82
Different theories describe the mechanisms of empathy. As mentioned earlier,
empathy requires a “shift of perspective. It’s not what I would experience as me in
your shoes; empathy is what I experience as you in your shoes...” (Glanzer 2006 ,
p. 135). Glanzer ( 2006 ) notes that “Empathy requires (1) an internal model of the
other and (2) the capacity to experience from the perspective of this internal model
of the other” (p. 125). Eisenberg and Eggum’s ( 2009 ) theory of empathy proposes
three processes: “(a) emotional stimulation – mirroring of the other’s experience, (b)
perspective taking – understanding the client, and (c) emotion regulation – soothing
interpersonal distress” (as described in Imel et al. 2014 ; p. 146). Consistent with this
model, Imel et al. ( 2014 ) studied vocal synchrony (imitation) and its relationship to
empathy in 89 psychotherapy dyads. They found vocal synchrony was strongly
associated with ratings of therapist empathy, and they recommended therapists pay
attention to both clients’ words and also “track the extent to which they are in tune
with clients’ vocal tone” (p. 151). Their findings demonstrate the interrelatedness of
physical and psychological attending in the experience and expression of empathy.
4.4 Effectively Communicating Empathic Understanding
Rather than having no idea what patients are feeling and thinking, you will probably
find that your bigger challenge is how to express your understanding to them. The
good news is that as long as you have some sense of what patients might be experi-
encing, you can always learn ways to convey your empathy. First and foremost, you
need to tune into what you are hearing and observing. The following suggestions
will help you do that.
- Imagine yourself in your patient’s place and ask yourself what you might think
and feel in their situation. This is called perspective-taking. - Try to differentiate between what patients are feeling regarding the genetic coun-
seling experience as opposed to their feelings about the problem at hand. - Mentally relate your patient’s experience to a similar life experience of your
own. - Pay attention to patient verbalizations. Listen to what your patient is saying and
how she/he is saying it. - Attend to patient nonverbals. As discussed in Chap. 3 (attending skills), nonver-
bals provide powerful clues to patient emotions. - Become aware of your own nonverbal reactions as you listen to a patient. Is your
stomach tightening? Do you find yourself close to tears? Are you sighing? - Gain experience. As you see more patients, you will recognize that certain expe-
riences and emotions frequently coincide with particular genetic conditions and
patient situations. For example, prenatal genetic counselors anticipate that most
women with abnormal screening test results will be fearful about the possibility
of an abnormality. Genetic counselors could anticipate that a couple who has lost
one child to a familial cardiomyopathy may be very ambivalent about having
another pregnancy.
4 Listening to Patients: Primary Empathy Skills