Monday, July 9, 2012

Preparatory Empathy

Empathy is such a central part of what makes therapy therapeutic that it's almost a cliche. You know what empathy is - understanding someone else's experience from within their experience, rather than superimposing your own experience, assumptions, etc. However, in all of our discussions of empathy, we often forget about a important but very difficult kind of empathy: preparatory empathy.

As you might infer from the phrase, preparatory empathy is empathy we experience in preparation for a clinical encounter - before it happens. Garden-variety empathy happens during a clinical encounter, with direct access to the person with whom we are trying to empathize. That makes it easier to know that we're connecting with that person's experience rather than superimposing our own. In contrast, trying to empathize with someone we haven't met - or even someone we have met but are not currently with - leaves more to the imagination, and is therefore more susceptible to the influence of our own "stuff."

So, given the potential for errors, why both with preparatory empathy? Why not just wait until the encounter occurs to call up empathy?

Here is my opinion: In the absence of preparatory empathy, we (being human) run the risk of making judgments that are not particularly empathic. Think about it: when we meet with a client for the first time, we have usually received some sort of information about that person already. We have a referral, or paperwork from another provider, or their own responses on an intake screening or questionnaire. Based on this information (particularly if it contains a diagnosis), we automatically form snap-judgments. Some might be accurate, and others are not. However, regardless of accuracy, they influence our initial interaction with the client - how we approach him or her, our tone and expression, the questions we ask and how we ask them.

When our judgments are accurate, we might chalk that up to "practice wisdom" - because, yes, some incoming information is accurate and does have clinical implications that we have learned about over the years. When they are inaccurate, it might be the result of cultural or clinical bias, or our own history. However, by the time we recognize our error, we may have already damaged our initial rapport with the client.

Preparatory empathy, while still leaving room for inaccurate judgments, seeks to minimize the risk of harm by extending the benefit of the doubt. Imagining what the client may be thinking and feeling, their distress, creates openness and compassion, and shifts our approach slightly. While both judgmental and empathic assumptions can both be erroneous...they can also both create self-fulfilling prophecies. People who receive a gentle and supportive welcome soften, and people who receive a brusque welcome become defensive. Therefore, it serves everyone's best interest for us to work - ahead of time - to foster empathy for clients and clients-to-be.

How do you sort out clinical wisdom from bias? How do you think about preparatory empathy?

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