Empathy, what is it?

In a previous post, I describe a growing feeling of incompetence as a student therapist.  When I express these concerns to my supervisor he jokes: “Give it about 5 years”.  

As time has progressed, I’ve adapted to the “learning as you go process”.

As a therapy student, I’m focusing on learning those “basic counseling skills” everybody talks about. In this series of posts, I hope to reflect on what I’m learning slowly week by week from an experiential rather than academic perspective.   Therefore, I did a quick google search and am using three online PDF’s as a quick jumping off point.  In this post, I will focus on empathy…

Empathy is derived from the German word “Einfuhlung” which directly translated means “one feeling”, (Pedersen, et al, 2008, p42).  It can be thought of as “the ability to perceive another’s experience and then to communicate that perception back to the individual to clarify and amplify their own experiencing and meaning. It is not identifying with the patient or sharing similar experiences, not ‘I know how you feel’!” (Abraham Lincoln University, n.d., p. 5).  In other words, empathy is a two-fold process that involves accuracy of perception and effectiveness of communication.   Two big questions naturally loom in my mind:

FIRSTLY, How can we improve our ability to appreciate another person’s perspective, thoughts & feelings?

SECONDLY, What considerations need to be kept in mind to communicate this empathy effectively?

4/12/17 @ 2:30 p.m.

I’m in the car, dictating another post into my IPhone.  A few thoughts have sprung to mind regarding the importance of empathy as a result of several events over the last several weeks…  

Therapy seems to require a dialectical thought process of oppositional perspectives.  We must discern diagnostically while remaining nonjudgmental empathetically.  The process of diagnosis first requires the observational skills to develop a phenomenological diagnostic understanding.  Then, in order to guide our progress an ever-changing case conceptualization provides an complex causal understanding.

In complete contradiction to this is the empathetic perspective which requires us to suspend judgment.  In those moments, you are attending to the human being before you and simply honoring the validity of a person’s experiential reality with a goal of developing a deeper felt understanding of it.  The divergent nature of these two simultaneous tasks makes the counseling process is oddly dualistic at times.  As a newbie, I’m interested in getting down the basics.

How can I know if my understanding of the patient’s felt & experiential reality is correct???  How can I be sure that I’m adequately conveying this empathetic understanding???  Here are a few random thoughts:  

Marsha Linehan on Suspension of Judgment 

Within every definition of empathy, the suspension of judgment is highlight as an essential characteristic.  Regarding the judgment suspension, I am reminded of something John Malkovich said once about characters and the importance of not judging them.  As I’ve observed, this requires a constant questioning, do I understand everything? What am I missing? Where are my blind spots?

A great way to begin answering this question is to first examine those instances where I experienced a lack of empathy from others who were trying to be “helpful”  

For example, in an earlier post I discussed an  abusive and dysfunctional relationship in college.  While I don’t tend to share this story often, it isn’t necessarily a secret.   I have on a few select occasions shared this experiences with people.  One response I real is: “why the hell did you put up with him for so long”, or “why didn’t you leave?”  Then there are those who attempt to be sympathetic yet misconstrue my motives or very nature.  The helpless victim who just lacks self-esteem.

All these responses fall short of the reality of things.  The fact is, I was a child who had experienced chronic invalidation and shame growing up….  

I discuss these experiences in greater length in posts on ostracism, bullying, & rejection amongst extended family members.  A professor I had last quarter made an interesting comment regarding battered women & why they don’t leave.  She noted that the key is to understand the issues they have not worked out.  When she said this, I silently thought to myself what it was I needed to work out.  It was simply a desire to not re-experience the hurt, rejection, and isolation I had in my childhood.  As a parasuicidal teen, who held on for no other reason than not to hurt her family, I met that “it” at a vulnerable time in my life.  I had just left home and was trying to fit in but experiencing difficulty as a freshman.  Years of isolation from sixth grade on, left me feeling “different” from fellow dorm-mates who had “grown up fast”.

It comes down to something I heard John Malkovich say about creating characters.  To do so successfully, you need to view them without judgment.   Doing so requires that we – for a moment – set aside our preconceived notions, and see the world through their personally experienced reality.  What would it be like, if you experienced chronic rejection, isolation, and invalidation as I had growing up?  These experiences were so bad, I was parasuicidal, hanging on day by day, just promising myself to keep going.

I simply desperately sought validation & acceptance from someone as a way of avoiding the possibility of re-experiencing the hurt I had long ago…..

I would take promises of acceptance & validation (even if he never did deliver),  like a carrot on a stick, over nothing at all.

Imagine yourself in my situation as a child, minus the judgment.  There would be  someone who had no other context in which to view herself than what others reflected to her.   You would then be left with a one-sided view of yourself as a result of a lot of unhealed baggage.  This would cause you to seek the first solution to avoid dealing with with the unresolved crap from your childhood.

The idea of re-experiencing the hurt similar to the childhood rejection in my childhood was overwhelming.  I just couldn’t do it.  

I would just like to conclude with some comments by Marsha Lenehan , founder of DBT.  There is a quote from something she published on validating a person’s emotions when they are suicidal.  This notion contradicts the sentiments of workers in the mental health care environment who all make a potion of  telling you that what you did is wrong and you did a bad thing and you were wrong to do this.   There is no one who is simply listening to what you’re saying and appreciating your story and how you feel without judgment that is the critical thing and the thing that often goes overlooked.

“Perhaps nowhere is the ability to empathize with another person more important than when one is interacting with a person who is on the brink of suicide.  This is true whether one’s views one’s task as helping the individual choose continued living over suicide or, more rarely, as helping the individual make a wise chose between suicide and continued life.  The ability both to hold a person within life, when that is needed, depend on an experiential appreciation of the other person’s worldview.  Finding hidden or obscure ways out as well as seeing that there is no way out require both the ability and the willingness to fully enter the experience of the individual ready to suicide and, at the same time, not become that experience…In attempting to apply standard behavioral therapy to severely and chronically suicidal individuals…focusing on client change is often experienced as invalidating by clients who are in intense emotional pain…focusing on understanding in absence of a…efforts help the client change..is often experienced by these same clients as invalidating because it does not recognize the uninsurability….of the present unremitting pain…” (Linehan, 1997, p. 353-354).  

Brene Brown on Empathy

In the above video, Brene Brown begins describing the difference between sympathy and empathy.  As a fan of her work, I feel the need to include this brief view by her in this post.  She states that empathy requires four critical factors:  (1) Perspective taking, (2) remaining nonjudgmental, (3) recognizing the feeling in others and (4) effective communication of this effectively.  In other words, empathy requires much more than putting ourselves in someone else’s shoes, we must be able to effectively communicate this to others. In the next section, we discuss how to communicate empathy effectively.

Rogers on Empathy

“I have come to believe that empathetic listening is one of the most powerful forces for growth that I know…. (Rutsch, 2015).

“…When I can let myself enter the softly and delicately into the vulnerable inner world of the other person…(Rutsch, 2015).

“…When I can temporarily lay aside my views and values and prejudices…(Rutsch, 2015).

“…When I can let myself be at home in the fright, the concern, the pain, the anger, the tenderness, the confusion that fills their lives…(Rutsch, 2015).

 “…When I can move about in that inner world without making judgment…(Rutsch, 2015).

“…When I can see that world with fresh unfrightened eyes…(Rutsch, 2015).

“…When I can check the accuracy of my acceptance with him or her and be guided by the responses I receive…(Rutsch, 2015).

“…Then I can be a companion to that person, pointing at the felt meanings of what is being experienced.  Then I find myself to be a true helper…(Rutsch, 2015).

As I stated earlier, empathy is a two-fold process that involves accuracy of perception & effectiveness of  communication.   In this section I’d like to begin by consider how to communicate it effectively.  After reviewing old papers, I noticed there are two that discuss the effective communication of this concept.  I include them below, for my own education / review….

PAPER #1 – Active Empathetic Listening 

Active empathetic listening is defined as an “active and emotional involvement of a listener during a given interaction – an involvement that is conscious on the part of the listener but is also perceived.” (Prout & Wadkins, 2014, p134). As a multidimensional concept involving sensing, processing, and responding, it isn’t enough to simply attentively listen and consciously process information. Affectively communicating this empathetic understanding is critical as well. With this in mind, what follows are key factors that are of a concern to this author from the standpoint of skill development.

Top-Down Processing & Culturally Inclusive Empathy.

Top-down processing is one of two forms of listening discussed in our course textbook. It involves the utilization of education and experience to contextualize the meaning of the communication with clients. It is a critical counterpoint to the bottom-up processing that exists as at a more automated level in which we respond to what is said at a face value (Prout & Wadkins, 2014, p135).

In fact, when considering the concept of top-down processing in the process of active empathetic listening, the author is reminded of a related concept: Inclusive Cultural Empathy. Discovered coursework elsewhere in this program, it is defined as “a dynamic perspective that balances both similarities and differences at the same time integrating skills developed to nurture a deep comprehensive understanding of the counseling relationship in its cultural context” (Pedersen, et al, 2008, p.41).   In considering this concept as a part of the active empathetic listening process, it is clear to this author that such skills require an ongoing lifetime commitment to skill development and self-reflection.

Affect Tolerance & Mindfulness.

Two final concepts are of concern to this author as key skills in the active empathetic listening process. Firstly, our textbook describes affect tolerance as an ability to handle distressing emotions experienced vicariously through hearing the client’s story without “becoming engulfed” (Prout & Wadkins, 2014, p136). Alongside this concept, the textbook mentions the notion of meditation as an ongoing practice. Essential in paying attention more fully, when considering such factors the idea driven home is a realization that one gives to others based on who they are and not just what they do (Prout & Wadkins, 2014). With this in mind, much work on oneself is necessary and essential, as an ongoing process of growth and personal development.

Active-Empathetic Listening Scale

            In this portion of the paper it is the goal of this author to review the Active-Empathetic Listening Scale discussed in our course textbook (Prout & Wadkins, 2014, p135).   As per the instructions I am to rate “how frequently [I] perceive each of the following statements to be true for [me] on a 7-point scale ranging from 1 (never or almost never) to 7 (always or almost always true).” (Prout & Wadkins, 2014, p135)

  1. “I am sensitive to what others are not saying.” (Prout & Wadkins, 2014, p135) – Based on an honest self-assessment I would rate myself around the 6-7 range.
  2. “I am aware of what others imply but do not say.” (Prout & Wadkins, 2014, p135) – Very similar to the question above, I would also place myself around the 6-7 range, depending on circumstances and degree of personal stress.
  3. “I understand how others feel.” (Prout & Wadkins, 2014, p135) – I rate myself at a 7 here. In fact the skill of affect-tolerance is an important skill for me as a result.
  4. “I listen for more than just the spoken words.” (Prout & Wadkins, 2014, p135) – As a mother to a teenager, and CNA/Psych tech, I actually spend quite a bit of time doing this and would be around the 6-7 range.
  5. I assure others that I will remember what they say.” (Prout & Wadkins, 2014, p135) – As mentioned above, I spend the majority of my time caring for others. I’m constantly being asked to reassure others I’ll remember what they are requesting and/or desiring from me. In this respect I do this as well all day long, and would be around the 6-7 range.
  6. “I summarize points of agreement and disagreement when appropriate.” (Prout & Wadkins, 2014, p135) – This factor doesn’t occur as much in the work context for me. In my personal life as much, (as I do agree it is a critical personal skill), I can at times get more caught up in making points than summarizing them. I would at about 5 here.
  7. “I keep track of points others make.” (Prout & Wadkins, 2014, p135) – As stated above, I do need a bit more work here and would rate myself at about a 5.
  8. “I assure others than I am listening by making verbal acknowledgements.” (Prout & Wadkins, 2014, p135) – As someone who cares for others, I do this all day long, and would be in the 6-7 range, in acknowledgement of the fact that nobody can ever be perfect.
  9. “I assure others that I am receptive to their ideas.” (Prout & Wadkins, 2014, p135) – I the context of my work as a C.N.A./psych tech, I am often acting as an “ambassador”. On the one hand there are the needs of the client and on the other hand there are the parameters that need to be followed according with the doctors plan of care. Finally, the hospital has its rules that we all must follow such as visiting hours and no smoking. With this in mind, I also work to reassure clients of this fact, and do my best to advocate for their needs. Based on this fact I would rate myself in the 6-7 range.
  10. “I ask questions that show my understanding of others’ positions.” (Prout & Wadkins, 2014, p135) – This skill isn’t utilized as much in the context of my job. While pretty good at it, I’m probably not as adept as in other areas and am about a solid 6.
  11. “I show others that I am listening by my body language.” (Prout & Wadkins, 2014, p135) – With many stresses and demands in my life, I find my ability to care for others is often depleted by these things.   While I am good at verbally showing that I listen and try my best, sometimes my body languages reflects my exhaustion and stress levels more than anything. I would rate myself at around a 5 here.

Effectiveness of Self-Rating

            After completing this scale, it must be acknowledged that as a self-rating method the results are clearly skewed on that basis. How I think I may come across to others may not be the same as how they tend to experiential first-hand encounters of me. It would be interesting to have key individuals in my life review my answers and provide their own feedback. The ultimate conclusion likely made would be that I may not communicate my intentions as well as I hope to. Additionally, as I will discuss next, any plan for improvement must acknowledge the depth to which these skills exists as core elements of how we choose to be in the context of our lives.   In this respect they really do require an ongoing commitment of personal growth and self-awareness as an lifelong process.

Plan for Improvement

In completing this assessment, this section briefly reviews my plan of improvement. It will combine insights from the scale above, with key skills this author feels are important.

  1. GOAL ONE – Multicultural Competency. Culture exists as an unseen paradigm in our lives defining not just our values and beliefs, but patterns of thinking and overall affective style, (Hays, 2008). With this in mind, active empathetic listening, does require a skill described in literature as inclusive cultural empathy (Pedersen, et al, 2008). Making an ongoing commitment to the development of multicultural competency is critical with this in mind.
  2. GOAL TWO – Mindfulness Practice & Self-Care. – The one biggest lesson from the self-rating scale its reaffirmation of the idea that self-care is critical.   Being there for others requires that I be there for myself first so I have something to give. Alongside this notion, is the idea of a daily mindfulness meditative practice that can aide in reducing stress levels and still my busy mind.
  3. GOAL THREE – Affect Tolerance. – It is natural, when encountering difficult emotions from others in the context of an interaction to take them in to a degree and personally experience them as well. We can take on some of the emotions of others and feel for them in an active empathetic sense. While clearly a good thing in some respects, over-identification is not healthy. This skill has been very critical in the acute mental health setting, and is one that requires much patience and active commitment to engage in at times.
  4. GOAL FOUR – Seek Volunteer Experience for New Learning Opportunities. Yet another insight from the self-rating skill is the fact that certain elements of active empathetic listening are practiced more than others.   When reflecting on the reasons underlying this, the hospital environment I work in, seems conducive to some forms of listening over others.   Engaging in brief communication more often than lengthy discussion, certain skills aren’t practice as much. It would be necessary, therefore, to seek other volunteer opportunities to engage with clients in a different capacity than what I’m familiar with at work.
  5. GOAL FIVE – Improve Listening Skills. Reviewing the basic listening and interviewing skills periodically, and being mindful of them as I engage with others, can be an effective way of learning to naturally incorporate them in the context of my interaction with others. 

Paper #2 – Inclusive Cultural Empathy

Culture and Emotion

The singular most beneficial lesson throughout this course is the realization of how culture exists as an unseen paradigmatic influence in our lives.   Definitive of our worldview, it represents a learned perspective that consists of instilled values, beliefs, and norms.

Beyond these obvious influences though, are less visible culturally impacted factors such as identity, emotion, and metacognition. Discussed often from a psychological, individually reductionist perspective, this paper will instead provide a unique sociocultural point-of-view of matters.

In determining the exact focus for this paper, I chose the topic of culture and emotion based on insights gained from the second exploratory paper activity. In the process of reviewing related literature for an interview with my mother, I came across the following:

“To the Filipino, actions always speak louder than words, so instead of conveying love and fondness with words, parents will endure extended periods of separation and/or hold down two jobs so that they can send their children to the best schools, pay for lessons and activities, and provide material support and other opportunities. This is the way they express their affection, and children are expected to recognize and value it. If they do not express or show appreciation, parents might perceive them as lacking utang na loob – serious infraction of social mores.” (Fortune, 2012, p12).

This quote manages to summarize a huge misunderstanding that existed between my mother and I throughout much of my childhood. As an American child, I failed to understand my Filipino mother’s expressions of love through action, (Fortune, 2012).   Preferring to hear and witness outwardly visible affective indicators of her love, it was instead an unseen dedication to her duty as my mother. As I only am able to contextualize now, it seems the underlying the cultural gap between us, was the byproduct of a failure to acknowledge key differences among us. At the core of these differences were varied views of what it means to be a person in the world, and what perspective we are to take it in from.

With this in mind as the focus of the paper, I begin with a discussion of the concept of inclusive cultural empathy. This concept provides a view of empathy from a unique multicultural perspective. Understanding how this concept as it relates to the overall notion of culturally competent counseling is critical if I am to effectively communicate it in such a manner. Also included in this paper is a brief review of the relationship between emotions and culture, and concluding commentary on with how to incorporate these insights into my future career development.

Inclusive Cultural Empathy.

Empathy is derived from the German word “Einfuhlung” which directly translated means “one feeling”, (Pedersen, et al, 2008, p42). From this perspective, empathy can be thought of as an ability to understand another’s experiences as if they are your own.   Best understood as an ability to relate to others due to shared experiences, the western Euro-American definitions predominating mental health are clearly problematic (Pedersen, et al, 2008). With traditional conceptions of empathy tending to reflect this cultural viewpoint, a more culturally inclusive perspective is vital. (Chung, 2002; Pedersen, et al, 2008).  What follows is a definition of this concept from literature:

“Inclusive Cultural Empathy describes a dynamic perspective that balances both similarities and differences at the same time integrating skills developed to nurture a deep comprehensive understanding of the counseling relationship in its cultural context.” (Pedersen, et al, 2008, p.41)

In light of this definition, it is useful to note that providing empathy in a culturally relevant manner requires more than simply understanding. Adding to the ability to “put yourself in the clients shoes”, is the notion of being able to adeptly communicate this (Pedersen, et al, 2008). After all, as a shared experience the therapist communicates and the client experiences, this notion encompasses two often culturally diverse perspectives. With culture as the key divergent component it is important to understand its influences over our emotions and our preferred means of affective communication. Therefore before beginning to discuss inclusive cultural empathy as a component in multicultural counseling I will discuss research on the nature of emotion from both a cultural and biological perspective.

Understanding Emotion.

“Emotions can be defined as psychological states that comprise thoughts and feelings, physiological changes, expressive behaviors, and inclinations to act.” (Vohs, et al, 2007, p285). Overall, two divergent perspectives exist regarding research that focuses on the nature of emotion.  Appraisal theories are based on the premise that emotions result from the way we appraise and interpret our environment. Research that utilizes this theoretical perspective focuses on culture and its influence over our manners of emotional regulation, perception and interpretation (Ellsworth, 1994). In contrast to this, categorical theories tend to view emotions as universal, innate and discrete.   Focusing on basic emotions such as fear or sadness, research from this theoretical perspective tests the hypothesis that feelings are hardwired byproducts of neural programming. (Ellsworth, 1994, p28).

Then & Now.

In reviewing literature for this paper, I found it interesting that research seemed to reflect the field’s developmental history overall. Based upon a predominantly westernized Euro-American perspective, the mental health field historically focused on DSM-based empirical data (Hays, 2008; Pedersen, et al, 2008). Along the way, notions such as social context and cultural relativitism seem to have been forgotten until recently. Interestingly, it seems the meaning of empathy in literature has undergone a shift in definitive focus reflecting these changes:

“The underlying assumptions about psychology are moving from a mono-cultural to a multicultural basis with profound consequences for counseling. The old rules of psychology focused on dissonance reduction. The new rules focus on the tolerance of ambiguity.” (Pedersen, et al, 2008, p224)

As per this historical shift, I begin with a review of biological perspectives of emotions, and then discuss emotions in relation to culture. I will then conclude by reviewing inclusive theories providing insights from both perspectives.

Emotion: A Biological View.

Universality Thesis. Some research exists that focuses on a limited number of innate and universal emotions as “basic” in nature. (Ellsworth, 1994). Described as matters of neural programming hardwired into the species overall, this research reflects a “Universality Thesis of Emotions.” (Effenbein & Ambady, 2002). While still asserting some degree of cultural variation this perspective stresses the universality to facial expressions in relation to basic emotions across culture. (Ellsworth, 1994; Ekman & Friesen, 1971). Referred elsewhere as categorical theories, research utilizing this perspective comprises the following key propositions: “(1) universality of facial movement as a form of emotional expression, (2) universality of attribution and understanding of key facial expressions, and (3) an associated rate of correctness regarding these attributions across culture” (Russell, 1994).

Examples of Studies. In one study by researchers Ekman & Friesen, the universality of facial expressions across cultures, was examined (Ekman & Friesen, 1971).   Using samples of individuals from cultures with little exposure to western society, research results supported their hypothesis, (Ekman & Friesen, 1971). Nonetheless, it is important to note in this research that “The growing body of evidence of pancultural element in emotional facial behavior does not imply the baselessness of cultural differences” (Ekman & Friesen, 1971).

While this study exists as an example of research that predominated the field prior to its focus on multicultural competency, recent literature focuses on contextualize these results. For example, Elfenbein & Ambady in 2002 re-examine the universality of emotional recognition, (Elfenbein & Ambady, 2002). In this study, it is found that while emotions were universally recognized, varied degrees of accuracy were noted. With greater in-group accuracy in expression and recognition, an advantage was also seen in culturally diverse settings (Effenbein & Ambady, 2002). Also notable was the fact that minority groups displayed greater degrees of accuracy in recognizing emotions from majority groups, as opposed to the other way around, (Elfenbein & Ambady, 2002).

Emotion: A Cultural Perspective.

Appraisal Theories. Appraisal theories of emotions interpret emotions as byproducts of the way people interpret and understand their environment, (Ellsworth, 1994). Research utilizing this theoretical perspective has traditionally focused on a few key dimensions such as: (1) individualism/collectivism, (2) certainty/uncertainty (3) Attention to Novelty (4) Valence/Degree of Perceived Pleasantness, (Ellsworth, 1994). Differences in emotional expression are largely attributed to emotional regulation, stating that culture defines the beliefs about appropriateness of emotional expression. Accounting for differences in understanding of emotional expression, the assertion is made that culture “provides a framework for understanding culturally general emotional phenomena,” (Ellsworth, 1994). With this as a quick and dirty overview of current research from this perspective, what follows are key insights I found particularly intriguing.

Emotion as a Social Function. Emotions function as cultural scripts that are comprised of an array of biological and cultural factors, (Kitayama & Markus, 1994). Developed as a result of individual, interpersonal and collective experiences, they represent culturally constructed adaptations to our surroundings. In this respect emotions are a “psychological process that may be seen primarily as social and cultural in nature” (Kityama & Markus, 1994):

Emotion as a Perceptual Process. When viewed within the context of a perceptual process, emotions can be seen as a level of readiness in response to immediate events (Frijda & Mesquita, 1994). For example, individuals experience emotions in response to events they encounter that are deemed significant. This significance is determined by the manner in which this situation is then appraised. This form of appraisal exists as a byproduct of both individual temperament and cultural influences. Culturally this appraisal reflects a system of meanings that are social in origin. Emotion then can be seen as a form of readiness to act, that reflects norms of expression based on cultural imbued interpretations (Frijda & Mesquita, 1994).

Emotion From a Goffmanesque Perspective. Yet another perspective of emotions can been seen when taken in the context of social interaction.   From this perspective they aren’t internal affective states influenced by cognition but a form of interaction with others and our surroundings. (Frijda & Mesquita, 1994). For example, witnessing emotional displays in others can be viewed as a social event. In expressing these feelings we “transmit important messages about ourselves in relation to our surroundings” (Leu, 2001). When we then interpret someone’s behavior we do so within the framework of norms regarding behavior, and cultural meaning systems. As a result of this event appraisal and the emotional responses we can then respond accordingly. Emotion in this respect contains five characteristics reflective of culture including: “1. quality, 2. intensity, 3. behavioural expression, 4. the manner in which they are managed and 5. Organization.” (Leu, 2001) This all occurs within what may be called a cultural framework defined as follows:

“A cultural framework includes a group’s sense of and attitudes toward emotions, that is what emotions are or feelings are, why they are experiencing, and what their significance is in social life, as well as the implicit answers to questions like when does one feel, where does one feel, and how does one feel.” (Frijda & Mesquita, 1994, p.99)

Culture & Biology: An Integrated Perspective.

In pulling together the insights from all of the above research, it seems to me all of the insights above play a part as elemental insights into what makes us work as humans. In other words, there are both biological and cultural factors that exist in influencing emotions. What follows is an example of research that considers particular/cultural factors, alongside the universal/biological ones.

Affect Valuation Theory. In an article titled, “Cultural Variation in Affect Valuation”, a key differentiation is made between ideal and actual affect, (Tsai & Fung, 2006).   Whereas our ideal affect reflects what we want to feel, our actual affect reflects our current emotional state. Based on the Affect Valuation Theory this research hypothesizes a difference between ideal and actual affect with greater cultural influence on ideal affect preferences, (Tsai & Fung, 2006).

With results of the study supporting their hypothesis, a brief example is provided that compares collectivist and individualistic cultures. With an individualistic cultural orientation likely to endorse values such as elation and excitement, participants from such cultures are likely to express this as an ideal affect orientation (Tsai & Fung, 2006) In contrast to this, collectivist cultures value a calm peaceful and relaxed state and participants are likely to endorse these as ideal affect preferences (Tsai & Fung, 2006).

As an interesting side note to this, it may be useful to mention the Marsha Linehan’s research that focuses on the concept of Dialectical Behavioral Therapy. I learned about this theory while in therapy myself.   Differentiating between primary and secondary emotions as a way of better understanding our emotions, it is a useful application to the above research.

While primary emotions comprise our immediate reactions to an event, our secondary emotions are aessentially our own interpretations of our emotional states. In other words, secondary emotions exist as “feelings about our feelings”. Utilizing the above research as an example, individuals from a collectivist culture would display more negative reactions to their own displays of excitement as a result of their own cultural references.

Empathy & Multicultural Counseling.

“Empathy has been described as the counselor’s ability to enter the client’s world, to feel with the client rather than for the client, and to think with the client rather than for or about the client. Empathy requires the therapist’s ability and effort to place him- or herself symbolically in the position of the client and understand the client’s world, “(Chung & Bernak, 2002, p154).

After a brief review of relevant literature on the nature of emotion and its relation to culture, a clearer understanding of inclusive cultural empathy seems vital. What follows is a bit of clarification on the concept, and how it fits in within the concept of cultural competency.

Clarifying the Concept.

Defined as an ability to put yourself in someone else’s shoes, empathy is a culturally relevant concept. Traditional perspectives of empathy are naturally self-limiting, based on a perspective that is largely empirical and individualistic in orientation. In contrast, culturally inclusive empathy is a useful dynamic perspective that requires two seemingly divergent viewpoints. Essentially, this concept requires that a counselor hold onto their own cultural perspective while maintaining an appreciation for their client’s culture (Chung & Bernak, 2002). Ensuring the counselor holds onto their own cultural perspective can be a useful and essential assurance against potential countertransference (Chung & Bernak, 2002) At the same time, appreciating and understanding a client’s culture is critical in the difference between sympathy and empathy (Chung & Bernak, 2002).   With this clarification in mind, what follows are key recommendations for the development of inclusive cultural empathy.

Developing Inclusive Cultural Empathy.

It seems in reviewing all of the above research, the best advice I found to develop inclusive cultural empathy existed as a reiteration of what I learned in this course. Essentially, two bits of advice stand as key insights I intend to utilize in moving forward. I discuss these each in turn below.

Attitudes, Knowledge, & Skills.  The concept of inclusive cultural empathy can best be understood as a dynamic process that exists as an exchange between client and counselor, (Pedersen, et al, 2008). It comprises three key skills: Affective Acceptance, Intellectual Understanding, & Appropriate Interaction (Pedersen, et al, 2008). With intellectual understanding best understood as a knowledge of similarities and differences, it is an essential to note this is not enough in and of itself. Affective acceptance requires that a counselor acknowledge culturally learned assumptions underlying divergent forms of affective communication (Pedersen, et al, 2008).  Finally, effectively communicating this means developing key interactive skills and abilities through ongoing direct contact within the community (Pedersen, et al, 2008). It is interesting to note that this discussion reflected much of what discussed in the class handout titled, “AMCD Multicultural Counseling Competencies” (Arredondo, et al, 1996).

An Ecclectic MAP/FACTS Approach. Alongside this ongoing commitment to the development of key skills as they relate to inclusive cultural empathy, is the need to utilize what our textbook describes as an eclectic approach, (Hays, 2008, p176):

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176)

Firstly utilizing the “Addressing Model” in a modified Axis-6 relevant to the DSM-5 (Hays, 2008), it will be essential to assess for sociocultural context throughout the counseling process, (Hays, 2008). Additionally, ongoing case conceptualization in the form of ongoing hypothesis formulation and testing will be important (Johnson, 2013; Pedersen, et al, 2008; Thomas 2007).  This ongoing hypothesis testing can occur much as described in the five-part FACTS Method approach including question formulation based on a knowledge and experience, and then assessing and adjusting as necessary, (Hays, 2008; Johnson 2013; Pedersen, et al, 2008; Thomas, 2007).   In conclusion, I wrap up this paper with a quote from an article titled “The relationship of culture and empathy in cross-cultural counseling.” (Chung & Bemak, 2002) This article contains a listing of seven useful guidelines in communicating cultural empathy:

“Counselors will not be effective working with clients from different cultural backgrounds if they cannot communicate cultural empathy in a way that demonstrates that they understand and appreciate the cultural differences and their impact on the therapeutic process.   Ridley (1995) identified the following seven guidelines for communicating cultural empathy….(a) describe in words to the client his/her understanding of the client’s self-experience; (b) communicate an interest in learning more about the client’s culture; (c) express lack of awareness regarding the client’s cultural experience; (d) affirm the client’s cultural experience; (e) clarify language and other mods of cultural communication; (f) communicate a desire to help the client work through personal struggles and challenges; and, (g) at an advanced level, help the client learn more about himself or herself and become more congruent.” (Chung & Bemak, 2002, p157)

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