I. Cultivating Compassion and Empathy

Compassion and empathy are very similar concepts and the terms are sometimes used interchangeably in medicine. Both involve being deeply engaged with the other person and present as you listen to their stories about their suffering and needs. Both involve being a very attentive witness to the other’s suffering.

The word “empathy” includes 1) feeling what another person is feeling, and 2) conveying your understanding to the person in a caring manner. The word “compassion” overlaps with empathy and includes the desire to help meet their needs.

To avoid feeling overwhelmed by the suffering they witness, medical professionals may try focusing on feeling just enough of another person’s pain or upset to understand it and then focusing their thoughts on expressing caring.

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What Is Compassion?

A description of compassion by healthcare providers

A study of healthcare providers’ understanding of compassion produced the following descriptions: (Sinclair et al., 2018):

Compassion Definition: “An intentional response to know a person, to discern their needs, and ameliorate their suffering through relational understanding and action.” 

Compassion’s Impact on Healthcare Providers: Deep satisfaction of coming to know another person deeply. Being able to use valued virtues to alleviate the suffering of another and strengthen the therapeutic relationship. 

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The Components of Compassion

The following aspects of compassion in clinical practice were summarised from descriptions by healthcare professionals and are similar to the way patients describe compassion. (Sinclair et al., 2018)

1. Virtuous Intent:
   • Purposeful expression of virtues, such as love, acceptance, honesty, kindness, genuineness, care, and peace
   • Expressed through one’s character and embodied presence
   • Self-effacing and curious attitude towards the patient
   • Orientation to the patient’s perspective
2. Relational Space:
   • The caregiver engages the suffering of the other person with virtuous intent (See #1)
3. Coming to Know the Person:
   • Engaging patients sensitively, attuning to their presence and interpersonal cues
   • Seeing the patient as a person, extending one’s vision beyond their illness
   • Understand patient circumstances and accept them unconditionally
4. Forging an In-Depth Healing Alliance, which is:
   • Being present in demeanor using verbal and non-verbal communication
   • In-depth understanding of the patient, becoming engrossed in their story. Using active listening to understand their needs
   • Relational, reciprocal communication, may include mutual story-telling
   • Therapeutic relationship with expressions of caring and your desire to promote health
5. Ameliorating Suffering:
   • Discerning, anticipating, and prioritizing patient needs
   • Proactively addressing needs, providing an attuned response to suffering
   • Providing emotional and existential support for fears, distress, and uncertainty by “eliciting meaningful memories, affirming strengths, and providing supportive touch and words of affirmation”

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What is Empathy? 

Empathy has been defined in medical literature as “the ability to sense, feel, and understand another’s emotions.” (Patel, 2018)

Finding the Words to Express Empathy

Words of empathy can validate the other person’s experience and show caring and concern. For some people, verbalizing empathy is a challenge, even when it is felt. They may find it hard to find the right words to say when a peer or patient is feeling pain or is sad. So, it can help to be prepared with a few commonly used responses. The following statements express empathy and might be appropriate, depending upon the situation: The following 28 empathetic statements are possible ways of expressing empathy in different situations that may help inspire you to find the words to say.

Are you okay?	I can appreciate how difficult it was for you.
Things like this are never easy.	That’s awful! I don’t know what to say.
That sounds frightening.	I am sad to hear what happened.
That sounds so challenging!	I could see it wasn’t easy talking about it.
I’m glad you told me.	What a shift you had!
Sounds like a really tough thing to go through.	What a disappointment!
That must have really hurt!	I can see how deeply it affected you.
That would upset me, too.	I’m sorry you are going through this.
It sounds discouraging.	I could tell it mattered to you a lot.
It looks like you have strong feelings about it.	I hear you.
That sounds exhausting!	I would be mad, too, if I was in your shoes.
It sounds like a major conflict. How difficult!	You just went through a lot.
Whew!	You did the best you could.
I can see how much you care.	You have a right to feel this way.

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Cultivate Compassion

For self and others

1. Contemplating loving-kindness

The steps for contemplating loving-kindness (each around 30 seconds) are:

1. Start seated in a relaxed, meditative posture in a quiet place: Bring to mind two people who love you standing on either side of you and imagine them sending you their love with an attitude of kindness. 
2. Now think about sending that love and kindness back to them. 
3. Next, imagine sending that loving-kindness feeling toward an acquaintance.
4. Finally, imagine sending that feeling toward the whole world. 
5. You can repeat these steps with wishes for happiness, well-being, and health. 

In a study of 134 college students, a 10-minute session of contemplating loving-kindness improved well-being and feelings of connection more than inducing a positive mood not related to compassion or a neutral visualization (Seppala et al., 2014). 

2. Wishing well-being for someone’s suffering (Tonglen)

This exercise is adapted from a meditative technique for cultivating compassion (Tonglen). It helps you become more aware of the suffering of other people and as you wish them well. 

It may be easiest to learn this skill while thinking of someone you love first and then to use it with others. Seated in a relaxed, meditative posture: 

1. As you breathe in, bring to mind someone you love who is suffering. If it feels sad, heavy, or another unpleasant feeling, open your chest and breathe freely and with ease so that the feeling does not get stuck. 
2. As you breathe out, imagine you are breathing out a sense of relief, freshness, and lightness as if you are sharing that with your loved one. Breathe freely and openly, as you wish this feeling for them. 
3. Repeat these two steps for several minutes. Breathe in, in a relaxed, deep, very open, non-stuck way. 
4. Switch the focus of your thoughts from just your loved one to a particular person or all people suffering in the same way, breathing in their suffering and breathing out relief, directed towards them. 

3. Focus on your breathing to support the release of your stuck feelings

You can use a similar breathing technique to the one described above, but focused on yourself, to process unpleasant or difficult feelings you may have that feel stuck, such as feelings of self-criticism, being unfairly judged, or resentment over an overwhelming work-load.

1. As you breathe in, think about your difficult feeling and breathe deeply into where it feels stuck in your body.
2. As you breathe out, think about that stuck feeling relaxing, the difficulty dissolving, or that burden being lifted and carried away. Try a second breath as if drawing the breath to that part of the body, and imagine it cleaning up and clearing out any remaining tension from that area of your body as you breathe out. You may still want to take some action to correct the situation if possible, but you will carry less of the pain and tension of it around with you all the time.