Teaching Empathy Skills: “Checking” (Part 2/3)

Kris English, PhD

The University of Akron/NOAC

In Part 1, a vignette depicts a patient informing her physician that her spouse had recently passed away. Unfortunately, the physician assumed too much about the patient’s life and experience, and expressed empathy for a situation that didn’t exist. The patient decided to correct the physician’s assumptions, an awkward counter-response that Frankel (2017) calls “rejected empathy.” Although hypothetical, we should spend a moment imagining the rest of this scenario: once the first exchange went off the rails, the physician would hopefully apologize, clarify, and try again — still appreciated by the patient but not an optimal outcome (Derksen et al., 2017).

An Avoidable Misstep

We would never intentionally cause hurt or harm by offering empathy that a patient will need to reject, but we may find ourselves taking similar missteps. Perhaps we still think of empathy as Barrett-Lennard (1981) did when he described an “empathy cycle” consisting of three phases:

  • Phase 1: the inner process of empathetic listening to another who is personally expressive in some way
  • Phase 2: the attempt to convey empathetic understanding of the other person’s experience
  • Phase 3: the other person’s reception or awareness of this communication

In light of Frankel’s vignette, it seems fair to say that this “empathy cycle” is incomplete. All three phases were involved, and yet the outcome was ineffective. Perhaps Barret-Lennard suspected as much, since he does point out, “There is room for considerable slippage” (p. 91).

Teaching “Checking”

When we take on the task of teaching empathy skills, we should base our instruction on the most complete definition possible.  Like Frankel, Mercer and Reynolds (2002) include the aspect of “checking for accuracy”:

  1. Understand the patient’s situation, perspective, and feelings (and their attached meanings)
  2. Communicate that understanding and check its accuracy (emphasis added)
  3. Act on that understanding with the patient in a helpful (therapeutic) way (p. S9)

In other words, regarding #2 above, “If you don’t get that confirmation, you aren’t done” (Coulehan et al, 2001, p. 225).

Applications to Audiology

Our time with patients and family is usually limited, and we certainly don’t want to spend time repairing rejected empathy if we can help it. Ideally, we keep the encounter on track by assuming nothing and inviting/waiting for relevant details that we can respond to with accuracy, or as Brené Brown describes it, “climbing down into the hole” (described in Part 3).  For example:

Learning objective #1: Identify “checking for accuracy” skills.

Learning activity: View this 2.5 minute segment from the animated movie Inside Out. Find an example of a listener who did not check for the accuracy of another’s feelings. What was the result? Find an example of a listener empathizing with another’s feelings who did check for accuracy of her perceptions. What was the result?

Learning objective #2: Demonstrate “checking for accuracy” skills.

Learning activity: With a partner, write an alternative dialogue for this video segment with an intentional “rejected empathy” exchange, plus a second version that checked for accuracy. Present your script to classmates. On a 0-10 scale, (0= easy, 10=very difficult), how challenging is it to listen to another’s story without assumptions or solutions?  How difficult is it to check for accuracy?


Improving our empathy skills requires consistent reflection of empathic opportunities and how we respond to them. Just by trying to empathize, we are bound to make mistakes occasionally. But as students of the process, we must ask ourselves: Why did the physician in Frankel’s scenario assume incorrectly? How do we avoid assuming too much? What do we routinely assume about our patients, and are we right in doing so? How do we know we are right?

And what skills will serve us best?  Every article and book on empathy offers the same answer: genuine listening.  But how do we describe and evaluate empathic listening? The final entry in this series will focus on the relationship between listening and empathy, and also breaking the habit of saying “at least.”


Barret-Lennard GT. (1981). The empathy cycle: Refinement of a nuclear concept.  Journal of Counseling Psychology, 28(2), 91-100.

Coulehan JL, Platt FW, Egener B, et al. (2001). ‘Let me see if I have this right…’: Words that build empathy. Annals of Internal Medicine,135(3), 221-226.

Derksen, F., et al. (2017). Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients. Patient Education and Counseling, 100, 987-993. 

Frankel, R. (2017). The evolution of empathy research: Models, muddles, and mechanisms. Patient Education and Counseling, 100, 2128-2130.

Mercer, S., & Reynolds, W. (2002). Empathy and the quality of care. British Journal of General Practice (Suppl.), S9-12.