To empathise or not to empathise?…that is the question!

In the last few years so much work has been done by people such as Daniel Goleman – Emotional Intelligence, Professor Simon Baron-Cohen – Zero Degrees of empathy and  Peter Balzalgette – The Empathy Instinct, all looking at the benefits of empathy; what impact it has, and what erodes it. Whilst a huge topic, empathy has been seen as the cornerstone of human relationships. It was something we are hardwired to do and should continue to develop. However this has now been challenged by Paul Bloom who states that empathy is actually damaging to the greater good of the human race, preventing objective decisions and should be replaced with rational compassion.

My blogs never have been and never will be about stating a definitive answer that suits every theory and person, as I have studied and worked with enough psychological theories to appreciate, they all have good merit, but, all have components that violently clash with the others too. In reality, we can look through many different lenses to get understanding of the human mind and behaviour, all valuable. More so what I offer is the evaluation of theories and research in real life scenarios. So this is what I do here…..

The question I pose in the title, does not have a clear-cut answer, as I do not think that empathy is clear cut any more than those who house it…..US (and other animals)…yep…living beings. Focusing on humans, we are so complex that we operate on many psychological and interactive levels. For example

best-research-psychology-psychiatry-may-2016#1 A personal and insular level – where we are focused on (consciously or unconsciously) on what will keep us as an individual in harmony….You know, that conflict, conversation and emotional dialogue that we have going on inside ourselves about what we need to feel safe, happy and fulfilled.

#2 A personal interactive level – where we are focused personally,addiction-support-program-family but in relation to our family, friends and colleagues, what they feel and what they need, their impact on us.

hsands#3 A social level – where we are focused on supporting people who we hardly know, if at all. The stranger in the street or the person who we come into contact with in our work. share_with_others_get_involved

#4 A global level – where we are focused on the greater good of the masses and those we will never meet.

With just this crude and simplistic breakdown of our many levels in using our mind and emotions (consciously and unconsciously), is it any wonder it is hard to assess sometimes the role that empathy and indeed, compassion, objectivity and procedures have. For every argument for any of these, there will be a counter one. This is what is so great about research and real life evaluations.

When it comes to my real-time evaluation of empathy, rational compassiCarolynon, objectivity and procedure, I draw on my experience of the presence and absence of empathy. Empathy I felt for example toward clinicians and an organisation after I lost a child in hospital, in circumstances I felt needed to be challenged (anyone familiar with me and my blogs, will be too familiar with this fact). I was blocked at every avenue, something that happens all too often in complaints sectors, with my emotional needs and understanding of my emotional motivations  not understood at all, let alone responded to in any kind of beneficial way.  They lacked empathy which had a potentially detrimental effect on not only me, but their staff, their practices and therefore, many other people.

Having had the background I had though in counselling, I found myself trying to put myself in the shoes of the clinicians and indeed organisation, to understand why empathy and consequential compassionate responses toward what happened to my child,  and their interest in learning lessons did not appear apparent.In fact it appeared the complete opposite.

3D man near red question markSo I asked empathic questions…. What might it be like to be a doctor with a complaint against them? What might that feel like? Can I imagine that feeling? What might be the culture in the hospital and what did that feel like to be working in it? Would I possibly want to hide away and not face things if I were feeling scared or threatened as I imagined they might be feeling? If so, what would make it worse for me and how might it be easier to face things.? These were all questions I asked myself and I can tell you now, they were not easy!!  To try to empathise whilst feeling tormented with grief and being met with such hostility, was no mean feat!  But it is exactly what I did. 

I stayed in an enquiring mind, I allowed myself to try to imagine the world of another, to 1cb68f5a5c34cf4d7906e5bab76ecf9d_thinking-clipart-clipart-clip-art-man-thinking_385-446feel it, and to respond appropriately…with compassion and objectivity. It did not mean I agreed with them….far from it! But I saw beyond my own feelings to be realistic and more objective.  It did not mean that I felt their feelings so strongly that my own were overwhelmed, debilitating me from factual investigation… compassion was measured. Tying to understand their world and feelings did not make me unable to work toward a solution that I knew would still cause distress to the medical staff involved…it did NOT debilitate me, I had a job to do and it needed to be done…make no mistake, but made me mindful of how I acted, it was more the how I did it and allowing my mind to be more open. Empathising with them did not mean that I backed away of finding answers that I desperately sought.

What it did mean is 3D X-Ray of head with gears in brainthat I used my empathy to see the situation in real human terms…because that is what we are…human.  I was able to use my understanding of what they might be going through to act myself in a less angry and blaming way, which in the end, was instrumental in getting heard and gain the opportunity to focus on the factual and objective issues at hand. One thing enabled the other.

What it also meant is that I responded with rational compassion toward them….rational compassion though that had its roots in empathy. Empathy did not make me less objective toward the situation, but more, as I considered the full picture to help me make informed decisions. It shifted my own personal and insular level of functioning to a morebest-research-psychology-psychiatry-may-2016 social level where I was able to consider others and understand actions and behaviours. Along with not being empathised with, if I had not tried to empathise, we would have continued to hit brick walls, practically and emotionally. I would have got angrier and angrier, my behaviour may well have reflected this as I unconsciously dehumanize them to cope. Their defences would have increased and productive, reflective and learning talks been less possible.

And here is the key hsandsthing, empathy helped on a social and global level too (by this I mean in helping others I would never meet-the greater good rather than the entire world!!) Valuable lessons that were to be gained from my insight of the illness and treatment that I had witnessed to help to understand why it happened and alter practice for others could have been lost without my empathic thinking and consequential interactions. It turned defensiveness to understanding, learning and reflective.

The CEO of the hospital wrote to me afterwards saying that ”

“Despite the distressing circumstances that led up to our two meetings, you  have at all times been articulate,  calm and dignified in the way you have dealt with me and my  colleagues. I acknowledge and agree with the points raised in your letter. I normally try to be compassionate and empathetic but I let you down that afternoon”

So I have no doubts, that any rational compassion, courage, objectivity, working with procedures, challenging and my own self care, came directly from my use of empathy. Yes it was placed in self-awareness, which is crucial, and something I promote in my work. As with anything, empathy needs managing. So does love, anger, sympathy, compassion, procedures and law….but they all have a place. I don’t deny there are times that empathy can cloud my judgement, but so too can being overly objective and procedural driven that cry out sometimes for flexibility and humanity. Empathy is and should be part of the decision getty_yes_and_no-184275539making process and should be given weight. So to empathise or not empathise?…..well having used, analysed and most importantly felt the presence of and absence of, I will always wish to live in a world where the balance is tipped in favour of the answer is YES!

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Blog:Why I believe in authenticity over perfection

authenticity-hoaxWant to know all the things that are not perfect in me? Oh please say no, as we could be here all day!!!

Perfect daughter…..NO

Perfect mum……..Most definitely not!!

Perfect friend…….Nope

Perfect person…….oh please!!! I may train in empathy and emotional development, but I am authentic, so I have an ego like everyone else. I am NOT perfect, but I am authentic.

The mistakes that I have made in communication and decisions in my life are multiple and once more are on going. I have beaten myself up emotionally over the years, questioned and analysed. I have acted in ‘perfect’ ways and then unravelled for some reason and acted in ways that this little voice in my head says ‘what are you doing?’ But through out it all, I have been real and authentically me. Yes that’s right, real and authentic. And in embracing those two attributes I have opened my mind to learn, connect with my vulnerabilities and imperfections and  grow.

ego-shadowI know now when my ego is in the driving seat and when it shouldn’t be. I know now the value of authentic communication, because I have experienced enough of both receiving it ….and not, to truly understand how it feels. I have parented in extreme circumstances and following losing a child at 15, I have had to look into my own eyes to see what is left in my soul to work with?

You see even from being a young child, I have noticed and picked up on a lack of authenticity in behaviour. You know, when someone says one thing, but there is something not consistent about their words, tone, body language or actions, often hours, days, weeks, months and even sometimes years, that inconstancy shows more obviously and you realise that what you picked up was real. They were pretending to be perfect, but losing authenticity. At now 47, I have seen this multiple times and can recognise when I do it. I have seen it both in individuals and organisations. I have seen it and felt it, personally and professionally.

Policies and procedures often create this, when they are used try to manage us human beings and stop any errors. People are forced into a tick box world and ‘say all the right things’ but show no real emotions which lacks authenticity. Who among us want a sorry for a wrong doing against us, if we think the person really doesn’t mean it. Does that not communicate the total opposite if authenticity.

To be authentic though, you must be vulnerable enough to understand yourself, accept and 235e090f944bf5d41d6d3981e555aef7own your emotions…..YES ALL OF THEM! You must be transparent. If you don’t feel something, then don’t pretend you do – not always easy, but something worth trying to do – because then you have integrity. As human beings, we recognise fake, but sometimes, we need to be honest with ourselves and recognise when we are slipping into that too….because we all will from time to time, to survive, while we try to understand sometimes complex feelings and interactions.

In my training and consultancy work, which is the epitome of honest and authentic, as I lay myself emotionally bare in demonstrating and cultivating empathy and emotional download-1development, I discuss incongurence and the difficulties that presents when we feel we do match the ‘perfect’ version of ourselves we hope to be.  I encourage people to discuss when things have gone well or not, as that is real. Who among us can say that we always act as we should or that we never question ourselves. I am not a someone who talks the talks but has never walked the walk. I know how hard empathy can be and I know what gets in the way sometimes, I had to find it for doctors and a hospital who I felt left my child, and who showed none to me. But I did and it helped….it helped the situation, the outcome, and it helped me long-term too. I know the benefits. And that is what connects me, authentically to those I work with.

Its why…since I was little, to 47 and for the remainder of my life, I will believe in authenticity over perfection. It is honest, transparent and real.

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Measuring the wonders of an empathetic ear in the doctor’s office

In an article in the Washington post 2 February 2017, Libby Copeland who writes many articles concentrating on culture and human behaviour, published an article on Danielle Ofri’s perceptive book “What Patients Say, What Doctors Hear.” The shortcomings of the patient-doctor relationship are on full display as Ofri’s book probes what goes wrong in the exam room and tallies the impact on the care we get.

Libby states we often think of medicine in terms of numbers and statistics. How many possible diagnoses are there for this mystery ailment? What’s the success rate for this surgery, or the likelihood of remission after chemotherapy? We rightly want our doctors knowledgeable about the latest treatments and side effects.

But Ofri makes a compelling case that patient-doctor communication in the exam room is as crucial to diagnosis and treatment as expensive tests and procedures. Offering empathy, asking open-ended questions, involving the patient in a treatment plan and checking again and again to make sure patients understand are all key to making the sick better, she writes.

screenshot-114Ofri, a physician at New York’s Bellevue Hospital and a professor at the New York University School of Medicine, delves into medical research and draws on her years of practice and observation to illuminate vital aspects of the patient-doctor relationship: Good communication lowers anxiety, raises patient confidence and makes us more likely to adhere to treatment plans. Longer visits with primary-care doctors are correlated with fewer malpractice suits. Doctors who listen well are more likely to uncover hidden causes of illness, such as sexually transmitted diseases. In one study, back pain patients receiving electrical stimulation experienced far more pain relief when accompanied by a physical therapist who was a good listener. Research shows that patients who visit more empathetic doctors even shorten the duration of their colds by more than a day.

We’ve known for decades that doctors who offer empathy, build trust and set expectations help their patients fare better. As far back as 1964, a study conducted with abdominal-surgery patients illustrated what Ofri calls the “demonstrable effect of the simple act of talking.” Before surgery, half of the patients were visited by an anaesthetist who said pain afterward would be normal and would last a limited amount of time, and explained how patients could relax their muscles to lessen the pain. These patients needed half the pain medication of others who didn’t receive a pain talk. If we are an over medicated nation, better communication would seem an easy and cheap way to relieve that burden — except that listening takes time, and doctors don’t usually have that.

Ofri’s insights are particularly instructive as the medical profession increasingly suffers from tight schedules, packed waiting rooms and tightwad insurance companies. With patient-doctor communication more important than ever, Ofri shows how it gets fouled up, pointing to unspoken assumptions, rhetorical differences and language barriers. (And she’s not talking about nonnative speakers of English; medicalese is its own language, impenetrable to laypeople.) When patients go to the doctor, Ofri writes, they’re inclined to tell the “story” of their illness, from beginning to end, while doctors are trained to look for the “chief complaint.” Little wonder, then, that research shows “doctors typically interrupt patients within 12 seconds.” The difference in speaking styles sets up an experience in which patients feel rushed and unheard, and doctors feel impatient about their rambling patients. Too often in exam rooms, we are speaking past each other.

An open, welcoming physician can draw out crucial information that otherwise might lie hidden. Ofri recounts examining a woman with a tense smile who described the pains she had in various parts of her body. After the woman left the exam room, she returned and, clutching the doorknob, said, “Doctor?” She hesitated. “ ‘Do you think it’s possible . . .’ She hesitated again. ‘Do you think it’s at all important that these are the same spots where my boyfriend shot me with a dart gun?’ ” The “hand-on-the-doorknob phenomenon is . . . well known to all doctors,” Ofri writes. “A physician can proceed assiduously through a detailed history and physical with a patient, but it is only when the patient is halfway out the door that the important information spills out.” Ofri invited the woman back into her office so they could continue talking, clock be damned.

Ofri seeks to humanize a profession often seen as haughty, privileged, uncommunicative and indifferent to criticism. She’s also sensitive to her colleagues’ resistance to “hokier-sounding soft stuff” such as communication, empathy and connection. “Something that simple and intuitive, something that doesn’t require specialized knowledge, can feel threatening to a physician who has spent a decade training to acquire unique medical knowledge. . . . There’s something vaguely discomfiting to realize that the techniques shamans used centuries ago can sometimes be as effective as our pharmaceuticals backed by million-dollar mega-trials.”

But, as Ofri’s compelling argument makes clear, modern medicine could benefit from a better understanding of how human beings like to be treated when they’re at their most vulnerable — sick and confused and naked save for a thin paper gown. If only doctors could bill for listening.


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