introduced to first-year medical student communication skills training at two UK-based medical schools. Twenty-eight participants in total agreed to be interviewed about their experiences using the empathy map, including sixteen students and twelve patient partners who assisted with communication skills training. RESULTS: Medical students and patient partners perceive value in empathy map training. Medical students stated that the empathy map training impacted on their views of empathy and patient-centredness by highlighting the importance of patient-centred care. Medical students and patient partners enjoyed the experience of completing the empathy map and had suggestions for how it could be improved in the future. CONCLUSIONS: Empathy maps could provide a cost-effective way to encourage empathic and patient-centred care in medical education. Furthermore, there is no reason why empathy maps would not aid in any caring profession. Further research is needed to confirm that empathy maps do increase empathy.] [This article is freely available online.]
IV. The idea of teaching empathy in medical school has gained quite a lot of momentum, and the following recent articles may be helpful especially to chaplains researching this area of education.
Paulus, C. M. and Meinken, S. "The effectiveness of empathy training in health care: a meta-analysis of training content and methods." International Journal of Medical Education 13 (January 26, 2022): 1-9 [electronic journal]. [(From the abstract:) Objectives: The meta-analysis examined the question of whether empathy training is effective in health care and whether specific training content and methods can be found to account for its effectiveness. Methods: We included 13 out of 50 studies (total N = 1315) that fulfilled the search criteria. ...Results: The overall effect size (Hedge's g = 0.58, s = 0.10, p = 0.00) indicated a moderate effect of empathy training. There was a significant heterogeneity (I2 = 76.9%, Q = 84.82, p=0.00), thus we examined whether individual training methods have influenced effect sizes, which could not be confirmed (F (8,4) = 0.98, p = 0.55). The same applied to the training contents (F (6,6) = 0.27, p = 0.93). Conclusions: The present study showed that empathy training could be effective. This confirmed previous findings and supported the use of such training. However, according to our results, no significant moderators could be found, i.e., the training contents or methods did not contribute to the effect sizes. For meaningful findings, a comparison of different training components should definitely be made, and it should be investigated whether empathy training spread over a period of time is more effective and sustainable than one-time training.] [This article is freely available online.]
Zhou, Y. C., Tan, S. R., Tan, C. G. H., Ng, M. S. P., Lim, K. H., Tan, L. H. E., Ong, Y. T., Cheong, C. W. S., Chin, A. M. C., Chiam, M., Chia, E. W. Y., Lim, C., Wijaya, L., Chowdhury, A. R., Kwek, J. W., Fong, W., Somasundaram, N., Ong, E. K., Mason, S. and Krishna, L. K. R. "A systematic scoping review of approaches to teaching and assessing empathy in medicine." BMC Medical Education 21, no. 1 (May 22, 2021): 292 [electronic journal article designation]. [(Abstract:) BACKGROUND: Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. METHODS: This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. RESULTS: In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. CONCLUSIONS: Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.] [This article is freely available online.]
V. What is the difference between empathy and such concepts as sympathy and compassion, in patients' minds? The following article may help chaplains think about conceptual differentiation.
Sinclair, S., Beamer, K., Hack, T. F., McClement, S., Raffin Bouchal, S., Chochinov, H. M. and Hagen, N. A. "Sympathy, empathy, and compassion: a grounded theory study of palliative care patients' understandings, experiences, and preferences." Palliative Medicine 31, no. 5 (2017): 437-447. [(Abstract:) BACKGROUND: Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients' perspectives of sympathy, empathy, and compassion are largely absent. AIM: The aim of this study was to investigate advanced cancer patients' understandings, experiences, and preferences of "sympathy," "empathy," and "compassion" in order to develop conceptual clarity for future research and to inform clinical practice. DESIGN: Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory. SETTING/PARTICIPANTS: Data were collected from 53 advanced cancer inpatients in a large urban hospital. RESULTS: Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual's suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful. CONCLUSION: Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients' perspectives is important and can guide practice, policy reform, and future research.] [This article is freely available online.]
VI. For more on the measurement of empathy for research, see the following new article:
Stosic, M. D., Fultz, A. A., Brown, J. A. and Bernieri, F. J. "What is your empathy scale not measuring? The convergent, discriminant, and predictive validity of five empathy scales." Journal of Social Psychology (2021): published online ahead of print, 11/2/21. [(Abstract:) Recent reviews of the empathy literature have revealed that nearly half of the published studies on empathy employed an empathy measure that did not align precisely with the theoretical definition the author provided. This may occur because researchers might not know what each published empathy scale actually measures. The present research begins to address this problem by reporting a large set of correlates for five different empathy scales to enable researchers to review the interpersonal traits and abilities each scale predicted. Participants (N = 182) completed the Davis IRI and the empirically derived Hogan Empathy Scale (HES). Each empathy scale produced its own unique pattern of correlates with empathy related traits that more or less supported each scale's description. However, none of the five scales reliably predicted empathy related abilities. We discuss the importance of examining a scale's predictive validity over its reliability, face-validity, popularity, or name.]
VII. NOTE: The journal Psychiatry has recently published a special theme issue on empathy, and the Journal of Social Psychology is preparing to do so (with articles online ahead of print). See the following example articles from these special issues:
Cottrell, L. S. Jr. and Dymond, R. F. "The empathic responses: a neglected field for research." Psychiatry 84, no. 3 (Fall 2021): 209-213. [(Abstract:) The more fully one comprehends the nature of the shifts in theoretical and methodological orientation which have been taking place in social psychology during the past two decades, the greater becomes his appreciation of the fundamental contributions made by Harry Stack Sullivan to this highly significant movement in social science. An appraisal of the changes here indicated has been made elsewhere1. Briefly stated the basic trend has been toward what may be called interactional theories of human behavior and personality and away from static atomistic attributive theories, with accompanying efforts to develop methods more appropriate for dealing with dynamic interactional situations. Sullivan's importance in this development is due not only to the fact that he has made the most explicit formulation of interactional theory and practice in psychiatry as such, but that these formulations are highly relevant and significant for the whole field of social psychology. There can be no doubt that he will rank as one of the major contributors to a matured social psychology.]
Hall, J. A. and Schwartz, R. "Empathy, an important but problematic concept." Journal of Social Psychology (2022): online ahead of print, 1/3/22. [(Abstract:) The concept of empathy as it is used in scholarly discourse has been challenged for over 50 years, yet the same ambiguities and controversies associated with the concept persist and, indeed, have accelerated with the accumulation of definitions, subconstructs that are included under the empathy umbrella, and measuring instruments. In this article we address the following interrelated problems: many definitions, authors not offering definitions, authors using instruments that do not match their definitions, authors not specifying definitions and measurements in cited studies, the jingle-jangle problem, and the persistent need for more construct validity research. In this Special Issue on empathy and its problems, authors bring new theoretical insights, creative research designs, and a critical focus on the empathy concept itself.]