Helen Riess: Seven Keys to Increase Empathy

Tami Simon: You’re listening to Insights at the Edge. Today, my guest is Dr. Helen Riess. Helen is the associate clinical professor of psychiatry at Harvard Medical School, and director of the Empathy and Relational Science Program at Massachusetts General Hospital. Dr. Riess is a psychiatrist who developed an E.M.P.A.T.H.Y. training approach based on research and the neurobiology and physiology of empathy, and she’s devoted her career to teaching and research in the art and science of the patient-doctor relationship. Here’s my conversation on “Seven Keys to Increasing Empathy” with Dr. Helen Riess:

To begin with, Helen, I’d love to know how it is that empathy became the focus of your research.

Helen Riess: Well, that answer actually has two levels, and the more proximal level is that as a psychiatrist, I began to notice that more and more of my patients in my practice were spending a lot of time sharing their unhappiness with how their visits to the doctors were going. I realized that there really was a pattern of patients feeling unseen, unheard, and somewhat dismissed, and some of them felt that even their attempts to try to improve their health or make lifestyle changes weren’t really being appreciated or reinforced by their doctors. What seemed at first to be kind of a unique window into what was going on in medical and surgical visits, I started to notice that there were headlines in major media talking about the need for patients to have a more connected experience, wanting their doctors to be nicer and paying more attention.

I realized that there was really a trend going on nationally because of many different circumstances happening in healthcare. I really regretted knowing that even some colleagues that I knew were extremely empathetic and caring people were sometimes saying things or doing things that were not landing well. I thought, “If empathy can be diminished or down-regulated in people, there has to be a way to upregulate it,” and so I took some time out to do a fellowship on the neuroscience of emotions and empathy to try to learn how we connect and how we can restore connection.

TS: Very good. Now, you said that this was multilevel. So this is one dimension of your interest [that] came from your patients who were reporting their disappointment with their physicians. Was there another element as well?

HR: Well, I grew up in a family that went through a very traumatic World War II experience, and my parents came to the United States just a few months before I was born as refugees who really had to start their lives over again, who had pretty much lost everything, and really had their faith and a faith community waiting for them on this side of the ocean to help them rebuild their lives. I recognized from a very young age how hurt and wounded people are, and the ripple effect of unkindness and cruelty on people. I think living with both the amazing lessons of resilience and ability to bounce back and grow from very troubled times, I also recognized the residue of when people are treated callously with no empathy and no compassion.

I think the early seeds of my interest in becoming a psychiatrist, and also really trying to help people recover and heal and get to a better place in their lives, really, the seeds were sown early in my life.

TS: In terms of the neuroscience of empathy, what do you think are the key discoveries that make a difference in terms of our understanding of empathy?

HR: Well, the neuroscience of empathy actually was a story of really good news, because what I learned is that we are really wired for empathy and we are hardwired to appreciate the emotions, their expression, and the pain and suffering of others because those emotions land on our own brains through specialized neurons and mirror circuits and shared neural circuits in our brains.

So the good news about what we learned is that we’re actually built for empathy, and it’s really more when we get distracted or pulled away from our natural-born ability to connect with others that we lose our capacities to empathize. So much of my interest in learning how to teach it, and whether we actually could, lay in the knowledge that even when we’re not trying, we catch the emotions and the feelings of others, and then it’s what we do with that that will predict whether we respond with concern and with compassion or whether we shut that down.

TS: I hope this won’t seem like an uncaring question, but why did you experience it as such a good news that neuroscience tells us that we’re built for empathy?

HR: Well, because it showed that if our brains are already wired for it, if it’s getting diminished, we probably can bounce back, as opposed to that only certain people have the wiring for it and it’s a special case when we have it. So just the generalizable condition that we have that most of us are built for empathy, to me, meant we have a good place to begin.

TS: Now I know from your book, The Empathy Effect, that you have experienced and evidenced that it’s possible to teach people to be more empathetic, that empathy can be taught. We’re going to get into that in this conversation, but here at the beginning, I want to address that person who says, “Gosh, the last thing I need is more empathy. I barely know how to walk around in the world and have a conversation with somebody without being flooded by their feelings or turn on the news, and I’m flooded and overwhelmed by the suffering of other people from a natural disaster, or some other event some place in the world.” What would you say to that person who is distressed by how naturally empathetic they already are?

HR: Well, Tami, you’re really addressing the other side of the spectrum from what I was working with, and a very important one, and that is that some people actually have too much of the shared neural circuits that they get very affected by witnessing the pain and suffering of other people to a degree that it causes personal distress. Those people are the last ones that need E.M.P.A.T.H.Y. training. They come so easily and naturally that they actually have to learn how to regulate the exposure to pain and suffering because they can get so easily overwhelmed.

The other point you bring up is when any of us are bombarded with catastrophic news day after day, night after night with people drowning in floods, burning up in fires, and suffering all kinds of pain and cruelty in difficult circumstances in other countries, we can get overloaded. When we are overloaded, the last thing we can do is really come up with an empathic response because when there is that much awareness of pain and suffering, we end up focusing on ourselves rather than others. So, limiting exposure is really important. I’ve heard from really countless people that they can’t watch the news every night, that they have to give themselves breaks from the media because just the degree and the intensity of bad news going on right now is more than they can bear. So we have to play a role in regulating how much exposure we have to bad circumstances and suffering.

TS: In addition to regulating the amount of exposure, what other techniques or viewpoints can you offer someone who’s easily overwhelmed with too much of someone else’s feelings?

HR: Well, there are many different roads to what I call self-regulation. Some people find that meditating and quieting their mind and centering themselves at the start of every day is a way to begin refreshed and renewed before facing whatever the day brings. Many people, and I hope they learn this from my book, will find some short techniques through diaphragmatic breathing that actually helps to slow down our heart rates and lower our blood pressure, because by slowing down our respiration rates, we actually trigger some pressure receptors in our necks that actually slow down the heart rate. So there are techniques people can learn to do right before they know they’re going to be in a difficult situation or before they’re going to have to get together with a friend where something difficult or bad has just happened.

So we have to get to know our own bodies, almost the way we would an instrument, like a violin. We need to know when it’s resonating with too much frequency and too much vibration, and when we need to soften it and down-regulate it, so we can be in a calm and an open and receptive place.

TS: One of the techniques that you teach in The Empathy Effect is the idea of breathing out all the way to one’s fullest extent—not just taking a few breaths, but this idea of breathing all the way out, and then, of course, a big deep natural inhale will occur. I thought that was very helpful, that subtle tip of don’t just take a few breaths, which I think we’ve all heard, but make sure that you breathe all the way out, why is that so helpful?

HR: Thanks for picking up on that detail. I agree with you that I think from the time we’re pretty young, we learned like, take a deep breath or count to 10 before you respond. But those techniques can be kind of mental and not really do any physiological good for ourselves. So the tip in the book, which is to say to yourself, “I am breathing in to the full extent of my breath,” and say that to yourself while you’re breathing in, it will slow the breath down to the point where it actually does have an effect in the respiration rate, slowing down the heart rate; and then breathing out, “I am breathing out to the full extent of my breath.”

So it gives our minds something to do while we are getting to that quiet place. I think a lot of people don’t really know or may not be aware of what’s going on in their mind when they’re saying, “I’m going to take a deep breath,” and their minds might still be quite full of chatter or anxiety. These words are a way to replace that.

TS: OK, so we’re hardwired for empathy, which then gave you the idea that empathy could be taught to anyone. It could be developed. How did you go about creating your E.M.P.A.T.H.Y. training program? How did you figure out what works?

HR: Well, I had over a year to read the neuroscience of empathy literature, which really got into fascinating ways that people were measuring empathy, and I realized that a lot of it had to do with creating experiments where people were looking at each other or not, or they were able to recognize emotional expressions or not. One experiment we did at my own hospital, Mass General Hospital, we were measuring, like, physiologic activity during interactions both positive and negative between doctors and their patients. So, we were able to get a look at what makes people connect physiologically and not.

So by reading all of this and being involved in some experiments, I started to form a cluster of behaviors that either expanded connection or shut it down. That’s how I came up with my E.M.P.A.T.H.Y. acronym.

TS: I’d love to go through it, if that’s OK, and we can go through each letter of E.M.P.A.T.H.Y. and the behavior that it communicates that we can develop. Let’s start with “E” for “eye contact.” What do we know?

HR: Well, we know from the moment an infant opens its eyes and can see its mother that the bonding hormone, oxytocin, is released when the two gaze at each other. That physiologic hormonal response doesn’t end at infancy. So, through eye contact and meeting someone’s gaze, we actually, first of all, show that we’ve actually met that person and it hasn’t been just a cursory “Hi. How are you?” But when you meet someone’s gaze, you’ve met that person and something different happens. We know from scientific research that people who are in love, when they look at each other’s eyes, a lot of oxytocin is released, and also in friendship. So by recommending that we meet our patients, or really whomever, with an intentional meeting of the eyes, we’re beginning in a positive place.

TS: You suggest in the book that physician can actually note the color of their patient’s eye and this is a good practice. Since reading The Empathy Effect, I’ve tried this here in the Sounds True work environment, just saying, “I’m going to note people’s eye color,” and it’s really profound. I’m connecting with people in a totally different way.

HR: [Laughs] It’s interesting. We do this exercise through my Empathetics work, and we have people have a little conversation with each other, and then we ask them to close their eyes and then raise their hands if they can [answer], “What is the eye color of the person I just spoke with?” It’s amazing how few people do it intentionally. And then we say to try it again, and this time pay attention, they have a very different experience. Just what you’re saying.

TS: The one cautionary note, I guess, is I didn’t want anyone to think that I’d become creepy. [Helen laughs.] I wonder if you can talk a little bit about that. I’m actually quite serious. How do you make sure you’re connecting without that kind of like, “Why is she staring at me like that?”

HR: Well, that’s the real nuance is that we do not recommend staring. No one really wants to be stared at. Another important point is that in some cultures, especially Asian cultures, a lot of direct eye contact is actually considered to be rude. So it has to be quite nuanced. You can get a signal when you glance at someone’s eyes whether they are holding your gaze or whether they are looking away. If you’re getting that signal, you don’t want to overdo it, but you reflexively turn your gaze away if the person isn’t welcoming your gaze.

TS: Now, we’re going to go through all seven of these behavior keys that increase the likelihood that we’re going to have an empathic connection with somebody. But I think the question that’s coming up for me, Helen, is underneath it, if somebody is low in empathy, can they just do these behaviors and will their feelings come online? I mean, can you just do it from the outside in like that?

HR: Well, we have a lot of evidence that people who start to do these behaviors will say that the quality of their interactions does change. I am not suggesting that it will happen overnight, because some of these things have to be practiced, but in the study that we did, we sent questionnaires to the participants and they said that something fundamentally different happened in their emotion recognition and their ability to connect with others. So it may sound kind of like acting or like “just follow these steps,” but they have to be experimented with. Just as you were saying about the eye contact, it’s not a one size fits all, and it takes practice. But the opposite, doing none of these things, will pretty much ensure that you’re not connecting with people.

TS: OK, let’s go the second key, the letter “M.” What does “M” stand for?

HR: So “M” stands for “Muscles of facial expression.” That simply means pay attention to the person’s face before you, and recognize that their face is a roadmap of emotions. If you are puzzled or you’re not sure what someone’s feeling based on what you’re seeing, you can always ask. But the biggest tip here is to actually look people in the face and don’t be looking at the computer or your iPhone when you’re talking with others, because then you’ll never know what they may be feeling.

TS: When you look at people’s faces and you’re deciphering or decoding the emotions that are going on, what are some of the big things you’re looking for?

HR: Well, I look to see if they’re smiling. I look to see if their eye muscles are involved, because true happiness involves both the muscles around the mouth and the eyes. A fake smile, you’ll just see the lips turned up but you won’t see any involvement in the eyes. So that’s one thing I look for. I look for furrows on the brow to see if there could be fear or consternation, and I look to see how widely open the eyes are just to see if there is any element of fear or surprise.

TS: And when you’re trying to connect with someone empathically,—perhaps it’s in a client relationship, that kind of thing—what are you doing with your face intentionally, if anything, or you’re just relaxing and being yourself?

HR: Well, there’s this thing called motor mimicry, which is a fact that we’re constantly feeding back facial expressions back and forth when we’re talking with people without even realizing it. I mean most people, if you’re telling them something funny, are not going to sit there with a still face, or if you’re happy. So these things are transferring back and forth at a pretty unconscious level, but as a psychiatrist, I am a little more aware, like if someone is telling me something deeply troubling or sad, I’m more aware of what my face is doing probably just because I’ve studied this for so long.

TS: OK. Let’s move on in terms of E.M.P.A.T.H.Y. training, the “P” stands for “Posture.” What posture promotes empathic connection?

HR: So probably the most important thing there is sitting at eye level, or being at eye level so that if someone is sitting down and you keep standing up, there’s going to be kind of a mismatch in your ability to connect. We also teach and train about noticing people’s posture as an indication of alertness and happiness as opposed to being slumped down and dejected or depressed. So it’s both a position that people are taking and also what the body language is indicating.

TS: OK, “A” is for “Affect.”

HR: So “affect” is a scientific word for emotion. Affect is … it’s really interesting. We might be talking with someone and not even aware that we have picked up on their emotional feeling. So one thing I do is I try to consciously name the affect. So if someone seems sad or anxious or confused, I’ll actually use one of those words to myself, and it makes me focus much more and use a certain lens that I’m listening to them with.

TS: OK. Now, we have “Tone of voice.” This seems very important to me.

HR: Well, you’re absolutely right, because we convey much more than 85 percent of what we’re saying to our tone of voice. We can say the same exact words, but they can mean like 30 different things, depending on our tone. So one thing is to just notice the tone. Is it soft? Is it halting? Is it fluid? Is it loud? Bombastic? One thing that is important is that if someone’s speaking softly and quietly, that trying to match the volume, the pace, and the rhythm of the person you’re speaking with actually makes them feel more understood, especially in my area, in the patient-doctor relationship, if if the person is speaking quietly and they’re getting a response that’s loud and abrupt, it’s going to feel like a mismatch and it’s not going to build the empathy. So tone is really important in what you’re hearing and also what you’re delivering with your own tone of voice.

TS: I mean, is it always true that a calm, slow, soft tone of voice is what’s going to help someone feel heard the best? Is that always true?

HR: If they’re speaking that way, it probably will work. If someone is talking quickly and more loudly and you answer with a completely different tone, that’s going to feel like a mismatch, too. So it’s more about matching, and I say that with the caveat that if someone is really triggered and loud and yelling, I don’t recommend matching that because that will just make the conversation escalate. So we want to match more when people are talking about neutral things or soft and slow, and conversations where the mutuality and the back and forth seems to be working.

TS: Here’s an interesting example, Helen: you and I having this conversation. So I might start with a deeper, slower tone because that’s just kind of my natural set point as a person. You might be a little bit more quick and kind of mentally sharp, but we’re having this conversation about empathy. So we’re going to find each other somewhere in the middle, yes? Because we’re both—

HR: I think so.

TS: Yes, because—

HR: We’ll have to listen to it [laughs] and see if that happened, but I think that is basically what really tuning in will result in.

TS: All right, let’s hear what the “H” stands for in your seven keys to empathic training.

HR: So initially, I just had “H” stand for “Hearing,” which means listening and really taking in what the other person is saying. But I expanded the “H” to “Hearing the whole person” because—I think this should be true in other types of interactions, but in healthcare, if we were just listening to a patient talking about their ailment or their injury or their disease, we might lose a focus on hearing them as a whole person; what’s going on in their lives, and what other factors might be contributing to worsening chest pain, for example. So I wanted to have the “H” stand for more than just hearing but actually hearing the whole person, so we don’t lose sight of the bigger picture.

TS: What are your tips for professionals who are working with someone—someone comes in and they have a problem with their knee or whatever they are reporting as their chief complaint—how do you get to hearing the whole person and not just why they’re in the doctor’s office complaining about whatever they’re complaining about?

HR: Right. So we really encourage asking about the chief concern, not just the chief complaint. The chief concern could be elicited by saying, “How is this knee injury going to affect you at home and in school?” Then we might hear that the chief concern is, “I have a football scholarship riding on this and if I can’t play, I’m afraid I’m going to lose my scholarship.” So that’s a whole other level of concern that will need to be heard and have some conversations around that. But if we just focus on the body part, the person might leave the office even more anxious and upset than when they came in.

TS: Are there any leading questions that are helpful in this regard?

HR: Yes. So, “What’s worrying you the most about this?” or “What are people at home worried about with your chest pain getting worse?” So you can hear maybe something in displacement that the patient might not be saying themselves, such as, “My family is worried that I’m getting a little down or depressed,” or something. So asking some open-ended questions that get to what the other concerns are and not just the reason they came in.

TS: OK, and finally, “Y,” the seventh key here.

HR: So “Y” stands for “Your response. ” The “Y,” I think, requires the most explaining because most people might think that the “Y” is about what you’re going to say next, and it’s really not about what you’re saying. It’s more what you’re feeling, like, “Are you comfortable with this person? Are you in tune? Does it feel like everything is going well?” Because most feelings are mutual, and if you’re feeling good, chances are the other person is. But if your response is some irritation or annoyance or just feeling a little out of sorts, you might be picking that up from the other person.

So “Your response” is an invitation to take a personal inventory, to say to yourself, “How is this going?” or “How did that go?” and to reflect and, if possible, if there’s any doubt, to say, “How do you think we’re doing? Am I really understanding what you were hoping for today?” So it’s an ability to check out both in real time, and also it’s an ability to go back if an interaction went poorly or you have regrets about what was said. It’s also a reminder if there needs to be an apology, to offer that, or if there needs to be a “Can we meet again? I felt like we may have not gone to everything last time.” So it helps to continue conversations that might have had the potential to end in a dissatisfying way.

TS: I’m curious, Helen, when you offer this training to people and you teach these seven different skills, if at the end some people have trouble changing all that much. Obviously, some people, they learn these skills and it completely changes how they go about things. But I wonder if there are other people who, let’s say their heart is shut down for some reason, and they identify the affect but they can’t really connect with it because it would require some internal opening that they’re not ready to do. What do you do in those kinds of situations?

HR: Well, you’re really getting at the point, the important point, that people are at different levels of readiness and preparation for this training. Our goal is to expand people’s perceptions of others and to give them some concrete skills to use. Not everyone is going to be able to use them all right away. I had one physician who really learned how to say “That must be hard for you,” and this particular doctor did not feel very empathetic and found empathy kind of difficult. But what she learned was by saying these words that really hadn’t been part of her conversation before, that patients started to feel very appreciative and they started to say, “Thank you. That means a lot to me.” By changing this one thing, she really has come to really enjoy her work more because it was a little crack in the door to really connecting with others.

So some people will take a suggestion that’s part of our training and it will land in a useful place for them, but they might not be able to embrace the whole thing at once. But then there’s greater openness for the other pieces sometime down the road.

TS: Have you seen that there’s a certain profile of the type of person that empathy training is difficult for them, like this doctor that you’re referring to? Like something from their early background or something like that?

HR: Well, I think—I don’t know about the early background, because I don’t know most of these people’s backstory, but I do know that some people are less—they have more trouble like connecting to emotion. Some of these people are extremely cerebral, research-oriented people who spent more time in labs and maybe in school than in clinical work. So it’s a re-orientation for some, and I would say that that might be one of the more challenging groups.

TS: I’m curious if there’s anything about medical training itself in the way that it’s currently conducted that almost trains the empathy out of us. I mean, you mentioned that we’re hardwired for empathy, so it’s this natural ability that we have, but then we all go through our educational system and then especially the intensity of something like getting a medical degree and the demands on the student, whether it’s demands that they become even more cerebral than they might be naturally, or that they figure out how they’re going to conduct themselves in a 30-minute increment or less with a patient. I’m curious what you think about that.

HR: Well, that’s a pretty well-documented phenomenon that medical students come to training with very high levels of empathy. It’s actually what makes them choose the medical profession. This is changing now, but usually for the first two years of medical school, they have almost no patient contact and they’re learning microbiology, histology, pathology, biochemistry, and all of these difficult subjects, and it remains in a competitive environment. Many medical schools are realizing that the students can get a little burned out before they even get to the clinical part because it’s just been now six years of rigorous study and not much connection to people. So they’re introducing more patient contact earlier on, and it seems to be having a very good effect.

The medical training tradition has been quite, quite intense, rigorous, and sometimes a culture of bullying and calling people on the spot and shaming them. These tactics, many people now agree, are contributing to a diminishing of empathy, because if you’re treating people during their training in an unempathic and uncompassionate way, you’re actually transmitting norms for the profession. So there’s a great deal of work going on now with empathy training, resilience training, mindfulness, and really trying to turn this educational system around.

TS: When it comes to teachers embodying empathy and teaching with empathy, what do you think are some of the most important qualities for a teacher to embody?

HR: So the point you’re making right now is the importance of role models and having teachers who really exemplify both the compassionate interest in patients and also the scientific and medical knowledge to treat their illnesses. These types of, I call the “master clinicians,” they know how to listen. They always sit down when they’re at the bedside. You never see a master clinician standing up. They sit down, they’re at eye level, and they connect with the person’s humanity. They’re not just checking a list like, “How is the wound healing?” and “It looks like you’re able to use the bathroom again, so we’re going to be able to get you out tomorrow.” So it’s not just on the technical functioning of the body, but it’s a shared humanity.

That is what medical students need to be exposed to. And I would say in any training industry, that’s the kind of culture you want to create, but it has to be done by modeling.

TS: Let’s take this E.M.P.A.T.H.Y. training in education to young kids. What do you think is the most important training in schools for young children, especially when it comes to developing empathy for children who are different? The subtitle of your book includes that we will learn how to work and “connect across differences.” So how can we bring this into our educational system?

HR: So my first answer is to introduce it as soon as possible. Developing children’s fluency with expressed emotion is just, I think, one of the most fundamentally important lessons and skills that young kids can learn. So there are programs—one of them is called Open Circle where children come together and the whole purpose of being together is to talk about feelings. So in a classroom with children with diverse backgrounds, if somebody is sad, there’ll be a question about sadness and then encouragement to talk about it. Kids can learn at a really young age to listen to whatever the other child’s story is and to learn the language of the experience. So making emotion detection and creating a safe place for its expression is the most fundamental skill and caring that can be shown already in kindergarten. It’s much harder to teach these skills in high school or college or medical school if listening skills weren’t taught early on.

TS: Now, it’s interesting that you describe the training that’s needed as a fluency in expressed emotion. Do you think young children, it would be great if they could identify 20 different feelings? Is it OK just to know a handful?

HR: [Laughs] Well, it’s a wonderful question. I think children don’t have the words for certain feelings, and so they might only know the sadness, anger, and happiness with words. So there are programs that use puppets to act out things like unfairness, and then the teacher will use the word or will say—so if a puppet steals, let’s say, an apple from another puppet and hides it, that can open a little conversation with the children and they’ll say that was bad or something, and then the teacher can introduce the word “unfair,” and it made him sad or it made him angry, whatever. So by using little scenarios that give names to interactions that either go well or are harmful, a child’s emotional vocabulary can grow.

TS: I mentioned, Helen, this idea of helping people connect across differences and whether this is starting with how we educate young children in schools or if it’s something we’re introducing in other ways in our culture. I think this is a big concern that people have. We see the increase in bullying. We see an increase in hate crimes. How do we help people empathize with people who are really different?

HR: Well, again, it gets to the appreciation and celebration of difference. I agree with you, the need today for people to see each other as human and all part of the human fabric and not separated and polarized is—I’ve never seen a need greater than today. One way to help with this situation is using the keys that we describe in the book, but also research shows that collaborating on projects with people who are different from you—and some organizations use all kinds of different tactics for this. But I heard one where people had to form a team and put a bike together. And when they mixed up people who were from diverse backgrounds, seeing how they work together, they had to collaborate and cooperate, it really broke boundaries down between them. There’s also really good evidence that reading about other people from other cultures in really good literature—so where you get into the mind and the experience of another person’s life—definitely improves empathy.

Organizations—whether it’s educational or medical, business—have to take a stand for respect for all people and look for opportunities like this, to bring in speakers who talk about unconscious bias. I think rallying against bullying is important, but coming up with solutions is even more important, and it has to be introduced really at every level from grade school on up to organizations and businesses and institutions.

TS: So, Helen, I know that one focus area for you has been the patient-doctor relationship, and we’ve been talking some about E.M.P.A.T.H.Y. training in education. But there’s one other area that I want to make sure we talk about, which is empathy in business. As I was researching for this conversation, one of the things that I read was that different parts of our brain are involved in analysis than when we’re being empathetic. This lights up different parts of our brain, when we’re analyzing versus when we’re being empathetic. I thought, “God, this really poses a problem in the business world, and this may also pose a problem in the medical world, too.” You’re analyzing data. No, you’re empathizing with the client. Different parts of our brain are being activated. How do we bring the right integration here?

HR: Well, you’re referring to the importance of what they call mental agility, and that’s the ability to flip back and forth between different modes of our brain. You’re right to bring this to light, because sometimes when we’re in an analytic mode of thinking, we get very focused and narrow. Then when we’re with trying to empathize and connect with people, it really calls for an openness, and non-judgment and non-linear thinking. Some people are better at one than the other, and I think even labeling this or raising awareness that these different modes are taking place can help people recognize when they’re in one mode or the other.

Different people have different endowments in different parts of their brains, and some will find one mode far easier to live in. In the E.M.P.A.T.H.Y. training that we developed, we’re not trying to shut off people’s mind so that they’re not using the algorithms they need to come up with the right diagnosis and a treatment, but we’re really trying to teach how to open a conversation, how to get to the middle with both the technical aspects, and also remembering to ask questions and then how to close it down with empathy. So there are ways to parse out how we’re interacting with people by thinking about them as having a beginning, a middle, and an end.

TS: What, in your experience, promotes mental agility?

HR: Practice. I would say that with the increased technology that’s in the room with physicians and patients right now, that the—probably many people listening to this have been in doctor’s offices where the back is turned to them and a lot of typing is going on into a computer. So what used to be a very natural, person-centered conversation, now the technical distraction is front and center. This is one reason why our E.M.P.A.T.H.Y. training is such high demand right now because part of the reason all those patients were complaining in my office is that the introduction of the computer just stirred everything towards the technical focus and lost the interpersonal.

Now that healthcare providers are becoming more facile with the computer or they’re having scribes enter the data or using other technologies, the arch is turning with more emphasis back toward the patient because everyone’s realizing that without care, compassion, and empathy, there’s no partnership in the healthcare experience and people’s health will get worse.

TS: Now there’s a quote, Helen, that I pulled from the beginning of the book. Here’s what the quote says. It says, “Scientific studies have shown that there’s an inverse relationship between power and empathy.” I thought, “This is really interesting. People who are interested in being more powerful in the world, in some way, have an inverse relationship with empathy.” I thought, “This is not good,” when I read this. I’m curious if you can help me understand this more and honestly, I would like to be a very empathetic person, but I’m also interested in being a powerful person, so I don’t want there to be an inverse relationship here.

HR: Well, it’s really an interesting phenomenon, and this doesn’t mean that all people who are in power positions are unempathetic, but it turns out that people in powerful positions often are less dependent on getting along with others because of their power; if they’re the boss or if they’re the unit chief, people do what they say. When they have a lot of power, they may forget that the interpersonal connection and relationship can really fortify the relationships, because people will follow directions, do what they say without necessarily so much empathic engagement. But we also know that really effective and powerful leaders can do both. I think the stereotype of like a CEO who barks orders and just says, “Get it done,” and forgets to really empower the workforce with a vision and with a sense of all contributing to something great together, something’s lost when that attitude isn’t there.

But another aspect of this power and empathy that I talk about in the book is there’s some studies that show that drivers of expensive cars are, for the most part, not as nice on the road as drivers of less expensive cars. These studies show that drivers of expensive cars cut people off more, they go right into pedestrian lanes, and they don’t follow traffic rules as well. Some of that, the speculation is that they feel entitled to just take up more space in the world, that the rules don’t apply to them; and also that the consequences of getting a traffic ticket may not be felt as deeply as if someone has fewer means. So power can have a self-centered effect that can forget the importance of really working well with others. But powerful people also have an incredible opportunity to influence how those relationships get set in organizations and what kind of norms will be followed. So I’d say it would go both ways.

TS: It seems like we need to hold up a vision of empathically attuned leadership.

HR: That’s absolutely true. When an organization has such a leader, everyone’s expectations of themselves rises.

TS: OK. Just one final quote from the book that I pulled here from The Empathy Effect. Here it is: “Without expanding empathy beyond our in-groups and borders, civilization as we know it will not survive. Empathy training is the key transformative education.” That’s a very powerful quote. Civilization as we know it will not survive.

HR: Tami, I think what you said a few minutes ago about the state of incivility, bullying, taunting others, lack of sensitivity to difference, really diminishing and putting people down for not being like the dominant race—the corrosive effects of these kinds of norms are deeply, deeply troubling and deeply concerning. I think many people recognize these tactics as being not just offensive, but really morally challenged, and we need to have an answer to these kinds of new norms that we’re seeing every day on television and in the news, and a call for people to unite as one humanity.

If we continue to splinter and disparage people of color, people from other countries, calling them names, our country is not going to be the same. I guess as a child of immigrants, I can see the incredible value in coming with different cultural norms, sharing those, really enriching a society, and also bringing a type of vigor and a type of hope that we can’t afford to lose in this country. So I know that your readership is very tuned in to a civil and compassionate way of being, and I just want to encourage everyone through my book and through our conversation to really dig deep and find ways to connect with others and to really heal the fraying fabric of our society.

TS: I’ve been speaking with Helen Riess. She is the associate clinical professor of psychiatry at Harvard Medical School, and the author of the new book, The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences. Helen, thank you so much for your good work and for all of the skills that you’re teaching people. I really learned a lot from the book and from our conversation. Thank you.

HR: Thank you, Tami. It’s been such a pleasure talking with you.

TS: SoundsTrue.com: Waking up the world. Thanks for listening.