Lessons From “Empathic: An Underappreciated Way of Being”

For many of us, our work consists of relatively short clinical encounters. There is an emphasis on decision-making, behaviour change, or other interventions that will result in measurable outcomes. Unsurprisingly, this can feel very rushed.

I previously wrote about building rapport during a brief encounter, and I wanted to delve a little deeper by looking at Carl Rogers’ seminal essay on therapist (one could substitute “clinician”)-patient interactions, “Empathic: An Unappreciated Way of Being.” The word “empathy” gets thrown around a lot in current medical education and practice, but it’s deserving of more study and thought than most of us spend on it.

It’s important to realize that empathy is much more than “putting oneself in another’s shoes.” Rogers himself noted in 1975, that empathy, nondirectiveness, and other rich and complex clinical concepts were being reduced to buzzwords and short definitions. The entire essay is worth reading – I come back to it frequently, whether I’m in the role of clinician and counsellor or whether I’m working with a therapist to attend to my own needs – but I have prised out a few clinical pearls here:

To be with another in this way means that for the time being you lay aside the views and values you hold for yourself in order to enter another’s world without prejudice . . . [T]his can only be done by a person who is secure enough in himself that he knows he will not get lost in what may turn out to be the strange or bizarre world of the other, and can comfortably return to his own world when he wishes . . .  It means frequently checking with him/ her as to the accuracy of your sensings, and being guided by the responses you receive.  ~ Carl Rogers, 1975

This is an intimidating goal, especially for the student or new clinician. Peering into the inner world of another can be a disorienting experience. Being able to actually step into that world, to recognize the landmarks of hurt and misunderstanding, to notice the signposts of well traveled paths of maladaptive behaviours, and then step back out again is a skill that is constantly developed and refined throughout one’s career. Some clinicians avoid this entirely and stay on the surface; this feels safer but can mean working with a map that is not wholly accurate.

As a genetic counselor, I usually work with patients short-term, but this practice of empathy doesn’t have to be the result of several months’ of weekly sessions. Even in a short-term relationship, there is the opportunity to set aside your point of view and allow yourself to “enter another’s world without prejudice.” Just making the decision to do this can redefine how you relate to the patient. In changing the nature of the interaction, it’s possible to provide solace and understanding even without giving concrete suggestions or assessments. In return, the clinician can derive solace and understanding, too – of knowing why a patient is making choices that seem illogical or harmful, or recognizing a common struggle beneath the camouflage of class, race, religious beliefs, or education.

(1) The non- evaluative and acceptant quality of the empathic climate enables [the patient] . . . to take a prizing, caring attitude toward himself. (2) Being listened to by an understanding person makes it possible for him to listen more accurately to himself, with greater empathy toward his own visceral experiencing, his own vaguely felt meanings . . . So we are perhaps not overstating the total picture if we say that an empathic understanding by another has enabled the person to become a more effective growth enhancer, a more effective therapist, for himself. ~ Carl Rogers, 1975

To enter another’s inner world, to create a space for another to share such deeply held and precious feelings, is a gift to us as providers. There is an inherent and unavoidable power imbalance in the patient-clinician relationship; for patients to allow clinicians into this space involves an enormous amount of trust. It underscores the need for clinicians to have the capacity to listen without judgment and without using that space to evaluate or search for a diagnosis, or try to institute a change in behaviour. Those important steps will happen eventually, but in order to create the trusting, honest environment that will allow for real change, the provider must first listen from an orientation of true empathy. It is easier to work with one’s clinician when one feels safe, accepted, and most of all, seen. This is the gift we must bestow our patients, before entering the more difficult territory of diagnosis and decision-making.

As I move through my life and career, different aspects of the piece resonate with me. I read certain sections differently. That’s the beauty of a great essay – you can appreciate new facets of it as your perspective changes. You can see hidden truths that were inaccessible to you before. For me, one of the most profoundly affecting parts of the essay only became accessible when I went through therapy myself:

In the first place, [empathy] dissolves alienation. For the moment, at least, the recipient finds himself/ herself a connected part of the human race. Though it may not be articulated clearly, the experience goes something like this. ‘I have been talking about hidden things, partly veiled even from myself, feelings that are strange, possibly abnormal, feelings I have never communicated to another, nor even clearly to myself. And yet he has understood, understood them even more clearly than I do. If he knows that I am talking about, what I mean, then to this degree I am not so strange, or alien, or set apart. I make sense to another human being. So I am in touch with, even in relationship with, others. I am no longer an isolate. ~ Carl Rogers, 1975

I remember that I  had just finished describing a particularly difficult part of my life, one that had instilled in me a sense of shame and regret, and which I had rarely shared with anyone. My recounting was tentative and I braced inwardly for a judgmental response. But my psychiatrist listened carefully throughout, and when I finished he paused for a moment, then said, “I completely see why you would react that way. That’s not pathology, that’s part of the normal human experience.” Hearing this from another, from someone outside myself, accomplished exactly what Rogers describes – it took me out of my mental isolation and reconnected this hidden part of myself to the world, to others. Through being recognized and acknowledged, I became more grounded in the world. I think of this experience often as I strive to do the same for my own patients, however short the encounter.

Read the essay for yourself – I recommend printing a copy and keeping it someplace where you’ll come across it again.