Kris English, PhD
The University of Akron/NOAC
The concept of empathy is a foundational aspect of audiologic care – foundational but elusive. Students and instructors generally know how to define it, for example, “the ability to understand the patient’s situation, perspective and feelings, and to communicate that understanding to the patient” (emphasis added) (Coulehan et al., 2001, p. 221).
However, as is often said in counseling texts, “knowing is not enough.” Knowing a definition does not mean a skill has been acquired. How can instructors bring the concept of empathy to life, and actively support the develop of empathy through course content and clinical training?
Guidance is available in related fields. For instance, Batt-Rawden et al. (2013) provide a systematic review of methods designed to teach empathy to medical students. These methods include a range of educational interventions that effectively maintain and enhance students’ personal capacity for empathy, such as:
- Patient narratives
- Reflective essays
- Communication skills training
- Problem-based learning
- Interpersonal skills training (role-playing, standardized patients)
Applications to Audiology
For our purposes, we can start with two simple exercises on the process of “sharing space” with another. Here is a combination of reflective essay and communication skills training, for both students and instructors:
Learning objective #1: Develop “empathic understanding” (Mercer & Reynolds, 2002), or more specifically, “the passive emotional response of one individual to the emotions of another” (Batt-Rawden et al, 2013, p. 1171).
Learning activity: View this popular 4-minute video developed by the Cleveland Clinic: Empathy: The Human Connection to Patient Care. Then, write down at least four specific scenarios that made an impact on you, and describe what the persons in those scenarios were experiencing. Include adjectives that describe emotional states. Repeat the exercise one month later; do any scenarios have a different impact than before? Again, write down your perceptions of patient and family experiences.
Learning objective #2: Demonstrate “empathetic communication” (Mercer & Reynolds, 2002); described as “an active skill that can be acquired and is amenable to nurturing” (Batt-Rawden et al.,2013, p. 1171) and “a visible communication behavior that is enacted when a clinician recognizes and responds to another person’s suffering” (emphasis added) ( Frankel, 2017, p. 2129).
Learning activity: Ask a friend or family member to view the same video, then ask for their reactions and listen carefully. Listen but do not insert your own reactions into the dialogue. Find ways to express that you are trying to understand. Provide some prompts: what else caught your attention? Other scenarios you’d describe as important or memorable? Later, evaluate your skills: did you refrain from interrupting? Was it difficult or comfortable to “just listen”? Did you understand the other’s experiences and actively communicate that understanding at least once?
Caution: “Empathic Communication” Could Go Awry
Empathic communication can be difficult at times. It can also be unintentionally inaccurate. Frankel (2017) offers this example:
Patient My husband of 67 years passed away last week.
Doctor Oh my goodness. I am so sorry. This must be awful for you have been married for such a long time.
Patient Well, actually, he had dementia for the last 15 years and it was hard work tending to his needs at home because his insurance ran out. It was actually kind of a relief when he passed (p. 2103).
Frankel describes the doctor’s effort as “rejected empathy.” Lacking relevant information, the doctor assumed too much, and the patient had to correct the assumption. Her need to do so neutralized the empathy the doctor was trying to provide. Because of this risk of “empathy breakdown,” Frankel suggests we keep in mind all four of these components to empathic communication:
- Recognizing emotions
- Sorting (assigning meaning to patient input)
- Responding
- Listening for evidence of response accuracy
Conclusion
Part 1 of this short series introduces a simple strategy for teaching empathy skills to audiology students. In Part 2, we will consider how not listening for evidence of accuracy per Frankel can cause a breakdown in the “empathy cycle” (Barret-Lennard, 1981).
References
Barret-Lennard GT. (1981). The empathy cycle: Refinement of a nuclear concept. Journal of Counseling Psychology, 28(2), 91-100.
Frankel, R. (2017). The evolution of empathy research: Models, muddles, and mechanisms. Patient Education and Counseling, 100, 2128-2130.