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Shut Up and Listen

How therapy can teach you empathy by Andrew Price

August 4, 2014

People are talking about empathy more than ever. A search of New York Times archives reveals that while the paper mentioned the term in only 18 articles in 1960, the count had risen to 241 by 2000. And in 2013, empathy was referenced 563 times. Last week’s Sunday Review section of The Times even included a piece on empathy and its connection to social status. And the Gray Lady isn’t the only one. News organizations ranging from the Harvard Business Review to The Huffington Post are enumerating the benefits of getting in touch with other people’s feelings and advising us on how to do so.

Whether this is a reaction to a perceived pandemic of self-centeredness, a side effect of the recent interest in holistic “wellness,” or simply a spontaneous collective desire to be better people, Americans are, it seems, interested in increasing their ability to share and understand the feelings of the other.

When it comes to actually altering the way we perceive or treat other people, therapy is often where the rubber meets the road. More than a quarter of all Americans are in therapy or taking psychiatric medication, and empathy plays a role in many of the issues that drive people to treatment, from marital issues to anxiety to eating disorders. So what do therapists actually do to help people become more empathetic?

The irony of affective empathy is that it requires being really good at listening to yourself.

Researchers identify two kinds of empathy. The first is “cognitive empathy,” the thinking part. This is the ability to identify what someone else is thinking or feeling. Recent studies suggest that cognitive empathy is closely related to the “theory of mind,” the ability—normally fully developed by around age 4—to ascribe full mental lives complete with independent beliefs, desires, and intentions to other individuals. This kind of empathy is often underdeveloped in people on the autism spectrum.

The second kind of empathy is called “affective empathy.” This is the feeling part. Affective empathy involves actively sharing someone else’s emotional state. With strong cognitive empathy and weak affective empathy, one might recognize that someone else is in emotional pain but not feel any personal distress. An extreme form of this imbalance is often found in psychopaths.

Therapists work with both types of empathy, but approaching the cognitive element has so far proven a more straightforward task, and several effective techniques are currently in practice. Often, strengthening empathy’s intellectual component requires encouraging individuals to pay conscious attention to, and express an understanding of, the emotional states of others. One way to do this is with “active listening.”

Active listening, a term coined by psychologist Thomas Gordon in 1977, simply means paying complete attention, considering what was said, and then directly acknowledging the feelings of the speaker. The listener doesn’t have to agree. The point is to allow the speaker to know that he or she was heard.

Active listening is a valuable skill in a range of contexts, from hostage negotiations to sales meetings to cocktail parties. But it’s also a difficult skill to master. Getting one side to express feelings while getting the other to fully comprehend, or even simply acknowledge, those feelings can be hard. When people are in an argumentative or defensive mindset, they may end up only listening for weaknesses or provocations. Learning to listen effectively is a critical part of cognitive empathy, because truly understanding what someone is saying, rather than just planning one’s rebuttal, is key to understanding what that person feels.

Photo courtesy of Jessica Kingsley Publishers

Patients with severe empathic deficits who find it difficult to identify others’ emotions can sometimes benefit from simple rote practice. Neuroscientist and autism researcher Simon Baron-Cohen has developed a game called Mind Reading, in which players are shown flash cards of faces and quizzed about the emotions portrayed. These kinds of exercises are generally used for autism-spectrum children, but they’ve been shown to help “neurotypical” people fine-tune their empathy skills as well.

Addressing the second kind of empathy, affective empathy, is a more complicated task than just intellectually understanding what someone is experiencing. Feelings are abstract and hard to quantify. The internet is littered with articles telling people how to become more caring by listening to others. But the irony of affective empathy is that it requires being really good at listening to one’s self. A person has to be able to identify his or her own feelings to notice how they’re resonating with someone else’s.

To help people better tune in to their own emotional states, psychiatrists help patients practice the act of feeling by paying closer attention to their own bodies. This is based on the idea that emotional perception—the sense that signals whether one is feeling happy or angry or disgusted—is related to the senses that tell people whether they’re feeling physical things like pain or hunger. Strengthening the ability to grasp what one’s body is feeling, the idea goes, can strengthen the ability to know how one feels emotionally.

The idea that yoga or Rolfing can help you become more empathetic might sound like dubious  New Age speculation, but it has a solid grounding in science.

One psychiatrist with whom I spoke described how patients who “don't have adequate access to information from their body” sometimes benefit from activities that help them connect their minds to their corporeal state, such as yoga, tai chi, or “Rolfing,” an intense regiment of intense, forceful massage. Practitioners describe Rolfing as a  “holistic system of soft tissue manipulation and movement education that organize(s) the whole body in gravity.”

The idea that yoga or Rolfing could help someone become more empathetic might sound like dubious New Age speculation, but it has solid grounding in science. In The Feeling of What Happens, neuroscientist Antonio Damasio writes about how consciousness may be built upon the ability of an organism to sense its own physical state and thus maintain homeostasis. The scientifically informed philosopher Alva Noe argues in his book Out of Our Heads that there is no way to understand the mind without understanding the body as a physical construct.

But confronting empathy problems, whether they are rooted in cognitive or affective empathy, is never easy. Becoming a better listener or “getting in touch with one’s body” is never just a matter of remembering not to judge or sitting through a few yoga classes. For people experiencing empathy deficits, effective treatment will require all of the other work of therapy—reconciling parental relationships, facing fears and trust issues, and perhaps tackling other knee-jerk emotional reflexes.

Developing one’s ability to empathize is rigorous, introspective work. And a lot of that work involves learning to be aware of both ourselves and other people in ways we might not be used to. It’s great that there’s so much interest in empathy these days, but if there’s one thing we can learn from all the chatter, it’s that talking about empathy isn’t enough—learning to listen is the hard part.

Illustration by David Schwen

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