5. Develop and Use Empathy (Part 3)

This is Part 3 of an article with the title Develop and Use Empathy. You can find Parts 1 and 2 here and here . This was to be the final part of my empathy article, but as there is so much more to share, I have decided to divide it in two. In this Part 3 I will explore why empathy matters and have a look at differing levels of empathy. There are a lot of references!

My learning from writing these articles includes that empathy is considered to be multicomponent, having affective and cognitive components which can contribute independently to understanding the emotional states of others and can operate in synchrony. Weisz and Zaki (2018) helpfully describe empathy as being comprised of related but distinct sub-processes. These include “experience sharing (or vicariously feeling others’ emotions), mentalizing (explicitly considering others' thoughts and internal states), and empathic concern (positive feelings of compassion and care for others’ welfare).”

You may have noticed in this and other articles that I often refer to research relating to healthcare and health professionals. This is because I have long been of the view that there are parallels between the skills needed by health professionals and those working with conflict, as both often have to balance connection and detachment in their relationships. And I have written before about how complaint handlers need to be both tender-hearted and tough-minded (see ‘Enabling Complaint Handler Wellbeing ').

Why Does Empathy Matter?

When considering why we feel empathy, De Vignemont and Singer (2006) propose that it has two major roles: one is epistemological and the other is social. They say that “Empathy might enable us to make faster and more accurate predictions of other people’s needs and actions and discover salient aspects of our environment. Furthermore, empathy might serve as the origin of the motivation for altruistic behavior and cooperation.”

Empathy matters in the caring professions. Jeffery (2016) writes about there being an empathy deficit in clinical care and I know that the reports into the severe failings in patient care at Mid Staffordshire and the Shrewsbury and Telford NHS Trusts both identified a lack of empathy and compassion as contributing factors.

I recently became aware of the Stoneygate Centre for Empathic Healthcare which was founded in 2022 and is based in in the College of Life Sciences at the University of Leicester. Their webpage on the ‘Importance of empathy ’ includes that “Empathic care improves patient experience and satisfaction, health outcomes and practitioner wellbeing.” Their vision is “to create a Centre of Excellence that will provide the leadership required to place empathy at the heart of improved and effective healthcare” and as well as carrying out research they also provide courses, workshops and events.

Their publication 'On the need for empathy in the acute hospital setting' (Slavin et al. 2023) acknowledges that "The General Medical Council and the Nursing and Midwifery Council recognise that empathy is a vital component of communication. Empathy is held as a core value for medical education, with the General Medical Council explicitly identifying it as an outcome for graduates."

In a scoping review of patient's views of empathic and compassionate healthcare interactions, Barker et al (2023) highlight the profound impact of empathic and compassionate interactions, finding that they “contributed towards patients feeling heard, cared for and understood. For example, the included studies referred to reduced suffering, enhanced patient dignity, enhanced patient-provider relationships and improved sense of well-being.” And that “This review has demonstrated that healthcare provider behaviours that patients define as empathic and/or compassionate are not time-consuming but rather, occur even in the briefest of encounters.”

Relating to justice, empathy is considered to be an essential element in legal practice (Westaby and Jones, 2018) and to play an important role in the development of a number of associated abilities. For example, in expanding the lawyer's toolkit of skills and competencies (see Daicoff, 2012) and in the development of communication skills, facilitating rapport, effective persuasion, influencing behaviours and sound decision-making (see Spivak et al. 2018).

In ‘The Heart of Lawyering: Clients, Empathy, and Compassion’ (2013) Kristin Gerdy writes that empathy is a vital lawyering skill. She quotes Professor Carrie Menkel-Meadow asserting that empathy “is an essential part of the client-lawyer relationship.” And Gerdy says that “To understand, from a human point of view, what the other wants to happen in the world requires the lawyer to think, feel, and understand what that person would think, feel, and understand, to be what Professor Martha Nussbaum terms an intelligent reader of that person’s story”.

It is worth notiing (and essential listening) that Baroness Hale of Richmond, when talking about her legal career and role as President of the Supreme Court in a ‘Radio Ombudsman podcast ' by the Parliamentary and Health Service Ombudsman, explains?how balancing objectivity with empathy is vital in her profession

The importance of empathy has also been recognised in legal complaint handling. In 2023 the Legal Services Board published ‘Improving service complaints in legal services ’ on the challenges consumers face when complaining about lawyers. Participants in this research said the ideal complaint process would be based on empathy, transparency, accessibility, fairness, and ease. A lack of empathy was picked out as a particular weakness of current processes and “There was much talk about the importance of providers demonstrating empathy throughout the complaints process. At the very least, recognising the power imbalance between providers and clients and the frustration and stress experienced by clients when they make a complaint.”

Empathy matters because it is key to building rapport between individuals and it can be conceptualised as a way of demonstrating and conveying respect for others. In ‘Nonviolent Communication: A Language of Life ’ Marshall Rosenberg emphasises how empathetic listening can help individuals understand each other's needs. He writes about how instead of empathy “we tend instead to have a strong urge to give advice or reassurance and to explain our own position or feeling. Empathy, on the other hand, requires focusing full attention on the other person’s message. We give to others the time and space they need to express themselves fully and feel understood.”

Baker-Eck (2022) references literature on empathy in therapeutic settings which describes the benefits of its use and the crucial contribution it makes in building trust and allowing for the client to feel comfortable enough to openly share within the session. She writes how therapists “may demonstrate empathy in session in several ways, including: 1) communicating with an interested, concerned, expressive tone of voice; 2) demonstrating a level of emotional intensity similar to the client’s; and 3) reflecting clients’ statements, nuances in meaning, or unsaid but implied meanings back to them.” Also that both rapport building and empathy are considered necessary aspects of a humane interviewing style.

Klimecki (2019) has examined the role of empathy in interpersonal and intergroup relations, including intractable conflicts. Her review finds “encouraging evidence that empathy and compassion are associated with more helping behavior, less aggression, more favorable intergroup attitudes during conflicts, and more readiness for reconciliation after conflicts. Nonetheless, these relations are not uniform for people with different political orientations, for periods of low versus high conflict for people who are low or high in trust toward the out-group.”?

In their book ‘Mediation: A psychological insight into conflict resolution’ Strasser and Randolph (2004) consider “the ways in which a psychotherapeutic approach to conflict resolution can usefully be implemented in the mediation process”. They write how mediators and therapists both work in a ‘time-limited environment in which they both attempt to secure a transition from adversity to co-operation, from an antagonistic platform to a working alliance.” However, they also acknowledge the differences, as a therapist seeks to bring about a paradigm shift in the client’s attitude to his or her life in general, whereas a mediator endeavours to change the party’s approach to the specific dispute in question.

Their book borrows many of Carl Rogers’ methods and techniques which they consider to be relevant to the mediation process, saying that Rogers was “probably the first successful and effective worldwide mediator.” And they quote Rogers claiming that “by empathy, warmth, genuineness, congruence and an unconditionally positive regard, one can establish a therapeutic relationship which is not only curative but also enables clients to resolve their own conflicts.” In a 2018 Kluwer Mediation blog on ‘Empathy ’ Charlie Irvine and Laurel Farrington write that “we believe empathy is at the core of mediation” and that “Empathy requires both the cognitive (thinking) and also the emotional (or affective) element :a balance and synergy of head and heart.”

In? ‘Negotiating the Nonnegotiable: How to Resolve Your Most Emotionally Charged Conflicts ’ Daniel Shapiro stresses the importance of understanding the emotional dimensions of conflict and fostering empathy to build trust and find common ground. And in ‘Getting to Yes with Yourself: (And Other Worthy Opponents) ’, William Ury discusses the importance of empathy and understanding the perspective of the other party in negotiation and conflict resolution processes.

I warmly recommend reading ‘The Dynamics of Conflict: A Guide to Engagement and Intervention ’ by Bernard Mayer, whose wisdom includes “When individuals in conflict view the truth as exiting not inside them but among all people involved in the dispute, they are more likely to achieve a higher level of understanding and empathy. This view is the foundation of all profound conflict engagement processes.” And? also recommend ‘The Dance of Opposites ’ by Ken Cloke, a profound book which is full of references to empathy, including that “The information gained through empathy will not provide us with an answer but sometimes it will give us a question that can take us to the heart of a conflict.”

But to be fair, not everyone is positive about empathy. For example, Ohreen (2022), when considering the managerial use of empathy, writes that “Empathy is an overblown concept suffering from several problems. Specifically, imagining what is like to be another person is difficult, in part, because we overstate our abilities to understand another’s point of view.” He says that perspective-taking is often coloured by our own self-interest, life-experiences, emotional past, immediate reactions, and ideological perspectives and belief systems.

Ohreen goes on to say that “Empathy is problematic because our inferences of mind are often inaccurate; not everyone is good at empathizing; it’s not necessary to understand action intention;?doesn’t motivate helping behaviour; and could lead to immoral actions.” I agree with Ohreen that we do often overstate our abilities to understand another’s point of view and that we make assumptions about what someone else is thinking or feeling, But I don’t agree that this diminishes why empathy matters. It just means that we need to better understand what empathy is and can do.

Weisz and Cikara (2021) say that “one might think society would be best served by increasing empathy across all individuals and contexts, but the available evidence paints a much more complicated picture.” They write about how empathy for one’s own group can exacerbate rather than mitigate hostility toward other groups. And that “though empathy can motivate people to help others, it can paradoxically reduce the impact of aid by narrowing the focus of helpers’ concern to proximal recipients instead of distal and needier ones.”

Preckel et al (2018) refer to why empathy matters in writing that “Our ability to develop social competencies and emotions, such as empathy and compassion, is essential for our wellbeing, successful communication, and cooperative interactions in society.” And returning to healthcare research, I think there is much for those working with conflict to learn from Christiansen et al. (2015) observing that when “empathic communication and compassion exist in healthcare cultures, clinical teams are more resilient, effective, morale and quality care are higher, and patient complaints are fewer.” They refer to “growing evidence of the positive relationship between staff wellbeing and patient satisfaction. Thus, delivery of compassionate care requires a compassionate environment, where staff are able to attend to their own emotional health and the wellbeing of the team.”

Differing Levels of Empathy

There has been much debate over whether empathy is an innate ability. Measuring empathy has been the subject of much study, with Baker-Eck et al (2020) writing that “Due to the complex nature of empathy, various tests have been developed in order to attempt to assess levels of empathy within individuals.” They refer to the Baron-Cohen and Wheelwright’s Empathy Quotient which is a questionnaire of 60 items (see Baron-Cohen and Wheelwright 2004). They also reference the Jefferson Scale of Empathy (see Hojat et al. 2018) which is a 20-item instrument specifically developed to measure empathy in the context of health professions education and patient care and has been adapted to measure empathy levels in law students.

Other measures include the Toronto Empathy Questionnaire, which is a self-reported measure assessing both? the cognitive and emotional components of empathy through answers to 16 questions (Spreng et al. 2009). A more recent study to do with empathy in research design (Surma-Aho and H?ltt?-Otto 2022) identified that current empathy measures can be categorized into six distinct: empathic tendencies, beliefs about empathy, emotion recognition, understanding mental contents, shared feelings, and prosocial responding. [Design empathy is a concept within the field of design thinking that emphasizes understanding and empathizing with the needs, perspectives, and experiences of users or stakeholders].

Williams et al. (2016) comments on how research suggests that law students tend to have low empathy, referencing a study which found that law students had lower empathy levels than students of pharmacy and nursing. This study also found that while empathy increased over the years for pharmacy students and decreased for nursing students, it remained the same for law students. And I also came across a 2015 Huffington post article which observed that “Those who tend to be attracted to law school in the first place tend to be logical thinkers (rule oriented) and have low EQ levels and that the training students receive in law school also causes an "erosion of empathy."

A question frequently explored in the research literature is whether there is genetic component to empathy. Early twin study research (such as Davis et al 1994) described evidence of significant heritability for characteristics associated with two affective facets of empathy - empathic concern and personal distress, but not for the non-affective construct of perspective taking. In a more recent review and metanalysis of twin studies, Abramson et al (2020) found that “emotional empathy is more heritable than cognitive empathy. Moreover, cognitive empathy as examined by performance tests was affected by the environment shared by family members, suggesting that emotional understanding is influenced, to some degree, by environmental factors that have similar effects on family members beyond their genetic relatedness.”

Abramson et al (2020) also found that “cognitive empathy develops more slowly and therefore may rely more strongly on learning experiences and growing exposure to cultural nuances.” And makes the point that “Heritability estimates of empathy may differ for different populations”, saying “it is crucial to examine the heritability of empathy in clinical populations who show empathy deficits e.g., people with callous-unemotional traits or autism spectrum conditions.”

I am not keen on the term ‘empathy deficit’, preferring ‘empathic disequilibrium’ which describes the level of imbalance between cognitive empathy and emotional empathy. But note how Baron-Cohen (2013) has described “Two different neurodevelopmental conditions involve empathy deficits: autism and psychopathy.” He asks: “So why do they not result in a similar outcome?” Responding that “The answer to this riddle may lie in the two “fractions” of empathy. The thesis is that while people with autism have well-established difficulties in theory of mind (the cognitive component of empathy) alongside intact affective empathy, psychopaths have intact theory of mind but impaired affective empathy. “

Chapple et al (2022) is a fascinating study exploring whether adult autistic readers read in a more advantageous and empathic ‘literary' way. They discuss how ‘deficit-based assumptions’ are the result of dominant medical framings and that “autism research has long over-focused on what autistic people lack.”, And say “In this way, autistic people are positioned as being in need of ‘fixing' in order to align their behaviors with those typically expected within mainstream cultures.” Also, that as a consequence of these views “the autistic community have been denied agency in shaping their own narratives and influencing how they are viewed within society.”

The findings in their study challenge previous assumptions of an empathy deficit amongst autistic individuals and includes how autistic individuals often showed enhanced socio-empathic understandings of the literature with no empathy deficits when compared to non-autistic participants.

There seems to have been relatively little research on autistic females, but from what I have seen studies suggest that they tend to show different characteristics than autistic males, such as increased use of masking of their social difficulties

McDonald and Kanske (2023) write that “Various explanations exist as to why social gender differences may occur. For example, evolutionary models propose that variation in reproductive investment generates sexual-selective pressures, differentially favouring the evolution of sex-specific social behaviours. In contrast, gender socialization models posit that cultural beliefs about gender roles influence gender expectations, orienting women and men towards different social behavioural patterns.” Their studies observed greater empathy, compassion and prosocial donations (giving or contributing with the intention of benefitting others) in women compared to men, but found no evidence that either gender performed better in Theory of Mind.

McDonald and Kanske (2023) suggest that “women’s average greater interest in social stimuli compared to men may favour the observed relationship between the ability to take another’s perspective (Theory of Mind performance) and respond to another’s needs (prosocial donations). This social interest may also foster women’s willingness to donate more when compared to men.”

As other writers have advocated, I suggest that any claims about the inheritance or the gender-specific nature of empathy need be interpreted with caution. And I am resisting exploring empathy and gender in any detail in this article, but may do so?in future. A related issue, which also needs more consideration, is a question raised by my valued friend and former colleague Jane Williams in her Doctoral dissertation ‘Shifting the culture and design of complaints systems: Participation, reflexivity and ethics ’. Dr Williams asks “whether, by highlighting the importance of skills such as empathy, emotional intelligence and communication, my publications are unwittingly reproducing gender effects in complaints, and if so how that should be addressed?”.

Martos et al (2013) found that emotion regulation accounts for most of the variance of cognitive and affective empathy, followed by the ability to understand emotions and the management of others’ emotions. This suggests that interpersonal abilities explained only a small part of the empathic involvement. Niven et al. (2024) say that people vary in how successfully they manage others' feelings. Their review “suggests that both cognitive abilities and personality traits influence success in interpersonal emotion regulation; cognitive ability primarily in the context of short-term performative episodes, and personality primarily over longer timeframes within ongoing relationships.”

Weisz and Zaki (2018) write about empathy being context dependent and “shifting depending on the environment in which it unfolds.” They say that context does not influence empathy directly, but indirectly shapes empathy by affecting a person's motives. Their paper explains that “people want to empathize with those most relevant to them. This tendency goes beyond group membership; people are motivated to empathize with those who look like them, those who are kind to them, and those who are close to them.” My understanding is that this is based on factors such as similarity, familiarity or personal biases. And that unconscious biases can influence empathetic responses.

My readings find that the capacity for empathy varies from person to person. And the conclusion I have reached is that empathy can be understood as both a trait and a state, depending on how it's conceptualized and measured. As we have seen, empathy is multifaceted involving cognitive, emotional and behavioural components. So it is not surprising that it would be influenced by a combination of genetic, biological and environmental elements (such as upbringing and socialisation), as well as the prevailing context.

I’ll stop here. And in Part 4 (definitely the final part!) I am going to consider whether you can have too much empathy, at acquiring empathy and look at the use of empathy in practice.

References

Abramson, L., Uzefovsky, F., Toccaceli, V. and Knafo-Noam, A., 2020. The genetic and environmental origins of emotional and cognitive empathy: Review and meta-analyses of twin studies. Neuroscience & Biobehavioral Reviews, 114, pp.113-133.

Baker-Eck, B., 2022. The psychology of investigative interviewing with suspects of serious offences: an examination of empathy. University of Derby (United Kingdom).

Baker-Eck, B., Bull, R. and Walsh, D., 2020. Investigative empathy: A strength scale of empathy based on European police perspectives. Psychiatry, Psychology and Law, 27(3), pp.412-427.

Barker, M.E., Leach, K.T. and Levett-Jones, T., 2023. Patient's views of empathic and compassionate healthcare interactions: A scoping review. Nurse Education Today, p.105957.

Baron-Cohen, S. 2013. Empathy deficits in autism and psychopaths: Mirror opposites. In M. Banaji & S. Gelman (Eds.), Navigating the social world: What infants, children, and other species can teach us. Oxford University Press.

Baron-Cohen, S. and Wheelwright, S., 2004. The empathy quotient: An investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of autism and developmental disorders, 34(2), 163–175.

Chapple, M., Davis, P., Billington, J., Williams, S. and Corcoran, R., 2022. Challenging empathic deficit models of autism through responses to serious literature. Frontiers in Psychology, 13, pp. 1-15.

Christiansen, A., O'Brien, M.R., Kirton, J.A., Zubairu, K. and Bray, L., 2015. Delivering compassionate care: the enablers and barriers. British Journal of Nursing, 24(16), pp.833-837.

Daicoff, S.S., 2012. Expanding the lawyer's toolkit of skills and competencies: Synthesizing leadership, professionalism, emotional intelligence, conflict resolution, and comprehensive law. Santa Clara Law Review, 52, pp.795 – 874.

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De Vignemont, F. and Singer, T., 2006. The empathic brain: how, when and why?. Trends in cognitive sciences, 10(10), pp.435-441.

Gerdy, Kristin B., 2013. The Heart of Lawyering: Clients, Empathy, and Compassion. Religious Conviction. vol. 3,. Paper 24. pp. 189-202.

Hojat, M., DeSantis, J., Shannon, S.C., Mortensen, L.H., Speicher, M.R., Bragan, L., LaNoue, M. and Calabrese, L.H., 2018. The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students. Advances in Health Sciences Education, 23, pp.899-920.

Jeffrey, D., 2016. Clarifying empathy: the first step to more humane clinical care. British Journal of General Practice, 66(643), pp.e143-e145.

Klimecki, O.M., 2019. The role of empathy and compassion in conflict resolution. Emotion Review, 11(4), pp.310-325.

McDonald, B. and Kanske, P., 2023. Gender differences in empathy, compassion, and prosocial donations, but not theory of mind in a naturalistic social task. Scientific Reports, 13(1), p.20748.

Martos, M.P.B., Lopez‐Zafra, E., Pulido‐Martos, M. and Augusto, J.M., 2013. Are emotional intelligent workers also more empathic?. Scandinavian journal of psychology, 54(5), pp.407-414.

Niven, K., Hughes, D.J., Tan, J.K. and Wickett, R., 2024. Individual differences in interpersonal emotion regulation: What makes some people more (or less) successful than others?. Social and Personality Psychology Compass, 18(4), p.e12951.

Ohreen, D., 2022. The managerial use of empathy: missteps into the mind of others. Philosophy of Management, 21(2), pp.135-161.

Preckel, K., Kanske, P. and Singer, T., 2018. On the interaction of social affect and cognition: empathy, compassion and theory of mind. Current Opinion in Behavioral Sciences, 19, pp.1-6.

Slavin, D., Winter, R., Ward, A. and Howick, J., 2023. On the need for empathy in the acute hospital setting. British Journal of Hospital Medicine, 84(10), pp.1-3.

Spivak, B., Batagol, B., Sifris, A. and Williams, B., 2018. Measuring empathy in undergraduate law students: Examining the factorial validity of the Jefferson Scale of Empathy-Law Students (JSE-LS). International Journal of Law and Psychiatry, 58, pp.143-149.

Spreng, R., N., Kinnon, CM, Mar, RA, & Levine, B. 2009. The Toronto Empathy Questionnaire: Scale development and initial validation of a factor-analytic solution to multiple empathy measures. Journal of Personality Assessment, 91(1), pp.62-71.

Strasser, F. and Randolph, P., 2004. Mediation: A psychological insight into conflict resolution. A&C Black.

Surma-Aho, A. and H?ltt?-Otto, K., 2022. Conceptualization and operationalization of empathy in design research. Design Studies, 78, p.101075.

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Westaby, C. and Jones, E., 2018. Empathy: an essential element of legal practice or ‘never the twain shall meet’?. International Journal of the Legal Profession, 25(1), pp.107-124.

Williams, B., Sifris, A. and Lynch, M., 2016. A psychometric appraisal of the Jefferson Scale of Empathy using law students. Psychology Research and Behavior Management, pp.171-178.

Williams, J., 2022. Shifting the culture and design of complaints systems: Participation, reflexivity and ethics [PhD by publication] (Doctoral dissertation, Queen Margaret University, Edinburgh).