Empathy
EMPATHY
Empathy is a core component of the therapeutic alliance. When patients express negative or distressing feelings or experiences, we want to communicate acceptance and concern both verbally and non-verbally. This skill is particularly relevant when we are reviewing distressing symptoms or problems in living, but empathy should be a component throughout the encounter
An empathic response includes the following components:
- Name, describe, or communicate that you understand the patient’s emotional experience
- Communicate concern for the patient’s feelings or experiences, or
- Express that a patient’s emotions or experiences are normal, expected or understandable
A poor demonstration of empathy is conveyed by the following elements of a response:
- Treat the patient’s feelings as insignificant
- Give advice on how to view the problem or what to do about it, or
- Communicate negative judgement about a patient’s feelings or behavior
Reflection
REFLECTION
Reflection is a core component of the therapeutic alliance. We restate what patients have said on those occasions where we want to highlight their experience, and in particular ensure their awareness of the link between distressing behavioral health symptoms or behavior and a particular life circumstance or problem in living.
A good reflection includes the following components:
- Repeat or restate the patient’s feeling or experience
- Repeat or restate life context issues, problems, or stressors, or
- Draw a connection between life circumstances and the patient’s behavioral health symptoms
A poor demonstration of reflection might contain the following elements:
- Misinterpret or make incorrect assumptions about the patient’s experience
- Refocus attention away from the patient’s emotional experience by asking concrete questions
- Refocus attention away from the patient’s emotional experience by probing past experiences or origins of the problem
Cultural Responsiveness
CULTURAL RESPONSIVENESS
Cultural responsiveness is a core component of therapeutic alliance. We want to interact with patients and deliver our interventions in a way that is responsive to and congruent with the patient’s cultural identity, context, and preferences. One aspect of cultural responsiveness is recognizing collectivist orientation and the important of family (and extended family) for many cultures in our conceptualization and treatment, in contrast to the individualistic culture of middle-class, White America.
A culturally responsive response may include the following components:
- Maintain a curiosity and openness to the aspects of cultural identity that are most important to the patient
- Have a knowledge base of a patient’s cultural identity and is responsive and sensitive to this identity
- Incorporate a strengths-based approach by reframing distressing emotions and experiences as opportunities for resilience and building positive coping skills
A response that is less culturally responsive may include the following components:
- Assume an overgeneralized (“one-size-fits-all”) understanding of culture
- Adopt an (over)reliance on the values of the surrounding dominate culture
- Interact with patient from a place of disrespect or ignorance, which includes minimizing the patient’s feelings or experience