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PubMed1990

A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships.

Empathic understanding in practitioner relationships is postulated as necessary for adherence to therapeutic regimens. It is considered to be one of the most important practitioner relationship skills leading ultimately to patient health benefit. Research literature from a wide-range of health disciplines including personality theory, social psychology, psychotherapy, psycho-analysis, and practitioner-patient communication highlights the key role of empathic processes in personal health care. A model of empathic understanding is described which attempts to integrate the substantive findings in the research literature and seeks to generate new ideas for further investigation. The model addresses theoretical relationships between practitioners' empathic understanding, patients' knowledge of their illness and motivation to get better, adherence to treatment advice, and outcome. Recent work on the selection and training of medical and nursing staff in empathic skills is reviewed. A number of areas for future research are outlined including the effect of individual practitioner differences in the components of empathy, empathic compatibility in practitioner-patient dyads, fluctuations in levels of practitioner empathy during long-term care, specific practitioner behaviours which communicate empathy, and the relationship between factors of patient satisfaction and the perception of empathic understanding.

Communication↗
PubMed1992

[The effects of role playing on prosocial behavior in preschool children].

The purpose was to examine the effects of two types of role-playing experience on prosocial behavior in preschool children. Subjects were 72 6-year-olds. In the Empathy role-playing (E), each pair of children enacted alternately a victim and an eyewitness using a glove puppet, in which the emphasis was only on empathizing with the victim. In the Empathy and Helping role-playing (EH), they enacted alternately a victim and a helper, in which the emphasis was on empathizing and helping a victim. In the Control role-playing (C), they played roles alternately of a customer and a salesman in a grocery store. All children were assessed as for helping and sharing behaviors for a real victim before and after the role playing session. In the comparison between pre- and post-tests for helping behavior. All groups (C, E, EH) increased helping tendency, but only in EH group the proportion of subjects, whose attitude changed from helper to non-helper. As for sharing behavior, all three groups increased the number of sharing significantly in the post-test.

Child↗
PubMed2005

Conscience in childhood: old questions, new answers.

Although conscience has been the focus of reflection for centuries, fundamental questions regarding its organization have not been fully answered. To address those questions, the authors applied structural equation modeling techniques to longitudinal data comprising multiple behavioral measures of children's conscience, obtained in parallel fashion at 33 and 45 months. The measures encompassed moral emotion (guilt and empathic distress) and rule-compatible conduct (internalization of maternal prohibitions and requests and of another adult's rules). Confirmatory factor analyses supported a differentiated view of conscience with 2 latent factors at both ages: Moral Emotion and Rule-Compatible Conduct. The structure of conscience was remarkably stable over time. The coherence between Moral Emotion and Rule-Compatible Conduct factors increased as children grew older.

Child↗
PubMed1989

It's how you say it: physicians' vocal behavior.

The present study was designed to assess evaluations of physicians interacting with patients via the telephone. Observers used ten adjective scales which resulted in three variables: empathic, dominant, and calm. Thirty doctor-patient interactions were presented in two different communication modes: audio-only and typed transcript-only. As predicted, female listeners rated doctors as more empathic, dominant, and calm, and communication modes were significantly different with audio segments rated as more empathic, dominant and calm. Middle phases of the conversation also were evaluated more positively than greeting phases. Significant interactions between temporal phase and mode indicated that audio segments were interpreted more positively during middle phases. Also, female listeners were more sensitive to audio segments. Physicians' amplitude and speech rate were positively correlated with dominance.

Cues↗
PubMed1998

Clinical vicissitudes of adoption.

Many interacting forces shape the unique experience of adoption. The adoptive parents' fantasies, fears, and perceived lack of entitlement to the child can detrimentally influence their parenting abilities. The adopted child's often powerful need to master early abandonment may lead to maladaptive behaviors that feed the adoptive parents' fears and fantasies regarding the child's past and future. The therapist familiar with the challenges of adoption can take an empathic stance with the adoptive parents and the adoptive child that can contain their anxieties and conflicts and pave the way toward a better resolution of their individual and shared experience.

Adoption↗
PubMed2005

Family interaction and the development of borderline personality disorder: a transactional model.

Although no prospective epidemiological studies have evaluated the relationship between family interactions and the development of borderline personality disorder (BPD), there is considerable evidence for the central role of family interactions in the development of BPD. This paper describes the role of family interactions or processes, especially those that might be regarded as invalidating or conflictual, negative or critical, and the absence of more validating, positive, supportive, empathic interactions, in the development of BPD. Perhaps more importantly, the proposed model considers how these parental and family behaviors transact with the child's own behaviors and emotional vulnerabilities, resulting in a developmental model of BPD that is neither blaming of the family member with BPD nor of her or his parents and caregivers, and has important and specific implications for both prevention and intervention.

Adolescent↗
PubMed1976

Empathic listening test: an instrument for the selection and training of telephone crisis workers.

Although telephone crisis centers have been shown to be a viable mode of community service, they are not without problems. Empirically based research upon which to make appropriate clinical and administrative decisions, particularly in the selection and training of volunteers has been lacking. In response to that need, a construct was developed that fused listening, the primary communicative behavior, with empathy, the most important interpersonal function of crisis center workers, to provide a criterion for selection and training. A 60-item situational instrument was developed to measure three dimensions of Empathic Listening, (a) Understanding, (b) Interest, and (c) Response-Ability. This study was designed to establish validity and reliability data for the instrument. The instrument was shown to have potential for selecting and training crisis center workers.

Communication↗
PubMed1991

[Behavior of the aged in a hospital environment. Case reports].

The author deals with the problem of adaptation of old people after admission to hospital, draws attention to the necessity of suitable preparation, a tactful, empathic approach in dealing with old people. On selected case-histories the most frequent difficulties are demonstrated--ament conditions, depressive syndrome and attempts to find an optimal preparation before hospitalisation of old people. At the same time attention is drawn to the most frequent mistakes which are made during an inconsiderate transfer and their sequelae.

Adaptation, Psychological↗
PubMed2005

Empathy in boys with disruptive behavior disorders.

BACKGROUND: The present study examined empathy in 8- to 12-year-old clinically referred boys with disruptive behavior disorders (DBD) (n=25) and age-matched normal controls (n=24). METHOD: Situational empathy was assessed by children's emotional and cognitive responses to six empathy-inducing vignettes (displaying sadness, anger or happiness). Dispositional affective empathy was measured by a self-report questionnaire for children. RESULTS: In line with predictions, results revealed deficits in dispositional and situational empathy among DBD boys, and inverse relationships between both empathy measures and parent-reports of aggressive/disruptive behavior among all children. The study also explored whether DBD boys are less responsive to just any emotion, or to specific emotions. Compared to normal controls, DBD boys responded less empathically to sadness and anger, but equally empathically to happiness. In addition, while DBD boys responded less empathically than the normal controls to each and every sadness vignette, they did not show equally low levels of empathic responses to all sadness vignettes. CONCLUSIONS: These findings suggest that situational factors may be involved in DBD boys' reduced responsiveness to another person's sadness.

Affect↗
PubMed1999

The relations between temperament and empathy in 2-year-olds.

The role of infant and toddler temperament in the prediction of empathy in 2-year-old children was examined. Assessments of temperament included reactivity and affect observed at 4 months of age, as well as inhibition at Age 2. Empathy was measured in 2-year-old children's responses to simulations of distress performed by their mothers and by an unfamiliar person. Children showed relatively more concern for the mother's distress, but they were also responsive to unfamiliar victims. Infants who were unreactive and showed little affect also showed less empathy toward the unfamiliar adult almost 2 years later. Inhibition toward an unfamiliar adult (but not toward the mother) at 2 years of age was negatively related to empathy. Inhibited temperament may thus have a major impact on young children's empathy in unfamiliar contexts. Findings also highlight the need to consider early underarousal as another dimension of temperament that may dampen expressions of empathic concern.

Adult↗
PubMed2004

Contagious yawning in chimpanzees.

Six adult female chimpanzees were shown video scenes of chimpanzees repeatedly yawning or of chimpanzees showing open-mouth facial expressions that were not yawns. Two out of the six females showed significantly higher frequencies of yawning in response to yawn videos; no chimpanzees showed the inverse. Three infant chimpanzees that accompanied their mothers did not yawn at all. These data are highly reminiscent of the contagious yawning effects reported for humans. Contagious yawning is thought to be based on the capacity for empathy. Contagious yawning in chimpanzees provides further evidence that these apes may possess advanced self-awareness and empathic abilities.

Animals↗
PubMed2001

Social inhibition and overfriendliness: two-year follow-up and observational validation.

Studied socioemotional functioning in 3 groups (n = 15) of high-inhibited, low-inhibited-overfriendly, and low-inhibited-low-overfriendly children at age 9, who were identified by parental ratings in a sample (N = 392) at age 7. Ratings of social inhibition and overfriendliness were stable over the 2-year period from age 7 to age 9. Validity of rated social inhibition and overfriendliness is established with behavioral observations, both predictively and concurrently. The groups are contrasted along the dimensions of social inhibition and overfriendliness with respect to socioemotional distress, social problem solving, empathic ability, and the disinhibitory phenomena of thrill seeking and hyperactivity. The high-inhibited group shows heightened socioemotional distress. The overfriendly group shows heightened levels of thrill seeking and hyperactivity. Social problem solving and empathy are less well developed in the inhibited and in the overfriendly group as contrasted to the low-inhibited-low-overfriendly group. The results are interpreted in terms of risks for socioemotional problems at both ends of the dimension of social inhibition.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Relation between empathy and aggression and behavior compliance among abused group home youth.

Physically abused youth are often described as more aggressive and noncompliant in comparison with normal children, despite inconclusive findings regarding the nature of behavior problems among these youth. The present study investigated whether empathy would be differentially related to aggression and behavior compliance of abused youth within the natural living context of a group home environment. As predicted, results suggest a strong, positive relationship between empathy and lower rates of interpersonal aggression and a strong positive relationship between empathy and higher rates of behavior compliance. In contrast to previous studies which support the intergenerational cycle theory of abuse, the results of this study do not support the belief that abuse results in stabilized aggression and suggests that the empathetic abused child is less likely to be aggressive and noncompliant than his/her non-empathic counterpart. The implications of these results for understanding and helping abused youth are discussed.

Adolescent↗
PubMed2006

The hateful patient revisited: Relevance for 21st century medicine.

While the practice of medicine has changed over the years, including technological advances, access to medical information, and the narrowing of socio-economic and educational gaps between the clinician and his/her patients, the importance of the doctor-patient relationship has not diminished over time. This can be a very rewarding interaction. However, many physicians experience a great deal of anger, inadequacy and frustration, and much of the actual practice of medicine may become a burden rather than a source of satisfaction. Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the "hateful patient" can therefore be very informative to the physician. Several categories of such patients may be described, and sensitivity to the phenomenon will lead to improved physician well-being, less self-destructive patient behavior and a lower risk of litigation. Several factors may assist the 21st century physician in managing the "hateful patient" in an empathic manner and in making some sense of why the patient has resorted to negative response patterns. Ultimately, a failure to consider these issues will result in poorer medical care and, no less important, reduced satisfaction of both patients and doctors. The intention of this article is to revisit the concept and to place it in the context of contemporary medical practice.

Journal Article↗
PubMed1990

What is empathy, and can empathy be taught?

Empathy is a commonly used, but poorly understood, concept. It is often confused with related concepts such as sympathy, pity, identification, and self-transposal. The purposes of this article are to clearly distinguish empathy from related terms and to suggest that the act of empathizing cannot be taught. According to Edith Stein, a German phenomenologist, empathy can be facilitated. It also can be interrupted and blocked, but it cannot be forced to occur. What makes empathy unique, according to Stein, is that it happens to us; it is indirectly given to us, "nonprimordially." When empathy occurs, we find ourselves experiencing it, rather than directly causing it to happen. This is the characteristic that makes the act of empathy unteachable. Instead, promoting attitudes and behaviors such as self-awareness, nonjudgmental positive regard for others, good listening skills, and self-confidence are suggested as important in the development of clinicians who will demonstrate an empathic willingness.

Attitude of Health Personnel↗
PubMed1983

The child sexual abuse accommodation syndrome.

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.

Adaptation, Psychological↗