Emotional Support, Empathy, and Relating: A Mindful Perspective

Not too long ago, I found myself speaking to a patient about their recent cancer diagnosis. It was their first clinic visit in oncology, and the principal goal of the discussion was to clarify the different treatment options for this new-found invasive disease. It was a challenging encounter; I wanted to be a point of support for this person, yet I was doing so from the inexperienced perspective of someone who had never had to hear and digest the words “you have cancer”. In many ways, I felt that I could not be authentic in this conversation, even though I felt comfortable explaining the risk factors of a surgical intervention and the basic pathophysiology of the disease, the less emotional stuff. Although it isn’t likely that most physicians will have experienced the circumstances of disease faced by patients, it is possible to call upon empathy to establish a relationship of trust and mutual understanding. Empathy is inherently built into our neural networks and, although modulated by lived experience, a person can be understanding of a situation without being directly implicated. It sounds so obvious, but it can be challenging to offer appropriate guidance to patients who are overcoming – in our eyes – what seem like insurmountable obstacles. How can we offer meaningful recommendations to patients whose experiences and realities are not within the scope of our understanding and which cause them significant distress? One possibility involves developing skills that will facilitate active listening and emotional support-giving. This can be achieved, in some respect, through mindfulness-based strategies.

Susanne M. Jones and colleagues studied whether college students who embody thinking patterns that are aligned with mindfulness principles are better suited to providing active listening and empathetic understanding¹. The group specifically focused on whether these students, who had never practiced mindfulness formally, would be able to identify messages which were more or less supportive in quality and what their natural disposition was towards helping someone who was suffering emotionally. According to the literature, providing “high quality emotional support” is very beneficial to recipients however difficult to achieve in practice, with “person centeredness” (PC) being one of the most important ingredients in doing this well. They defined PC as an “awareness of and adaptation to the affective, subjective, and relational aspects of communication contexts”². The problem is of course that most people want to be emotionally supportive for their friends, family, colleagues, clients, patients, but trying to navigate another person’s suffering, especially in the context of the current pandemic, can be taxing. Mindfulness comes into play when you realize that understanding and accepting your own emotional woes will make you better suited to attending to those of your entourage¹. 

183 undergraduate students at Midwestern university were assessed using various questionnaires (Five Facet Mindfulness, Empathic Concern Subscale, Interpersonal Scale, Active-Empathic Listening Scale, Interpersonal Competence Questionnaire) and asked to rank pre-written “comforting messages” according to effectiveness of emotional support in a hypothetical encounter with a friend going through a tough time. Students who scored highly on mindful facets of observing and describing correlated with higher self-reported empathy scores as well as better active listening scores. Those with higher non-judging scores also tended to be better at facilitating reappraisals (helping people examine their own thoughts and feelings around a challenge they are experiencing). The study was limited in that the population had never practiced mindfulness before, making the assessment of participants somewhat artificial. But the general message it conveys is to be an emotional support for those around us, we need to be non-judgmental and understanding of our own struggles and challenges. 

Practically speaking this could mean using simple techniques during patient encounters to reflect back on what you understand the patient to be telling you (“what I hear you saying is …”) and taking a moment to be fully present with them, without worrying about how much time the encounter is taking up, whether the next patient will be on time, or mentally planning for investigations to-be-ordered for the patient in front of you. In many ways we’re trained to be proactive and forward thinking to facilitate promptness and efficiency (getting through the patient list by time X). But patients will do better when they are seen and heard. Taking time at the end of every week to journal or simply reflect on particularly emotionally-charged encounters and think on what you were able to bring to and take away from a given session can also be helpful.

I think we’re living through a time where we could all use some extra emotional support. We need to go back to basics and take care of ourselves whether that be through formal meditation practices such as the loving kindness meditation or setting time aside for regular self-care. Challenge yourself this week to set aside 25 minutes every day doing something that will add value to your personal sense of mental wellbeing (go to bed 25 minutes earlier, call your friend or family member after that heavy study session, do a quick HIT workout before calling it a night). If you can get a good handle of your own perspectives of medicine, health, and wellbeing, then it becomes natural to have the emotional energy and attention to invest in seeing from a different perspective, that of the patient, friend, and colleague.

References:
(1) Jones SM, Bodie GD, Hughes SD. The Impact of Mindfulness on Empathy, Active Listening, and Perceived Provisions of Emotional Support. Communication Research. 2019;46(6):838-865. 
(2) Burleson, B. R. (1987). Cognitive complexity. In J. C. McCroskey & J. A. Daly (Eds.), Personality and interpersonal communication (pp. 305-349). Newbury Park, CA: SAGE.