Using Empathy in Communication

Introduction

Successful communication in healthcare leads to favourable patient care and improves patients' satisfaction and independence. In addition, effective communication can protect the patient from adverse health consequences resulting from poor communication such as medication errors or contraindications. One way to effectively communicate with patients is to use emphatic communication. Provider-patient empathetic communication has shown to lead to better outcomes and treatment adherence.

Empathy vs. Smpathy

Empathy involves the ability to understand how someone thinks, feels and believes and respond appropriately Sympathy, in contrast refers to an immediate and uncontrolled emotional reaction when a person puts themself in another person’s position. Empathy motivates one to act on someone else's behalf understanding their perspective and knowing how to help. Sympathy is feeling sorry for someone. Empathy can be learned and is a choice. Empathy is accomplished by Understanding someone else's listening, understanding and experiencing from another persons' position.

In healthcare, empathy creates a therapeutic relationship based on understanding another person and interacting accordingly. It allows the healthcare worker to make logical decisions and maintain professional objectivity regarding patient care. Sympathy on the other hand may interfere with ethical decisions due to its emotional subjectivity. Empathic care sends a caring message to patients, increases patient's positive responses, decreases anxiety and contributes to improved patient outcome.

Cognitive and Affective Empathy

Empathy can be further divided into two cognitive empathy and affective empathy (responding to someone's mental state with an appropriate emotion) Cognitive empathy refers to the ability to perceive a situation from another persons perspective beyond their own experience without judgement. Cognitive empathy can include verbal and/or non-verbal skills and can be learned through observation and experience. Affective empathy refers to the involuntary, internal response to someone else's emotional state. Affective empathy is thought to be "built in" from birth as part of personality and disposition.

Empathic Communication

According to Babaii et al., 2021, empathic communication with patients is achieved through three categories:

1. having unique and humanistic behaviors with the patients
   • maintaining their dignity
   • consider their culture and beliefts
   • friendly behaviour
   • unique way of dealing with each patient
2. providing a happy and calm and environment for the patients
   • using jokes
   • being happy
   • pleasant environment
3. decreasing the patients’ fear and consolation to them
   • giving hope
   • normalisation of new conditions
   • use of distraction and spirituality to reduce stress and anxiety

Steps to Empathic Communication

Empathic communication can be achieved with just a few steps. The Grossman Group has narrowed it down to 6 steps:

1. Listen without interruption
2. Pause and imagine how they feel
3. Let them know you hear them by reflecting back what they have said: “What I hear you saying is…”
4. Validate their feelings: “I understand you’re feeling…”
5. Offer support and close the conversation
6. Follow up after a little time has passed

Barriers to Active Empathic Listening

(AEL) A common problem with listening is that we tend to overemphasize the physical aspect of it; we assume that if we are hearing what they are saying Empathic Listening 65 then we are being a good listener. In reality, listening is so much more than nodding our heads, not interrupting, and being a blank slate at whom they can throw their words (McClelland, 2017; Shrivastava, 2014). If basic listening is a difficult process, then it can be assumed that active empathic listening (AEL) is even harder. Knowing this, the necessity of education, especially for leaders, on common barriers to AEL is crucial. Having this knowledge will better prepare leaders and future leaders to recognize AEL barriers in their own lives and navigate a course to more empathic listening. Speaking Rate Versus Listening Rate One logistical barrier to AEL is the fact that we process words much quicker than a speaker can speak them. A 1992 study found that the average speaking rate is 120–180 words per minute whereas the average listening capacity of the brain is 500–800 words per minute (Shrivastava, 2014). This gap naturally results in excess time for our brain to wander in the listening process. In a perfect world we would use this extra time to tap into empathy, perhaps by dialing in to what the speaker’s nonverbal communication is telling us about how they are feeling. Instead, it often becomes a time where we get off track; we rehearse in our head how we will respond or become distracted by a memory their story reminds us of (Salem, 2003). Defensiveness and Shame In conflict especially, defensiveness and shame are toxic habits that fuel the conflict cycle and directly halt the empathic process. While empathy draws us to another person and allows us to accept and understand their pain, defensiveness repels us from one another, undermining any hopes of connection. When we are focused on protecting ourselves and guarding our position, listening to and validating the other side of the story is most likely not the first item on our agenda (Beckenbach, Patrick, & Sells, 2010). Shame also prevents us from exploring the other’s perspective. Note that there is a difference between shame and guilt. Guilt originates when we recognize we have caused another person distress through a particular action; we see how reparative acts, like apologizing, may restore our relationship with them. Guilt is linked to perspective taking (the goal of empathy) and motivates us to do so. Shame, on the other hand, 66 The Journal of Student Leadership condemns the whole self, resulting in personal distress. Shame tells us that the affliction we have caused another person is not because of a particular action but because we ourselves are inherently bad. Why then would we want to hear the other’s perspective and further recognize the problem that we believe we are? When shame envelops us, we don’t listen with empathy; instead, we resort to more damaging behaviors such as ignoring the problem or the person, denying responsibility, or even lashing out at the very person who needs our empathy (Leith & Baumeister, 1998). Other Barriers There are other barriers to empathy, including: criticizing, challenging the legitimacy of the speaker’s feelings, giving advice, interrupting, and changing the subject (Salem, 2003). In the vulnerability of sharing one’s story, perhaps the worst response one can receive is that of criticism. Critical phrases such as “Why did you do that?” can staunch the open flow of information sharing and may result in feelings of shame if the speaker feels that the listener is negatively judging their character and actions. Likewise, the speaker should not feel like the purpose of sharing their story is to convince the listener of the truthfulness of their feelings; they want to be trusted and validated. Furthermore, if we are interrupting, giving advice, or changing the subject, the listener may feel that we are there to listen minimally and then get our point across. These responses may communicate that we want to change them and how they do things instead of communicating understanding and support (Jones, Bodie, & Hughes, 2016; Serbin, 2013). Enablers of AEL Admittedly, we are all human, and because of this we give in to behaviors that hinder AEL. We get distracted, become defensive, shame ourselves or others, interrupt, criticize, and give advice even when we have good intentions in our listening. But, as leaders, we can do better than this. We can become agents of change in our lives and in the lives of others by learning how to overcome these barriers. The solutions to these barriers are contained within the AEL process, the steps of active listening with empathic habits woven throughout them. When acted upon, these are the habits that have the potential to transform communication, relationships, and leadership. Empathic Listening 67 Active Listening The active listening process is composed of three steps: sensing, processing, and responding. Sensing involves an active awareness of both the verbal and nonverbal, explicit and implicit information the speaker is communicating. Processing comprises synthesizing the information gained during the sensing stage into a narrative whole. The final step, responding, is the listener’s way of letting the speaker know that they hear and understand what is being communicated. This is done through verbal and nonverbal cues such as nodding one’s head, asking questions, and paraphrasing (Jones et al., 2016; Shrivastava, 2014). Together, the combination of sensing, processing, and responding contribute to the listener’s efforts to communicate empathy to the speaker. Mindfulness in the Sensing Stage In the active listening process, leaders can utilize the following empathic concepts to encourage a more compassionate flow of communication. David Sauvage, a corporation consultant, states that, “The basis of empathy is emotional self-awareness” (as cited in Manning-Schaffel, 2018). This means we have to sense and accept our own thoughts and emotions before we can do the same in our communication with others. In support of this claim, research shows that individuals who score high on mindfulness also score high on empathy and that vulnerable (empathic) listening is dependent on the listener’s understanding of what is happening internally for them (Jones et al., 2016; McClelland, 2017). In summary, if we are to accurately interpret and articulate someone’s emotions back to them, we must first be able to internalize and comprehend our own emotions. Part of this emotional intelligence is being able to differentiate when we are feeling guilt versus shame. In leadership, identifying shameful thoughts is an important step in correcting our thinking. Rather than resorting to defensiveness or retreating from a situation (which are common side-effects of shame), we can instead engage in reparative acts (i.e. apologizing, listening to the other person’s narrative) that produce empathic results in our relationships. 68 The Journal of Student Leadership Self-Exper

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