Empathic Relationship Research Articles

Empathy in family medicine

AIM: Empathy is crucial in therapeutic relationships. An empathic relationship has several positive outcomes: improvement of doctor-patient relationship, increased satisfaction and diagnostic ability, and patients’ empowerment. This study aims to assess empathy levels in a Portuguese Primary Health Care Practice (PPHCP) and to verify the relation between doctor-patient empathy and socio-demographic characteristics. DESIGN: cross-sectional study LOCATION: a Portuguese Primary Health Care Practice located in Senhora da Hora, Matosinhos. PARTICIPANTS: patients registered in the PPHCC who went to an appointment with their Family Physician (FP) during the month of June 2009. METHODS: Empathy value measured through the Consultation and Relational Empathy (CARE) questionnaire. Associations between variables were tested with nonparametric tests (Mann-Whitney, Kruskal-Wallis) and Pearson correlation. The adopted significance level was 0.05. RESULTS: A sample of 353 questionnaires was obtained. FP mean empathy value was 41.1 points on a scale of 10-50 (CI 95%, 40.1-42.2). The only significant statistical association was related to educational level (p = 0.02). Patients with lower levels of formal education provided lower scores for FP empathy. CONCLUSION: The patients of this PPHCP scored high for empathy. Lower levels of formal education were correlated with lower scores for empathy, an association not found in other studies.

Service users' beliefs about acute in‐patient admission

PurposeAs the beliefs people hold exert more influence over their behaviour than any other single factor, the purpose of this paper is to elicit those held by service users about being cared for in acute mental health settings.Design/methodology/approachData were collected by means of a semi‐structured, non‐standardised, 17‐item interview schedule from an opportunistic sample of 44 respondents (18 men and 26 women) following their admission over a nine‐month period.FindingsFindings suggest that those admitted to acute care settings harbour very different beliefs about what to expect, what is being offered and how it will affect them. While some respondents saw admission as an event simply to be endured, others saw it as a means of gaining relief, accessing better care and treatment as well as providing respite for their families. Whereas previous knowledge and experience of acute care did influence their beliefs, this was largely due to how they interpreted experiences rather than the experiences themselves. The data also suggest that service users can be assisted to reframe their beliefs by means of genuine, consistent and empathic relationships, thus putting services users in a position to derive maximum benefit from being admitted.Originality/valueRelatively little attention has been paid to the beliefs that service users have on entry to mental health services, in comparison to that paid to problem‐identification, care planning and intervention regimens. A starting point for any health care intervention, especially mental health care, should be the identification of the beliefs held by those about to embark on treatment programmes. This area deserves much more attention than it has been given hitherto.

Face off: searching for truth and beauty in the clinical encounter

Based on Lucy Grealy's memoir, Autobiography of a Face, this article explores the relationship between gender and illness in our culture, as well as the paradox of "intimacy without intimacy" in the clinical encounter. Included is a brief review of how authenticity, vulnerability, and mutual recognition of suffering can foster the kind of empathic doctor-patient relationship that Lucy Grealy sorely needed, but never received. As she says at the end of her memoir, "All those years I'd handed my ugliness over to people, and seen only the different ways it was reflected back to me."

Promotion of participation and mediation in multicultural classrooms

This essay presents the theoretical framework and main results of a research on intercultural mediation which has been performed in eight multicultural classrooms of Italian secondary schools. Intercultural mediation is conceived as a form of dialogic communication which should empower empathic and equal relationships between the participants by changing the existent negative patterns (dialogic mediation). The empirical features of mediation have been investigated in the interactions between mediators and adolescents in the selected classrooms. The analysis demonstrated that some dialogic actions were effective in empowering students’ personal expressions, promoting effective reflections and new narratives about their relationships, and management of their conflicts. Two limitations of dialogic mediation emerged from the analysis: (1) dialogic actions were always effective in demonstrating mediators’ involvement and coordination with students, but they were only occasionally effective in promoting dialogue among students; (2) promotion of active participation was more frequently successful than coordination of reflection and conflict management.

The riches of embarrassment

Two newspaper articles caught my eye the last couple of months. In the first, leftie photo-journalist Paul Alberts tells of the unanticipated and disturbing rapport between him and Eugene Terre'Blanche (aka ET). After doing a week-in-the-life-of photo essay of ET, Alberts confesses: 'Ek verskil van die AWB's soos dag en nag--politiek, godsdiens, alles--maar dis my mense. Dit was 'n tuiskoms. Daar 't ek besef ek's oneerlik met myself om my 'n Afrikaanssprekende Suid-Afrikaner te noem. Ek's 'n Afrikaner, en basta met die res' (Retief 2009). (1) In the second piece, Deon Maas (2010) stands up for the right of his children to attend an Afrikaans university. According to Maas, the only problem with making this argument, is that by defending this right be is associating himself with a group of people with whom be has nothing in common: 'Ouens wat oulike kakiehempies dra wat 'n ander kleur hier op die sleutelbeen het' en luister na 'Kurt, Steve of Juanita'. 'Ouens wat Afrikaans as 'n (rassistiese) politieke statement sien eerder as 'n medium van kommunikasie' (Maas 2010). (2) Read together, these seemingly contradicting points of view correspond, to a certain degree, with my conflicted feelings towards boeremusiek and, by implication, to that marked collective, 'Afrikaner'. This is, however, not the epiphanous story of my journey into Afrikanerdom; nor is it a politically correct vilification of Afrikaner whiteness. Rather, I'd like to explore in this essay, how the embarrassments of crossing over between these two hegemonies are influencing my research decisions, and some of the good and the bad that have come from it. Both Alberts and Maas are describing a self/other relationship that has evolved beyond recognition from the easy dichotomies of modern thinking. In the last few decades, it has become fashionable to theorise this relationship as one of hybridity, where the Self and the Other are in a relationship of close proximity, sometimes quite literally sharing the same blood, yet remaining fundamentally incommensurable. The space between Self and Other thus belongs to both at the same time and, yet, exclusively to neither. The problem with any kind of ethnomusicological study, like mine on boeremusiek, is that as a discipline, ethnomusicology relies ata very basic level on the modern distinction between a radically different researcher and native. This is probably why embarrassment does not usually feature in ethnomusicological writing. Embarrassment requires an empathic relationship between Self and Other. Psychologists Robbins and Parlavecchio (2006: 325-326) write: The self-reflexivity of embarrassment may involve a kind of proto-self that understands itself through an empathic, imaginative projection of one's self through the other ... To be ashamed ... is to have one's existence reduced to the object of another person's evaluative gaze. Beyond that, the experience of shame requires the shamed person to have the capacity to project him- or herself into the position of the observing other. To the extent that one is capable of putting oneself into the perspective of the other, one is therefore capable of also having a reflexive relationship toward one's own self as an object subject to evaluation. From this description, it is reasonable to contend that embarrassment can function as an unexpectedly enriching component--even a driving force--for research. This 'unwanted exposure of the self', as one definition of embarrassment goes, is evident from a recent exchange with one of my Facebook friends: [ILLUSTRATION OMITTED] After joining the group I quickly looked into ways of hiding the fact from my Facebook friends, but, even though I knew this status update would cause me embarrassment, I decided to let it remain on my wall. I can think of at least two distinct but related reasons why I would feel embarrassed about my boeremusiek status update. …

Befriending for mental health problems: Processes of helping

One avenue for addressing the social consequences of mental health problems is through befriending, a supportive relationship in which one-to-one companionship is provided on a regular basis. Although there is some evidence that befriending can improve psychological and social functioning, little is known about how it works. This qualitative study aimed to understand the helping processes occurring in befriending relationships, from the perspectives of both befriendees and befrienders. Semi-structured interviews were conducted individually and jointly with eight befriendees and their corresponding befrienders. Thematic analysis was carried out on the data set of 23 interviews. The analysis generated nine themes concerning qualities of the relationship valued by befriendees and befrienders (e.g., empathy and mutuality), processes of making meaning (e.g., considering alternative perspectives), and how change was effected in befriendees' lives (e.g., learning how to have healthier relationships with others). The accounts emphasized the importance of the quality of the relationship itself, and highlighted aspects of the relationship that were sometimes difficult to negotiate. The findings suggest that befriending shares commonalities with other types of psychological help. However, it is also characterized by some particular challenges, such as establishing an empathic relationship and managing boundaries and endings.

DEPRESSÃO NO DOENTE ONCOLÓGICO Considerações Diagnósticas e Terapêuticas

Oncologic diseases currently have a high prevalence and present as one of the leading causes of death in the western world. Clinical depression and emotional distress are often the outcome of the threat these diseases present to individual existence. Although its precise determination is hampered by methodological problems, up to 50% of cancer patients may become clinically depressed and experience intense personal distress. We performed a literature review on screening and evaluating clinical depression in cancer patients (risk factors, instruments and strategies) and its treatment (psychotherapy, drug treatment and care management). Non-systematic literature review. The search was performed on Pubmed with the following keywords in title/abstract fields: cancer, oncology, depression, psychiatry, morbidity, screening, treatment, psychotherapy, psychiatric status rating scales, with no time restriction. Articles written in Portuguese, English and Castilian were included. A cross-reference search yielded additional included articles. Several risk factors for an increased likelihood of clinical depression in oncologic diseases have been identified which, together with screening strategies, including validated scales such as Hospital Anxiety and Depression Scale (HADS), may enhance our ability to detect cases. While not having, for the moment, the highest possible evidence for effectiveness from randomized trials, the treatment strategies for clinical depression in this population should be available and make use of multidisciplinary interventions, including psychopharmacological and psychotherapeutic options. The need for health care workers to spend adequate time with patients is underscored. This not only enhances their ability to detect and treat depression cases but also allows for an empathic and understanding relationship, validating the existence and suffering of the patient.

A Spatial and Perspective Change Theory of the Difference Between Sympathy and Empathy

Abstract Empathy is a multicomponent faculty of the human brain which is funda-mental for social interactions.Understanding its behavioural, cognitive, emotional neural mechanisms and pathology is a major interdisciplinary challenge..Here we propose, in relation with a modern conception of the Philosophical tradition of Phenomenology and a primary role of cognitive embodiement, a new theory in which we give an important although not exclusive, role to the brain mechanisms which also are involved in spatial cognition: we show, that there is a basic difference between *sympathy* and *empathy*. Whether sympathy is akin to emotional contagion and does not require the siubject to adopt the point of view of others, empathy requires a dynamic and complex manipulation of spatial reference frames. We give an example of an experiment using virtual reality in which a subject interacts with an artificial tight rope walker and discuss also the possible interindividual differences, and gender differences, in the different strategies used by subjects to have an empathic relationship.

The String of an Empathic Relationship

The String of an Empathic Relationship

Cultural Relational Leaders: Unraveling, Understanding, and Utilizing Narratives in Leadership Practice

The arguments for using narratives to organize one's leadership practice are helpful in that they justify and organize many of the activities that go into the leader's professional and personal life. This paper explores the complex nature of narratives in a professional setting and the manner in which leaders can use the therapeutic methodology of cultural relational psychology to address multiple meanings embedded in narratives. People narrate their own subjective and embodied realities and reveal themselves metaphorically and symbolically through the stories they tell. The author outlines methods that leaders can use in the context of giving and sharing narratives; including empathic attunement, contextualization, relationship authenticity, using conflicts and tensions to make relationships stronger, understanding why people feel disconnected or disempowered, and honoring individual differences.

T1031 Attitudes Regarding the use of Patients' Writings About IBS in the Outpatient Setting Among Physicians, Medical Students, and Patients

Aim: An exploratory, qualitative study examining the attitudes of gastroenterologists, patients, and medical students regarding the use of patients' expressive writings about IBS in the outpatient setting. Methods: IBS patients (P), Gastroenterologists (GI) and Medical students (MS) from a single academic institution (BU) were asked to read three representative IBS expressive writings selected by the authors from a previous study. All participants were interviewed regarding the utility and feasibility of using the writings in an outpatient clinical setting. All responses were recorded verbatim and qualitatively analyzed by the authors. Results: 10/10 GI (8 attending, 2 fellows), 10/14 P and 10/13 MS agreed to participate. GI: age (mean ± SD) 39.2 ± 7.7, M 80 %, y of practicing 7 ± 12.4, average # of IBS patients/ week 8.5 ± 7.2: MS: age 24.6 ± 2.0, M 40%, y of med. school 1.7 ± 1.10; P: age 43.3 ± 15.2, M 30%, y with IBS 15 ± 16, number of visits for IBS / 12 months 2.7 ± 2.9. The length of the writings was a 1/2 typed page (range: 1/2 3/4 typed page), interview time 15.4 ± 5.5 minutes. The actual time needed to read one writing was (1.7 min ± 0.5) vs. perceived time (2.8 min ± 1.1). 9/10 patients expressed interest in writing in the future. Although 7/10 of GI reported not learning anything surprising from the writings, 9/10 GI were interested in using them in clinical practice. 10/10 P felt that home is the best setting for writing, while GI favored the waiting room over home in order to limit length of writing. MS first response to writing was more empathic than that of the GI. The main themes identified during the interviews are outlined in Table 1. Conclusion: Our results indicate that gastroenterologists, medical students, and patients are very receptive to using IBS expressive writing in the outpatient setting and find it a useful tool in obtaining clinical information as well as helpful in promoting empathic physician patient relationships. A follow-up trial will study the effects of using this modality in outpatient setting on IBS clinical outcomes. Further implications include the use of patients' writings for medical training. TABLE 1

T1032 Broadening the Access to Specialized IBD Care Using a Consumer Grade Affordable Telemedicine System

Aim: An exploratory, qualitative study examining the attitudes of gastroenterologists, patients, and medical students regarding the use of patients' expressive writings about IBS in the outpatient setting. Methods: IBS patients (P), Gastroenterologists (GI) and Medical students (MS) from a single academic institution (BU) were asked to read three representative IBS expressive writings selected by the authors from a previous study. All participants were interviewed regarding the utility and feasibility of using the writings in an outpatient clinical setting. All responses were recorded verbatim and qualitatively analyzed by the authors. Results: 10/10 GI (8 attending, 2 fellows), 10/14 P and 10/13 MS agreed to participate. GI: age (mean ± SD) 39.2 ± 7.7, M 80 %, y of practicing 7 ± 12.4, average # of IBS patients/ week 8.5 ± 7.2: MS: age 24.6 ± 2.0, M 40%, y of med. school 1.7 ± 1.10; P: age 43.3 ± 15.2, M 30%, y with IBS 15 ± 16, number of visits for IBS / 12 months 2.7 ± 2.9. The length of the writings was a 1/2 typed page (range: 1/2 3/4 typed page), interview time 15.4 ± 5.5 minutes. The actual time needed to read one writing was (1.7 min ± 0.5) vs. perceived time (2.8 min ± 1.1). 9/10 patients expressed interest in writing in the future. Although 7/10 of GI reported not learning anything surprising from the writings, 9/10 GI were interested in using them in clinical practice. 10/10 P felt that home is the best setting for writing, while GI favored the waiting room over home in order to limit length of writing. MS first response to writing was more empathic than that of the GI. The main themes identified during the interviews are outlined in Table 1. Conclusion: Our results indicate that gastroenterologists, medical students, and patients are very receptive to using IBS expressive writing in the outpatient setting and find it a useful tool in obtaining clinical information as well as helpful in promoting empathic physician patient relationships. A follow-up trial will study the effects of using this modality in outpatient setting on IBS clinical outcomes. Further implications include the use of patients' writings for medical training. TABLE 1

Story Sharing

National surveys often report nursing home deficiencies related to the preservation of residents' dignity and respectful care. Many nurse aides (NAs), who provide the majority of personal care, are unprepared to engage in empathic and meaningful relationships with residents. This article reports the findings of a pilot mixed method study comparing two interventions, Story Sharing (StS) and Communication Skills, on NA levels of mutuality, empathy, job attitude, and self-efficacy and resident levels of empathy and perceived caring behaviors. A quasi-experimental/interpretive phenomenological design was used. Total Mutuality and subscale (Shared Values, Affective Closeness, Shared Pleasurable Activities, Reciprocity) scores were significantly higher in the StS NA groups only, as were postintervention Empathy scores. Other trends are reported as well. StS is one approach toward helping NH staff and residents understand, respect, and connect with one another.

Der Körper als Dritter - Psychosomatische Triangulierungsprozesse am Beispiel der Adoleszenz

One of the earliest developmental tasks of childhood is the child's possession of its own body, which it formerly had shared with its mother, and which it more and more can experience as belonging to himself. What is called the "psychosomatic triangulation" requires the mother's internal handing over of the responsibility for its body increasingly to the child. For a while the body can play the role of a third between mother and child until in the adolescence the young person completely takes responsibility for his body. There are three ways which can lead to the development of psychosomatic symptoms: Firstly the body can remain the bearer of all emotions, if no empathic relationship with a primary object is available, in which the symbolization of emotions can be learned. Secondly psychosomatic symptoms can emerge from the symbiotic islands of the body regions which are still shared phantasmatically by mother and child. There is a third way of developing psychosomatic symptoms in which the subject falls back upon the body as a third object either if no other third--characteristically the father--takes in a firm place in the relation between child and mother or if the family's development is blocked for other reasons. With regard to the medical and therapeutic treatment of psychosomatic symptoms it will finally be discussed the communicative function of psychosomatic symptoms as a sign in the relation to important persons and how the factors, which contribute to biosemiotic regression or progression can be identified.

Music Therapy Entrainment: A Humanistic Music Therapist's Perspective of Using Music Therapy Entrainment with Hospice Clients Experiencing Pain

“I'm not afraid of dying, I'm afraid of the pain” is a proclamation made by numerous hospice clients. In response to this statement, I will present four case studies that describe music therapy entrainment with hospice clients experiencing pain. These case studies will demonstrate specific needs of dying clients and how music therapy entrainment can meet those needs. The discussion section will explore insights I discovered about myself and music therapy entrainment. Those lessons include the use of the empathic relationships that evolved, the role of boundaries in this technique, the need for flexibility within the stages of music therapy entrainment, the participant's use of control during the process, musical interactions with nonverbal participants, my observations about the participants' relationship to music, and my observations about how this technique influences the participant's dying process. I will share my perspective and define music therapy entrainment.

The nurse's role in emergency triage systems: literature analysis

Emergencies are both nationally and internationally accountable for patient overloads that result in an overcrowding of the sector. In emergency service settings, triage scales are used to organize the processes of patient care. This article discusses the work of nurses in Emergency Triage Systems in a contextual and reflexive way . For this purpose, literature analysis on structured triage scales and work organization was developed. The nurse is a professional who meets the conditions necessary for the performance of scales triage, which include language oriented clinical signs and symptoms and empathic relationship to the fundamental aim of the triage process. In the logic of health work, care is understood as a product of the encounter between users seeking emergency care and nurses providing that care. In this perspective, it is considered that nurses, through the interaction with patients, produce the care resulting from the dispute and the pact established in the moment of triage, aiming at meeting the patients’ demands and thus making their inclusion in the emergency system possible.

Vivência da entrevista fenomenológica com prostitutas: relato de experiência

Este artigo tem por objetivo descrever minha vivência na obtenção dos depoimentos utilizando a entrevista fenomenológica. Foram entrevistadas onze prostitutas em Teresina, PI. No caminhar dessa etapa vários momentos foram marcantes como: a estratégia de aproximação com as depoentes, o local das entrevistas e o próprio relato emocionante das prostitutas. Esse meu caminhar possibilitou-me identificar que é necessário familiarização e empatia com os sujeitos da pesquisa, que não existe formula para a condução da entrevista, mas cabe ao pesquisador identificar as dificuldades e propor estratégias para a obtenção dos relatos. Assim é que a relação empática vivenciada por mim na obtenção dos relatos das mulheres-depoentes no seu mundo-vida por meio da entrevista fenomenológica foi fundamental para compreensão do vivido da violência no cotidiano da prostituição.

Wrapping and Unwrapping Emotions: Clinical Practice with East Asian Immigrant Elders

Using the cultural norm of the way gifts are wrapped, unwrapped, and exchanged as a metaphor for interpersonal connections, this paper presents the way therapists can establish therapeutic relationships with East Asian clients who do not express emotions openly. We first discuss the ways in which emotions are conceptualized, experienced, and expressed in East Asian cultures. We then present vignettes of our work with older Chinese and Japanese immigrant women to illustrate the importance of therapist authenticity and co-construction of the therapeutic relationship. Using the framework of relational/cultural theory, which posits that healing takes place in the context of mutually empathic growth-fostering relationships, we illustrate the importance of establishing mutuality between therapist and client as a form of cultural empathy.

The Need for a "Mental Health Home"

Back to table of contents Previous article Next article LetterFull AccessLetterJames McCreath Ph.D.James McCreath Ph.D.Search for more papers by this authorPublished Online:1 Jul 2009https://doi.org/10.1176/ps.2009.60.7.993AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleThe Need for a "Mental Health Home"To the Editor: In the April issue Drs. Smith and Sederer ( 1 ) do a terrific job presenting a rationale for the "mental health home." There is no doubt that our fragmented behavioral health system is inadequate for individuals most at risk. There is no reason to think that the public's demand that general hospitals substantially improve both process and outcomes shouldn't apply to the behavioral health industry. The coordination and delivery of behavioral health services must improve, and the mental health home concept warrants a close look. At the heart of the model the authors see "generalists working with the entire individual and coordinating care among a range of behavioral and rehabilitation service providers." I couldn't agree more, although an empathic relationship is a must, and no one framed this better than Deitchman ( 2 ), who felt that the "chronic client in the community needs a 'traveling companion not a travel agent,'" or Lamb ( 3 ), who advocated for "therapist-case managers." Coordination without an empathic worker-consumer relationship is bound to fall short of expectations for improved service delivery. Coordination will also fall short if the mental health home team's added value is limited to advocacy. Advocacy is helpful but not adequate to overcome the system's numerous structural weaknesses. Achieving continuity of care for individuals most at risk would require the team to have resources and authority to acquire services.In 2007 Jersey City Medical Center's Behavioral Health Center established a "clinical home" pilot for adults with co-occurring disorders and histories of high recidivism and treatment nonadherence (I was vice president for behavioral health at the time). Every behavioral health program—partial hospital, outpatient department, emergency department, residential facility, and intensive case management—can function as a clinical home. The clinical home duties are above and beyond that program's routine services and are considered "enhanced." The pilot assigns "navigators" to consumers with high use of emergency or inpatient services who will not accept community-based services or are ineligible for intensive case management or assertive community treatment. The evidence to date is that the clinical home reduced recidivism and enhanced treatment adherence for consumers whom the system had given up on.The model is unique in that the clinical home clinician (or team) follows the consumer through all services. If the partial hospital accepts responsibility for a consumer and that consumer needs hospitalization, the partial hospital worker follows the consumer through the inpatient stay. If the emergency department is the clinical home and the consumer wants partial hospitalization, the emergency department worker escorts the consumer to the program until linkage is established. Consumer choice must supersede program and system concerns.One reason that the pilot works is that all the services are under one agency. No doubt this model would create potentially insurmountable turf issues in multiagency systems, but there can be no minimizing the value of a mental health home, where one team has the resources and authority to acquire services valued by the consumer. Certainly the mental health home warrants significant demonstration project funding.Dr. McCreath is president and chief executive officer of Hall-Brook Behavioral Health, Westport, Connecticut.

Humanization through touch: a qualitative research

With a view to identifying new knowledge on nursing care that will give additional support to nurses, this qualitative study sets out how final year nursing students conceive of the meaning and value of touch as a therapeutic instrument. Data was gathered from workshops on awareness-raising, expressiveness and creativity; through participative observation; and from field diary records. 13 final year nursing students at the State University of Paraíba, Campina Grande-PB took part. The findings, based on statements taken, emphasize touch as a fundamental strategy for humanization, which makes it viable to have an empathic relationship between client and professional. Professionals must display the sensitivity needed to use touch appropriately and at appropriate times. Therefore, the act of touch needs to be understood beyond its physical aspect, because this involves subjective factors, both by those who do the touching and those being touched. The workshops were successful in reawakening a sense of humanization, which had apparently lain dormant amongst group participants. They now regard touch as a means to establish a relationship of exchange, reward and respect between nurse and client, which is indispensable in the caregiver’s daily routine.