Motivation and emotion/Book/2023/Empathy training

Overview
 Consider this couple, Ryan and Blake, who have been married for 8 years. They used to have a strong bond but lately their bond and communication has been strained, with growing misunderstandings and conflicts. The emotional distance they've experienced has left them feeling disconnected. Due to the consistent feeling of disconnection and the longing for igniting that spark between them, they have decided to embark on the journey of empathy training in hopes to rejuvenate their emotional connection.

One might wonder if the gap between misunderstanding and connection can be bridged? Can empathy training be the key to conflict resolution and rekindling relationships?

In a world where miscommunication and misunderstandings tend to tamper the peace within a relationship, the power of empathy is looked upon. Empathy is the ability to understand and share the feelings, thoughts, and perspectives of others. The key concept of empathy involves putting oneself in the shoes of the other, enabling them to have a deeper connection with one another (Riess, 2017). Empathy is an essential aspect of human relationships and communication as it helps grow trust, understanding, and developing cooperation and coordination between individuals. This is where empathy training comes in play.

Keeping the story of Ryan and Blake in mind, empathy training is a developmental or enhancement process that enables individuals to understand one another, share, and resonate with the feelings of others. It is a structured process involving a series of interventions that can serve to benefit many people in strengthening relationships, lessening conflicts, and increase communication with one another.

In this book chapter, empathy training is described, examining how empathy can be enriched and how theories such as social learning theory and the empathy-altruism hypothesis provide invaluable insights, what other impacts empathy training brings forth as well as the complications involved.

Focus questions:
 * What is empathy training?
 * What are the impacts of empathy training?
 * What theories can be used to enhance and understand empathy?
 * Are there any complications in providing empathy training?

Foundations of empathy training


Empathy is a concept that involves cognitive functions to be used to comprehend another individual's perspective as well as affective functions to resonate with what another might be feeling (Davis, 1996). Empathy can be expressed through various emotions such as joy, excitement, anger, confusion, or sadness (see Figure 1). Individuals are able to connect with one another and experience their emotions. The significance empathy holds in one's lives can be seen in either personal or professional relationships. It is an essential quality to have in order to understand the thoughts, emotions, and feelings behind certain actions. Hence, it plays a pivotal role in prosocial behaviour. Many countries practice empathy as a community. Japan, for example, has a strong sense of shared responsibility and empathy. In events of natural disasters, the Japanese citizens come together to provide immediate food, shelter, or aid to those affected (Lampert, 2005).

While empathy is an innate trait, it is not fixed. It can be nurtured or expanded through the process of empathy training. Empathy training involves a diverse range of techniques and practices that increase empathic capacity. Empathy training recognises the fact that empathy itself is a trait that can be improved through the right tools. It involves a range of cognitive, emotional, and behavioural exercises. The overall goal of empathy training is not to change one's identity but to bring light to the compassion that is within each individual (Rogers & Farson, 1957). A necessary factor for empathy training is the Theory of Mind. This is the ability to understand mental states such as beliefs, intentions, desires, and emotions of oneself and others (Leslie et al., 2014). In simple terms, it aids in creating inferences about other's intentions as well as emotions. While these are distinct concepts, they are very much interconnected as without theory of mind, one is not able to recognise the different mental states people posses.

The importance of empathy training
Extensive research has been conducted on the positive impact of empathy training. It has shown to play a pivotal role in conflict resolution. Empathy is crucial in transforming unresolvable conflicts to reconciliation. Based on work by Bar-Tal (2000), empathy training gives those involved in any conflict, the necessary tools and skills to resonate with and genuinely understand the perspective and feelings of others involved or affected. As empathy promotes trust and open communication, it thus paves the way for practical solutions. Hence, empathy training is seen as a powerful mediator in decreasing hostility and promoting the power of understanding, which is crucial for obtaining long-term peace.

Furthermore, empathy training is a catalyst for improving communication within relationships by fostering deeper understanding and connection among individuals and groups. Studies, such as those by Decety and Jackson (2004), highlight that empathy is a core component of effective communication. Empathy training aids individuals in recognising and acknowledging the emotions and perspectives of others but also to respond in a way that promotes openness and trust. By enhancing empathetic listening, perspective-taking, and emotional intelligence, empathy training facilitates more meaningful exchanges. This, in turn, leads to improved communication in various contexts, from personal relationships to professional settings. Empathy training highlights the idea that effective communication is not solely about transmitting information but also about creating an emotional connection through understanding.

A longitudinal assessment conducted by Long et al., (1999) identified how empathy training is used in strengthening communication with a significant other. This study showed that ongoing training enables couples with tools to navigate their relationship. This increased empathetic awareness is seen as the building block for improved communication. Empathy training helps couples not only to communicate more effectively but also to create a deeper connection through mutual understanding and compassion. Such research reveals the transformative potential of empathy training in romantic relationships, emphasising its capacity to solidify bonds.

There is also a heavy emphasis on the cultivation of cultural sensitivity through empathy training. In a world as diverse and interconnected as ours, it is highly beneficial to be equipped with the skills needed to successfully interact with people from different cultures, races, and nationalities. The study by Jackson and Ruderman (1999) shed light on the importance of empathy in bridging cultural divison and promoting cross-cultural understanding. Through this training, individuals are able to recognise but also appreciate the uniqueness of different cultures, beliefs, and emotions. It encourages individuals to step into the shoes of others and be able to easily to navigate diverse settings, promoting cultural competence and meaningful cross-cultural interactions.

Enhancing empathy based on theory
Rather than merely understand what empathy is, the focus should be shifted towards the psychological theories that contribute in training empathy. These theories provide unique perspectives and insights, offering pathways to deepen the understanding of others, refine emotional intelligence, and ultimately become more empathetic beings. By understanding the theoretical foundations of empathy, individuals can engage in training that is not only practical but also deeply rooted in empirical understanding.

Social learning theory perspective
Social learning theory was proposed by Albert Bandura (1978), stating that individuals learn their behaviours, emotional attitudes, and responses thrrough observing others and witnessing the consequences to their actions. Applying it to empathy training, individuals are able to grasp the basics through interpersonal interactions. It gives individuals the opportunity to learn from empathetic role models, providing a valuable framework when it comes to designing empathy training programs. The theory emphasises the role of social interactions, role models, and the environment shaping the individual's behaviour. This theory has components such as role-playing, observational learning, and behavioural reinforcement through which observation takes place.

Role-playing/modelling behaviour
Role-playing or modelling behaviour is essentially individuals acting out specific roles that mimic real-life situations. This role-playing is mostly carried out in a controlled environment. It is a very accurate method in allowing one to step into another person's shoes. Research carried out by Clore and Jeffery (1972) showed that when a group of undergraduate students were given the task to role-play by travelling across the university campus in a wheelchair for an hour, it resulted in the students to have a more positive and empathic attitude towards students with disabilities. They were able to empathise on a deeper level with the emotions of those who do have disabilities.

Observational learning
This learning process focusses on observing another persons behaviour in a particular situation and obtaining information about that situation and the consequences of the actions taken by the person in that situation. It is to be noted that the observation in question can either be natural or in a controlled setting. Goubert et al. (2011) were able to identify how through observational learning, individuals were able to learn how to respond to those who are seen in distress or in pain. This involved focussing on emotional cues, reactions and body language on those that were in distress. This in turn creates an altruistic concern towards those in distress, increasing empathy.

Behavioural reinforcement
Behavioural reinforcement refers to behaviour being encouraged or discouraged based on the reward or punishment received after carrying it on. This process is used to encourage and deepen the need for individuals to perform empathetic behaviours. When individuals demonstrate an empathetic behaviour, they will be rewarded. This reinforcement can either be external or internal. For example, if a child is seeking validation after a certain behaviour, it is an external reinforcement. Whereas, if the child feel satisfaction or happiness upon performing the behaviour, it is an internal reinforcement. When it comes to empathy training, it is essential the individual receives an internal reinforcement as this has shown to highly motivate in performing the behaviour more frequently.

Longobardi et al. (2019) tested this out by identifying the relationship between empathy, internal reinforcement, and defending victims against bullies. The study showed promising results as the children involved in this study were more likely to continue the prosocial behaviour if they were internally reinforced. Hence, shifting the attention in developing intrinsic reinforcements regarding empathy will likely show a lasting effect.

Empathy-altruism hypothesis


Similar to behavioural reinforcement, the empathy-altruism hypothesis is a motivational theory focusing on understanding the reasoning behind why individuals perform certain selfless and altruistic acts to help another individual (Batson et al., 1991). In terms of empathy training, this hypothesis is crucial because it implies that strengthening the individual's empathetic skills will increase altruistic acts. These could be in the form of comforting, supporting others, giving charity, and even showing kindness. This theory focusses on feeling the increase in empathy by merely taking part in doing certain things specifically for the betterment of others. This further suggests that true empathetic or altruistic behaviours appear when the individual is helping the other without any reciprocity in return. The hypothesis works on a cost-benefit analysis, not weighing the reward of the behaviour but instead, weighs what the best method to help is. As shown in Figure 2, this could be either getting another individual to help, helping the individual by themselves, or doing noting at all. Empathy training programs can use this knowledge to develop and promote an empathetic culture for individuals.

Social exchange theory
While empathy-altruism focuses on intrinsic motivation when helping those in need, social exchange theory has an extrinsic outlook (Hollander & Homans, 1963). This theory also utilises a cost-benefit analysis of their social interactions. Individuals are motivated by self-interest when showing empathy, engaging in altruistic behaviour if the benefits of helping outweigh the costs. Empathy training programs can focus on limiting the costs by providing guidance to minimise them such as the model developed of employee-customer empathy (Ngo et al., 2020). Its main role is to explain that employees showing customers empathy, develops customer-oriented behaviour. This further enhances employee-oriented behaviour, minimising the costs of empathy.

Further strategies for empathy enhancement
Based off of the psychological theories like the social learning theory or empathy-altruism hypothesis, empathy training programs can be developed with a more comprehensive approach. These theories aid in providing an understanding behind the psychology of empathy and the motivation that individuals have behind such pro-social behaviours.

Narrative Sharing
This technique involves the use of storytelling in order to enhance empathy. Participants are to share their personal narratives and experiences with all those participating in this exercise. By listening and feeling the depth of the personal stories being shared, they are able to understand more deeply what the emotions and experiences of the sharer are (Keen, 2006). This increases the participant's ability in active-listening and perspective-taking. It is an example of empathy-altruism hypothesis in action, encouraging participants to care about the experiences of others. Adamson et al. (2018) discovered that empathy levels in nurses showed an increase when they were instructed to listen and feel the stories of the patients.

Mindfulness practices
Mindfulness is the act of purposely focussing attention to the present moment, without any judgement (Tirch, 2010). Attention is turned inwards to observe sensations and emotions. Mindfulness-based techniques focus on individuals becoming more self-aware, while staying in the present moment and regulating their emotions. This enables individuals to have non-judgmental observation of their surroundings and the people around them. Mindfulness techniques such as Acceptance and Commitment Therapy (ACT) enable individuals to emphasise with themselves which results in empathetic behaviours being carried out.

Empathy support groups


These support groups focus on empathy as their talking point and the struggles of those within the group face when it comes to empathy. Individuals share their experiences and challenges in a non-judgmental environment so that they have a support system with people they can relate to as well as work on their challenges together with (see Figure 3). There are also certain empathy support groups in which participants do not share the same values and beliefs as others in the group. This is done to initiate constructive dialogue and active-listening amongst the group, regardless of their beliefs, enhancing the emphatic growth within these individuals.

Incorporating empathy training in educational settings
Empathy training in educational settings, specifically healthcare, has played a role in preparing future healthcare workers (Özcan et al., 2012) in taking better care of their patients. These students have been equipped with the right skills to navigate through patient care. By incorporating empathy training in their academics, these institutions not only aid the students in being better empathetic professionals, but also empathetic individuals. Keeping the social exchange theory in mind, this creates a reciprocal effect as the patients receiving the empathy, will be likely to cooperate and comply much better with the carers.

Magshud et al., (2020) researched how empathy training in healthcare professionals not only cultivated personal growth by increasing the emotional connection between the healthcare professionals with their patients, but also in building a relationship with them. After nurses underwent an empathy training program, they were able to understand the patients' emotional needs much better. This in turn had a positive effect on the experience of the patients as they were obtaining better care. Healthcare settings can thus notice massive improvements in their facilities and notice immense relationship building with patients, beneficial for their business as well.

Schools can hold empathy-based seminars or even add empathy learning into the curriculum. As shown through the social learning theory, children are more easily influenced as their brains are highly adaptable during those years. Teaching empathy will lead to more lasting effects and ingrain empathetic behaviour in them. Furthermore, integrating empathy reduces bullying and aggressive tendencies in children as well. Second Step program is a violence prevention program that focuses on children, mainly in early learning and elementary classes. It emphasises on developing strong emotional skills as well as pro-social behaviour. Such programs have proved effective as studies have found bullying and aggressive behaviours have lessened significantly when compared to those students in a control group (Sahin, 2012).

Challenges
While empathy training serves many benefits not just to the an individual, but those around them, it does not come without any challenges. While empathy training serves many benefits not just to the an individual, but those around them, it does not come without any challenges. While some theorists argue that empathy can be learnt, others argue that empathy is a very personal experience, it cannot be easily nurtured (Michalec & Hafferty, 2021). It is a process and trait that individuals possess naturally. Furthermore, many people have the fear of vulnerability and might find it difficult to express themselves without the constant worry of being judged or criticised. It might also be difficult to express themselves due to a lack of trust between the individual and those involved in the training. There could also be other challenges such as personal struggles one is going through which might not necessarily equate to lack of empathy. Depersonalising effects of burnout may cause lack of empathy and high resistance to empathy training programs.

Cultural differences in empathy are also seen as a distinct limitation. Not all cultures share the same meaning of empathy. Healthcare professionals must be aware that dealing with culturally diverse patients means showing various forms of empathy, meaning there is no "one size fits all" empathy training. Physical gestures and facial expressions associated with empathy can vary in terms of meanings across cultures (Lorie at al., 2017) which could lead to misinterpretations.

There is also a possibility that introducing training programs to institutions might not be feasible. Such programs require skilled and trained professionals as well as materials for the various activities involved. Moreover, maintaining ongoing training may not be sustainable if funding is limited.

Conclusion
Empathy and empathy training has shown to prove its worth and significance in this day and age. Developing empathy does not only affect the individual but plays a part in the broader community as well. To enhance this trait, it is necessary to understand the various theories that influence empathy and work on training programs based off them. However, it does not exist without any challenges. Cultural differences may create a barrier as well as individuals not willing to be vulnerable enough. In navigating through these limitations,, it is necessary to create such training programs that cater to everyone. Future research should focus more emphasis to be put on developing internal reinforcement, as drawn from the social learning theory, to have a long lasting effect in enhancing and maintaining empathy.

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