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cates the counselor understands how the patient is feeling about this information”
(VandenLangenberg 2012 , p. 130).
Most authors (e.g., Barrett-Lennard 1981 ; Duan and Hill 1996 ; Gladstein 1983 )
agree that empathy is a multistage, interpersonal process that contains at least three
elements:
- Can I sense what you experience?
- Can I communicate this sense to you?
- Can you perceive this communication as my understanding you/your experience?
This third element depends to a great extent on the characteristics of the recipient
of the empathy response (Barrett-Lennard 1981 ).
4.1.1 Types of Empathy
There are two major types of empathy responses, primary empathy and advanced
empathy:
Primary empathy communicates initial understanding of what a patient is expe-
riencing. Primary empathy is particularly important for rapport building and prob-
lem exploration. In genetic counseling, you use your own words to concisely convey
an understanding of surface, fairly explicit patient experiences.
Example Pt (tearfully says): “I don’t want anything to be wrong with my baby.”
Co: “It’s upsetting to think that something could be wrong.”
Pt: “This is so much information! I’m so confused about what I should do. I don’t
think I can make this decision.”
Co: “You’re feeling overwhelmed by the amount of information.”
Advanced empathy communicates an understanding of underlying, implicit
aspects of patient experience. This type of empathy is useful for dynamic under-
standing (assessing the patient’s deeper, less obvious feelings and experiences).
Your responses are additive in that they go beyond surface patient expressions.
Example A patient is focusing on her fear of having a genetic test because she dis-
likes having her blood drawn. You believe there is more to her reaction and say, “In
addition to being fearful of having your blood drawn, maybe you’re also scared
about what the test results might reveal?”
This chapter is about primary empathy. We consider advanced empathy in greater
detail in Chap. 8.
4.2 Importance and Functions of Primary Empathy
Psychotherapy research consistently demonstrates that therapist empathy is posi-
tively related to therapy processes and outcomes (Elliott et al. 2011 ; Norcross and
Wampold 2011 ). Specifically, empathy enhances the working alliance (therapeutic
4 Listening to Patients: Primary Empathy Skills