Part
I. Developing Empathy
Hoyle Leigh,
M.D.
Professor of Psychiatry, UCSF
Course Director
Community Regional Medical Center, (559) 459-4995, hoyle.leigh@ucsf.edu
Part
I. Developing Empathy Schedule
See
below for session contents and reading matter
Essentials
of Psychiatry
Course
Description:
This is a series of three
courses, 1. Developing Empathy, 2. Perspectives in Psychiatry, and 3.
Introduction to Psychotherapy, designed to introduce the beginning psychiatric
resident to the basic skills and perspectives necessary to develop as a skilled
clinician and scholar. The series begins with a discussion of empathy,
the sine qua non of a doctor-patient relationship, with skills training in
empathy. This is followed by a mini-course on the history of psychiatry
and the evolution of ideas important to psychiatry. A series of seminars
on basic psychodynamic theories follows.
Textbooks:
The two books below must be purchased and are not on line. They are
usually available at Barnes & Noble or Amazon.com
Brenner,
Charles : An Elementary Textbook of Psychoanalysis
paperback,
Doubleday Anchor Book
Basch, Michael Franz: Understanding
Psychotherapy: The Science Behind the Art
paperback,
Basic Books
Optional:
Hall, Calvin S & Nordy, Vernon J: A Primer of
Jungian Psychology
paperback, Penguin Books
Other
reading material are usually provided on line and available by clicking on the
link.
Course
Objectives:
This course is designed to teach
the resident or advanced student the basic concepts and skills concerning
empathy and to teach basic counseling techniques utilizing empathy. At
the end of this course, the trainee should be able to define and discuss the
concept of empathy, and associated terms (such as active listening), be able to
conduct an interview using empathic skills, and perform problem-oriented
counseling.
Reading
Material (Sections provided in the Syllabus):
The
basic textbooks are: The Skilled Helper: A Systematic Approach to Effective Helping, by Gerard Egan, Brooks/Cole
Publishing Co, Pacific Grove, CA, 1990.
and
Interpersonal Living: A Skills/Contract Approach to Human-Relations Training
in Groups, Brooks/Cole Publishing Co, Monterey, CA , 1976
Sections
of The Skilled Helper are reproduced in the syllabus followed by
sections of Interpersonal Living.
Other
reading material will be distributed as necessary.
Session 1. Doctor Patient Relationship
Reading: Leigh & Reiser, The Patient: Biological, Psychological, & Social Dimensions of Medical Practice, 3rd Edition, Chapter 17, The Doctor-Patient Relationship
Fabbri-Destro, M & Rizzolatti, G: Mirror Neurons and Mirror Systems in Monkeys and Humans
Topics for discussion
1. What is doctor-patient relationship? Doctor-client ?
2. What are the expectations of the doctor by the patient?
What do patients feel when they call a doctor, sees him/her,
Leaves the office?
3. Why is the doctor the most frequently prescribed drug (Balint)?
4. What are the specific therapeutic effects of simple doctor-patient
relationship?
5. Are all expectations of the patient about the doctor conscious? If not,
why and what?
6. What are the expectations of the doctor about the patient?
7. What are "sick role" expectations (Talcott Parsons)?
8. What is the role of communication in doctor-patient relationship?
9. Why is empathy a sine qua non of successful doctor-patient relationship?
Session 2. Developing Empathy
Readings:
Egan G: Skilled Helper Chapter 5. Communication Skills I: Attending and Listening (pp 106-121)
Topics for discussion:
1. Is communication skill itself beneficial? If so, for whom, if not, why not?
2. What are the implications if a patient’s verbal communication is at variance with his/her non- verbal communication?
3. What is active listening?
4. Why should a helper not sympathize with a client?
5. What is the goal of attending and active listening?
6. What is empathy? Why might it be in itself therapeutic?
7. What is context and why is it important?
8. How do you know if empathy is accurate?
9. How might empathy be misused?
Reading:
Egan G: Exercises in Helping Skills Part Two - Basic Communication Skills for Helpers
In what helping situations would one or more of SOLER be inappropriate?
Major points:
a. Respond empthically to move on (make progress)
b. The Empathic Response
What core messages are being expressed in terms of feelings, and the experiences, and behaviors that underlie these feelings? What is most important in what the client is saying to me?
Then, check out your understanding with the client with the formula:
You feel……because…..
You feel is followed by appropriate FAMILY and INTENSITY of feeling
Because is followed by experiences and/or behaviors
Listen to the CONTEXT, not just the words
Selective responding may be necessary at times, emphasizing either the feeling, the experience, or the behavior
HOW TO TELL IF EMPATHY IS ACCURATE
a) some form of verbal or nonverbal confirmation
b) client moves on to provide more details about the problem situation
IF INACCURATE:
a) some verbal or nonverbal indication of inaccuracy
b) should lead to helper’s restatement, modification, or correction
c) which will move the therapy forward
The Uses of Empathy
1. Build relationship
2. Stimulate self-exploration
3. Check understanding
4. Provide Support
5. Lubricate communication
6. Focus attention
7. Restrain helper
8. Pave the way
Some Do's and Don'ts in Expressing Empathy
Do:
give self time to think
short responses
gear yourself to client, but remain yourself
Avoid:
no response
a question
a cliche
an interpretation
advice
pretending to understand
sympathy and agreement
sympathy --- leaves the helper in a participant stance only
1. Do not assault clients with volleys of questions
In psychiatric interview, first begin with open ended interview, then, after an empathic relationship has developed, indicate to patient that you need to ask some specific questions, and then do the survey if the answers have not already emerged during the open-ended discussion.
2. Ask questions that serve a purpose
3. Ask open-ended questions that get clients to talk about specific experiences, behaviors, and feelings
4. Keep the focus on the client : have clients ask relevant questions of themselves
5. Statements that encourage clients to talk and clafify
6. Interjections that help clients to focus
7. Cautions in the use of probes
"if helpers find themselves asking two questions in a row, they have just asked two stupid questions"
The Communication of Accurate Empathic Understanding: Creating a Climate of Support
Primary-Level Accurate Empathic Understanding
Accurate Empathy:
You are accurately empathic if you 1)discriminate - get inside the other person, look at the world from his perspective or frame of reference, and get a feeling for what his world is like; and 2) communicate to the other this understanding in a way that shows him that you have picked up, generally, both his feelings and the experiences and/or behaviors underlying these feelings.
Primary Level Accurate Empathy
Communication to the other person that you understand what he says explicitly about himself.
Session 4. Techniques of Empathy, Part II.
Reading: Egan G: Skilled Helper Chapter 6. Communication Skills II: Empathy and Probing
Advanced Accurate Empathy
Not only what the other person states but also what he implies or leaves unstated or doesn't clearly express.
If advanced accurate empathy is used too early in a relationship, it can be too frightening.
Some Common Problems in Communicating Primary-Level Accurate Empathy
1. cliché
2. Premature advanced accurate empathy
3. Inaccuracy
4. Feigning understanding
5. Parroting
6. Jumping in too quickly or letting the other ramble
7. Longwindedness
Session 5: Counseling - A Basic Technique in Psychotherapy
Reading:
Egan, G: The Skilled Helper Chapter 2 - Overview of the Helping Model
Exercise:
Egan, G: Exercises in Helping Skills: Part One - Laying The Groundwork
The Kinds of Helpers: formal, informal, etc.
The Goal of Helping
Helping as an Education Process
The Starting Point: Clients with problem situations and unused opportunities
The stages of the helping process
Stage 1: The Present Scenario
Stage 2: The Preferred Scenario
Stage 3: Getting There
Outcome-Producing Action
Session 6: Counseling Part II
Readings:
Egan, G: The Skilled Helper Chapter 3 - Building the Helping Relationship - Values in Action
Egan, G: The Skilled Helper Chapter 4 - Action I - helping Clients Act
Session 7. Exercises
Session 8. Exercises with Role Playing
Session 9. Exercises with Role Playing
NEXT, WE START THE FIRST SESSION OF PERSPECTIVES OF PSYCHIATRY