Jeremy Howick is the inaugural director of the Stoneygate Centre for Empathic Healthcare and professor of empathic healthcare at Leicester Medical School. He is on X: @JeremyHowick
Amber Bennett-Weston is a postdoctoral researcher at the Stoneygate Centre for Empathic Healthcare at Leicester Medical School. She is on X: @a_bennettweston
Research on empathy has increased tenfold over the last two decades. Controversy has accompanied this growth, with some claiming there are more definitions of empathy than there are researchers on the topic. Yet, a recent study found that these differences have been exaggerated by the narcissism of small differences and fuelled by the publish or perish ethos within academia.
If we couldn’t reconcile the definitions of empathy, the serious problems related to the concept’s ambiguity would be destined to persist. For example, it would remain difficult to choose between the plethora of methods for measuring empathy, or interpret and implement studies of empathy’s benefits. Equally, blurred boundaries between empathy and related concepts such as compassion and sympathy would persist. Worse, in the absence of an agreed definition, the door remains open for people to hand pick definitions of empathy that lead to paradoxical inferences about its benefits or harms.
Fortunately, it seems that existing definition of therapeutic empathy share have more similarities than differences.
Fortunately, it seems that existing definition of therapeutic empathy share have more similarities than differences. Starting with a sample of 3948 definitions, we randomly sampled batches of 10 and analyzed them using a method called “thematic analysis”. This method is a way of identifying patterns or themes in data. We did this until “saturation” (the point at which no new emerged) was reached. This occurred after we had analyzed 39 definitions. Six themes were generated through this process.
- Exploring: exploring through non-judgmental, active listening and curiosity are required to achieve understanding.
- Understanding: Following the process of exploring, the practitioner develops their own understanding. This requires drawing on experiences, imagination, logic, and reasoning to try to put themselves in the patient’s shoes (although fully experiencing the same emotions as a patient is neither required nor generally desired).
- Shared understanding: Once the practitioner has developed their own understanding, the patient and practitioner can reach a shared understanding of the patient’s values, preferences, and options. This will usually involve dialogue and the practitioner checking whether their understanding is correct.
- Feeling: Although feeling something was usually stated as being part of empathizing, it need not involve feeling the same thing as the patient. In fact, if the patient is angry or attracted to the practitioner, then sharing the same feelings would not be appropriate. Rather, the feeling could be compassion, concern, or an altruistic desire to help.
- Therapeutic action: Unlike related terms such as compassion and sympathy (as well as empathy outside the healthcare setting), therapeutic empathy requires action. The action could be prescribing a treatment or providing helpful information. Importantly, yet the very act of exploring and reaching a shared understanding is both therapeutic and can suffice as a treatment for many mild ailments seen by general practitioners. Most patients also report wanting to have an honest and appropriate positive message of hope. Provided they are not exaggerated, positive messages often improve subjective (and sometimes objective) patient outcomes.
- Maintaining boundaries: While feeling is an important component of empathy, it is important for the practitioner to maintain professional boundaries.
These themes can be digested in plain English as follows:
Therapeutic empathy (empathy in the healthcare setting): listening, understanding someone’s situation and feelings, caring, and helping, all while respecting personal boundaries. The practitioner must make sure they understand through communication. And, sometimes, just listening carefully, showing care and understanding is enough to help—especially they also offer a positive, encouraging message.
Our ability to identify common ground in so many of the definitions suggests that claims about the differences between definitions have been exaggerated. This exaggeration can be explained to some degree by the narcissism of small differences and is almost certainly inflamed by the publish or perish ethos in academia.
The need to publish “new” definitions is also a likely contributor to the over-fragmentation of empathy definitions.
The ‘narcissism of small differences’ is a term used by Freud to describe how we often passionately defend our uniqueness—often to the point of becoming antagonistic—towards those who are very similar to us as opposed to those who are fundamentally different. For example, Oxford and Cambridge students share more in common than any other group on the planet yet have heated and often antagonistic debates about the differences between the institutions and those who attend them (In our opinion).
The need to publish “new” definitions is also a likely contributor to the over-fragmentation of empathy definitions. To survive, academics must publish a lot. Easy ways to increase the volume of publications include publishing trivial studies and outright fraud…to exaggerating criticisms of concepts such as empathy in order to justify proposing a new one.
In short, the quest for defining therapeutic empathy reveals more about our academic culture than our differences. By recognizing the fundamental similarities in our approaches, we can move beyond semantic battles and focus on what truly matters: genuine connection, active listening, and meaningful support for patients. The power of therapeutic empathy lies not in its precise definition, but in its practice—a nuanced art of understanding that bridges individual experiences with shared humanity.
Deputy Editor’s* note: This article is focussed briefing based on Howick J, Bennett-Weston A, Dudko M, Eva K. Uncovering the components of therapeutic empathy through thematic analysis of existing definitions. Patient Educ Couns. 2024 Dec 1;131:108596. doi: 10.1016/j.pec.2024.108596. Epub ahead of print. PMID: 39657390. The full article may be accessed here: https://www.sciencedirect.com/science/article/pii/S0738399124004634
Declaration of interest: The Deputy Editor is currently working part-time with the Professor Howick and the Stoneygate Centre for Empathic Healthcare and professor of empathic healthcare at Leicester Medical School.
Featured photo by Tim Marshall on Unsplash
