November 30, 2011

Learned Empathy

Is empathy an innate trait or a learnable skill?

Following my recent post about cognitive and affective empathy, a friend sent me a CBC story about oncologists who participated in a study that tested a computer-based empathy and communication skills training program. The doctors in the study were recorded during interactions with their patients, and received one month of feedback and training on how to recognize and improve their response to patients' distress signals. They were taught how to present information about prognosis empathetically, and how to identify opportunities to allow patients to talk about their feelings. The doctors were subsequently measured on "emotion-handling skills" (i.e., naming, understanding, respecting, supporting, and exploring emotions, rather than changing the topic, joking, denying the emotion, or ending the conversation). Patients' perceptions of their physician were also measured.

Results: At the end of the study, the empathy-trained doctors responded empathetically to their patients twice as often as did a control group of doctors who merely attended a lecture on communication skills. More importantly, patients whose doctors were in the training group reported greater trust in their doctor and greater perceived empathy from their doctor, and were more likely to report that they felt understood as "a whole person."

I thought this was pretty great--what's better than doctors who are willing to improve their bedside manner and patients who benefit? Not everyone agreed. In fact, several commenters on the CBC story seemed quite offended by the idea of empathy as a teachable skill and argued that in-born empathy is a required trait for good doctors.  

This seems misguided. Insisting on strong innate empathy as a prerequisite for access to healthcare professions would exclude many intelligent and intuitive people who have excellent diagnostic and technical skills and who want to help others. I'm not suggesting that doctors don't need empathy, but who cares whether or not it's innate? It's hardly uncommon for professionals to take continuing education courses to brush up on skills and to fill gaps in their training.

Another commenter wondered whether the doctors in the study really learned empathy or whether they simply learned empathy behaviour. For the purposes of the doctor-patient relationship, I'm not sure there's a difference. The oncology patients in the study knew that their doctors were participating in a program to improve their empathy skills, but they still reported that they felt better understood and listened to--that is, they felt that their doctors were empathetic. That the doctors learned empathy from a computer didn't bother the patients and didn't limit the positive impact of the program on the doctor-patient relationship.

Any intervention that improves healthcare professionals' clinical skills and makes patients feel better supported should be applauded and pursued. I would love it if my doctor took an empathy course. Likewise, I would love it if I had a therapist who participated in a skills training program to improve her ability to identify and respond appropriately to my distress signals. Wouldn't you?

November 17, 2011

Apology Rules

Some people (ahem) can't stand it when someone is mad at them. They apologize repeatedly--calling and emailing to say how sorry they are and to see if the other person is still mad.

Is this effective? Not usually. The wronged party might issue forgiveness eventually, but it's mostly just to get the apologizing to stop. It's often an unsatisfactory resolution for both parties, leaving one annoyed and the other emotionally exhausted.

The last time this happened, I started thinking about some ground rules for apologies. Some readings on assertiveness and communication skills helped me identify two rules that can help you (and me) apologize appropriately, while keeping a level head.

1) Figure out what you did wrong and take responsibility for it. This rule has two steps and is particularly important when we make a mistake that initiates a chain of unfortunate events. Example: your friend confides in you that he's dating someone new, but hasn't yet told his recent ex. You can't resist sharing this news with your work friend, who knows both parties. Unexpectedly, your work friend declares that your friend's ex has "the right to know" and calls her up. The next thing you know, your friend is livid with you because his ex confronted him in furious tears, and now won't speak to him and is refusing to share custody of their beloved cat. You are dumbfounded by this turn of events and your impulse is to apologize to your friend profusely and repeatedly, begging desperately for forgiveness for your awful sins. What do do instead:
  • Identify your crime and apologize for it. You shouldn't have gossiped with your work friend; for that, you should apologize directly and genuinely.
  • Don't apologize for the parts that aren't your fault. While it's true that your behaviour triggered the chain of events, you aren't accountable for your work friend's decision or for the ex-girlfriend's dramatic reaction. You can, and should, be sorry that your initial mistake prompted the whole mess, but you still aren't responsible for other people's behaviour and you don't need to apologize for it. 
2) Let the apology fit the crime. If it's hard for you to tolerate someone being upset with you, you may use the understandable but unhelpful strategy of "keep apologizing until you're forgiven." The problem with this strategy is that eventually, the apology no longer fits the crime. Example: you accidentally bump a guy on a crowded bus and he spills his coffee on the floor. You apologize sincerely, but rather than accepting your apology or your offer to buy him a fresh cup, the guy continues to berate you as though you had purposefully grabbed the coffee from his hand and thrown it in his face. Your impulse is to apologize even harder, but wait a minute--you didn't abduct his first-born child; you merely spilled his $1.25 cup of coffee. If he doesn't accept your first or even your second apology, it's time to stop apologizing and walk away.

This rule applies to your friend and his ex as well. Say you issue a sincere apology for gossiping and for initiating the ensuing trouble, and your friend remains as angry as if you had personally kidnapped his cat. His anger doesn't fit the crime, and if you keep apologizing, soon the apology too will no longer fit the crime. It's time to walk away and give your friend some time to cool down.

Apologizing is hard and not over-apologizing can be even harder. Keeping in mind these rules can help you make a sincere and appropriate apology, with minimal anxiety and without going overboard.

November 11, 2011

Inside Out

You know how you sometimes look at other people and feel like they are smarter than you are, more together or more successful than you are, and have a more fulfilling life than you do? How it sometimes seems like you're always stressed or depressed or panicked or angry, whereas others are well-adjusted and high-functioning?

News from the front line: Other people look at you and think the same thing. 

Yesterday I attended a workshop on mindfulness in psychotherapy. During one exercise, we were invited to get in touch with the thing that we like the least about ourselves, the thing that makes us different from and inferior to everyone else. As we wrote down our shameful secrets, people sniffled, people wiped away tears, but not one person raised their hand to say "There's nothing wrong with me. I'm just as good as everyone else." Later, the workshop leader showed us images of cue cards on which former workshop participants had described their inferiority: I'm too selfish; I'm defective; I don't fit in anywhere; I'm not as smart as others; and I don't measure up.  

Wait--what? How can everyone be different and inferior? Why does everyone think they don't fit it and don't measure up? What makes us think that we are the only one who doesn't have it all under control?

I think I know the answer: It's the phenomemon of comparing your insides to other people's outsides. Consider that painful emotions and judgmental thoughts are invisible; so is the sinking belly feeling and the tight chest feeling. So while we're extremely aware when these processes occur in our own body and mind, we don't see or feel them happen in other people. All we see are their sleek exteriors, and when we compare them to our own rumpled interior, of course we come up short!

What the workshop exercise made clear is that everyone's interior is rumpled and everyone is comparing their insides to others' outsides. It's not a fair comparison, and it's one that's practically guaranteed to make you feel bad. It might help to remember this next time you're feeling inferior.

NB: Facebook is a great example of this phenomenon, which explains why reading your news feed can leave you feeling like everyone is more fulfilled/having more fun than you are. No one posts statuses like "I'm so jealous of my friend's new baby I can barely breathe," "Wracked with guilt for not calling my sick grandmother again today," and "I feel like an imposter in my new job" (rumpled interior). Rather, we post about our our triathlon success, our adorable new nephew, and what a great time we had in Costa Rica (sleek exterior).