The Relationship of Culture and Empathy in Cross-Cultural Counseling

Clients' and genetic counselors' perceptions of empathy in Japan: A pilot study of simulated consultations of genetic counseling

The rapidly increasing availability of genetic testing is driving the acceleration of genetic counseling implementation. Empathy is important in medical encounters in general and forms a core component of a successful genetic counseling session; however, empirical evidence on empathy in genetic counseling is minimal. This study aimed to explore the perceptions of empathy in simulated genetic counseling consultations from the perspectives of clients and genetic counselors. Semi-structured interviews and interpersonal process recall were used with participants of simulated genetic counseling consultations to elicit their experiences of empathy. A constructivist grounded theory was used for data analysis. A total of 15 participants, including 10 clients and 5 genetic counselors, participated in 10 simulated counseling sessions. The genetic counselors attempted to demonstrate empathy and were sensitive toward detecting changes in clients. Meanwhile, the clients' perceptions represented their feelings and thoughts elicited through the counselors' empathic approaches. This was the first process study to examine empathy in simulated genetic counseling sessions. Our model of communication of empathy is a process in which counselors try to address implicit aspects of clients, and clients are provided with time and a safe place for introspection, which contributes to discussions on building good relationships with patients. There is also a suggestion of the utility of simulated consultations for healthcare providers to learn empathic communication.

Psychometric Validation of the Scale of Ethnocultural Empathy in a Sample of Undergraduate and Graduate Students in Rehabilitation: A Brief Report

Ethnocultural empathy is one of the most important multicultural competencies in counseling psychology. Wang et al. developed the Scale of Ethnocultural Empathy (SEE) for counseling psychology educators as an outcome variable to evaluate multicultural counseling competencies of counselors-in-training. The purpose of this study was to evaluate the measurement structure of the SEE in a sample of undergraduate and graduate students in rehabilitation. Confirmatory factor analysis results indicated that the four-factor intercorrelated model fit the data very well. The four factors include (a) empathic feeling and expression, (b) empathic perspective taking, (c) empathic awareness, and (d) acceptance of cultural differences. The SEE can be an invaluable tool for rehabilitation counselor educators to evaluate their students’ level of multicultural rehabilitation counseling competency and as an outcome variable for multicultural rehabilitation counseling training.

The Association Between Racial Privilege and Ethnocultural Empathy

Racial minorities living in U.S. society hold fewer privileges in day-to-day life than those in the racial majority. Some propose that the shared experience of a lack of racial privilege among minorities may promote increased empathy for people of other ethnicities and cultures, although there is a lack of evidence demonstrating this empirically. In this study, we examine the intersection of racial privilege and ethnocultural empathy in a diverse sample ( N = 404) of U.S. residents recruited using Amazon’s Mechanical Turk. Results indicated statistically significant differences in racial privilege and ethnocultural empathy between racial groups such that White participants had higher levels of racial privilege than racial minority participants and lower levels of ethnocultural empathy than Black participants. Results further suggested that the difference in ethnocultural empathy between White and Black participants remained even after racial privilege was controlled for statistically. These results integrate and advance research on the intersection between racial privilege on ethnocultural empathy.

Exploring the enablers and microfoundations of international knowledge transfer

Purpose

The purpose of this paper is to examine the enablers and barriers influencing international knowledge transfer at the team-level in the context of product innovation within an emerging-market multinational enterprise (EMNE) in the insurance industry.

Design/methodology/approach

The research applies an exploratory case study design considering an emerging-market multinational insurance company headquartered in Colombia. Four subsidiaries (El Salvador, Chile, Argentina and Colombia) and the Corporate Office (headquarter) served as the research sites. It also adopts an interpretive research approach providing a grounded theory framework linking international knowledge transfer and product innovation.

Findings

The empirical findings emphasize the central role played by the enablers (i.e. shared vision, empathy and knowledge sources) in facilitating international knowledge transfer, which, in turn, enhances product innovation. More important, however, is the detailed explanation that the paper provides regarding the enablers’ microfoundational antecedents in terms of key activities that are performed at the team-level.

Research limitations/implications

The grounded theory framework was constructed using data collected in a single firm associated with a particular industry and regional context. The study only considered a single aspect of knowledge management (i.e. knowledge transfer). Other aspects of knowledge management systems, such as knowledge creation and knowledge application, should be used for explaining product innovation in EMNEs more comprehensively.

Practical implications

The study suggests a set of enabling conditions and activities that should be adopted by managers of EMNEs to improve international knowledge transfer with the aim of triggering product innovation. This includes the design of strategies for strengthening empathy among geographically dispersed teams by providing opportunities for regular live videoconferences among team members aimed at building close bonds, fostering trust and creating a sense of belonging in which participants get to know each other better and to establish a shared vision and a set of guiding principles and commitments for how the team will work. These suggestions are particularly important today when several multinational enterprises (MNEs) have been forced to rearrange their workplace by replacing face-to-face interactions with virtual work dynamics due to the COVID-19 crisis.

Originality/value

Previous studies have confirmed that international knowledge transfer positively influences MNEs’ innovative performance. However, no studies have been conducted linking both variables in the context of EMNEs in Latin America in the service sector. The research tries to fill this gap. Besides, the paper introduces empathy as a novel enabler for international knowledge transfer and a moderator able to diminish the negative effect that cultural differences and geographical barriers have on the knowledge transfer process.

Factors affecting the cultural competence of visiting nurses for rural multicultural family support in South Korea

Background

With the recent growth of multicultural families in the Korean society, the importance of the role of qualified visiting nurses in the delivery of culturally sensitive health care has grown dramatically. As the primary health care provider for multicultural families enrolled in public community-based health care centers, the cultural competence of visiting nurses is an essential qualification for the provision of quality health care for multicultural families, especially in rural areas. Cultural competence of visiting nurses is based on their cultural awareness and empathetic attitude toward multicultural families. This study aimed to examine the levels of cultural competence, empowerment, and empathy in visiting nurses, and to verify the factors that affect the cultural competence of visiting nurses working with rural multicultural families in South Korea.

Methods

Employing a cross-sectional descriptive study design, data from 143 visiting nurses working in rural areas were obtained. Data collection took place between November 2011 and August 2012. The measurement tools included the modified Korean version of the Cultural Awareness Scale, the Text of Items Measuring Empowerment, and the Interpersonal Reactivity Index to measure the level of empathy of visiting nurses. Analyses included descriptive statistics, a t-test, an ANOVA, a Pearson correlation coefficient analysis, and a multiple linear regression analysis.

Results

The cultural competence score of the visiting nurses was 3.07 on a 5-point Likert scale (SD = 0.30). The multiple regression analysis revealed that the cultural competence of visiting nurses was significantly influenced by experience of cultural education, empathy, and scores on the meaning subscale of the empowerment tool (R² = 10.2%).

Conclusions

Institutional support to enhance visiting nurses' empowerment by assuring the significance of their job and specific strategies to enhance their empathy would be helpful to improve the cultural competence of visiting nurses. Additionally, regular systematic education on culturally sensitive care would be helpful to enable visiting nurses to provide culturally sensitive care for multicultural families.

Latino Sexual Beliefs Scale: An Exploratory Factor Analysis of Latino Men Who Have Sex With Men

The catalyzing forces behind risky sexual behavior are a rich area of interest for public health researchers concerned with reducing HIV risk. Social cognitive theory would suggest that sexual beliefs are a viable example of one such influential agent. Recognizing that culture plays an important role in forming such sexual beliefs, and seeking to understand the unique HIV risks present for Latino men who have sex with men (MSM), this article presents an exploratory factor analysis of the 13-item Latino Sexual Beliefs Scale (LSBS) created as part of a larger study to investigate predictors of condom use among a sample of 482 MSM born in Brazil, Colombia, and the Dominican Republic and living in the U.S. The current analysis identified two psychometric factors in the LSBS as Romantic Exigency (containing six items with a mean loading of .62) and Sexual Acquiescence (containing seven items with a mean loading of .57). This is the first factor analysis conducted on the 13-item LSBS and represents the first known quantitative measure of Latino cultural sexual beliefs related to condom use for Latino MSM. Implications for future research include further validation, use in studies exploring the role of sexual beliefs on condom use, and possible thematic targets in HIV risk reduction interventions.

Relating Therapist Characteristics to Client Engagement and the Therapeutic Alliance in an Adolescent Custodial Group Substance Misuse Treatment Program

BACKGROUND

Client engagement in substance misuse treatment programs is directly associated with positive treatment outcomes. The nature of these programs means there are often difficulties engaging and retaining clients, but authors have consistently found a strong therapeutic alliance is associated with client engagement. While research has focused on the association between the alliance and engagement, the factors that influence the therapeutic alliance have received less attention.

OBJECTIVE

To examine therapists' characteristics, namely therapists' stress and empathy levels, as potential predictors of client engagement and the therapeutic alliance, within an adolescent substance misuse group treatment program.

METHOD

The sample included 84 adolescent clients and 14 therapists from a Secure Training Centre in England. Client engagement in the treatment program was observed, while self-reporting measures assessed the therapeutic alliance (client and therapist-rated), and therapists' stress and empathy levels.

RESULTS

Multiple regression analysis revealed that therapists' stress levels negatively influenced the therapeutic alliance and had a curvilinear relationship with client engagement, indicating that stress is not exclusively negatively related to engagement. Although stress was found to negatively impact both cognitive and affective empathy, neither cognitive nor affective empathy were significantly related to client engagement or the therapeutic alliance.

CONCLUSIONS

This study demonstrates the importance of therapist characteristics on client engagement and the therapeutic alliance. Within practice stress can have a positive impact on clients' engagement. Nevertheless, therapists may need additional support to deal with stress effectively. Therapists' empathy may too be fundamental to client engagement, but only it if is perceived by clients.

Culture and nonverbal expressions of empathy in clinical settings: A systematic review

OBJECTIVE

To conduct a systematic review of studies examining how culture mediates nonverbal expressions of empathy with the aim to improve clinician cross-cultural competency.

METHODS

We searched three databases for studies of nonverbal expressions of empathy and communication in cross-cultural clinical settings, yielding 16,143 articles. We examined peer-reviewed, experimental or observational articles. Sixteen studies met inclusion criteria.

RESULTS

Nonverbal expressions of empathy varied across cultural groups and impacted the quality of communication and care. Some nonverbal behaviors appeared universally desired and others, culturally specific. Findings revealed the impact of nonverbal communication on patient satisfaction, affective tone, information exchange, visit length, and expression decoding during cross-cultural clinical encounters. Racial discordance, patients' perception of physician racism, and physician implicit bias are among factors that appear to influence information exchange in clinical encounters.

CONCLUSION

Culture-based norms impact expectations for specific nonverbal expressions within patient-clinician dyads. Nonverbal communication plays a significant role in fostering trusting provider-patient relationships, and is critical to high quality care.

PRACTICE IMPLICATIONS

Medical education should include training in interpretation of nonverbal behavior to optimize empathic cross-cultural communication and training efforts should accommodate norms of local patient populations. These efforts should reduce implicit biases in providers and perceived prejudice in patients.

Mothers' perinatal and infant mental health knowledge in a Johannesburg township setting

OBJECTIVE

This paper examines maternal knowledge regarding perinatal and infant mental health amongst mothers in Alexandra township, Johannesburg. The applicability and utility of these Western-derived concepts in a low socio-economic South African setting is examined.

METHOD

A concurrent mixed methods approach was used. Descriptive statistical analysis was conducted on the responses of 255 mothers on a structured questionnaire, designed to elicit levels of knowledge about the relational needs and awareness of infants and the psychosocial needs of mothers, to determine trends in mothers' knowledge. A thematic content analysis was also conducted on the responses to determine themes and understandings within the mothers' responses.

RESULTS

Maternal knowledge in Alexandra regarding perinatal and infant mental health correlates with maternal education levels. Cultural, contextual and psychological factors appear to influence maternal understandings of infant sentience and maternal ambivalence.

CONCLUSIONS

Further research is required to determine possible contributions of the denial of negative maternal affect post-birth to elevated levels of post-natal depression found amongst South African mothers parenting in adverse circumstances. There is a need for education regarding key messages from the neuroscience of development, to give these parents opportunities to raise their children in a way that supports healthy cognitive and emotional development.

Age, Gender, and Ethnicity of Counsellor Trainees and Corresponding Counselling Self-Efficacy: Research Findings and Implications for Counsellor Educators

This study explored the counselling self-efficacy of students in a counsellor education programme, in regard to age, gender, and ethnicity characteristics. To assess counselling self-efficacy, the Counselling Self-Estimate Inventory (COSE) of Larson et al. (Counsellor Education & Supervision 41: 120-130, 1992) was administered at the end of a semester to counselling students engaged in different stages of a counsellor training program. No significant differences were found in regard to gender and age-group categories, but significant differences were found among ethnic groups. It was found that Asian and White students generally had similar and also lower counselling self-efficacy means than the other ethnic groups in the sample in regard to several counselling-specific categories. Implications for counsellor educators in training counselling students of diverse characteristics are discussed.

Look to the relationship: a review of African American women substance users' poor treatment retention and working alliance development

Emergent findings specific to African American women confirm that their substance user treatment retention rates are significantly lower than other groups, which is problematic given that substance user treatment is effective largely to the extent that clients are retained in treatment. This article reviews existing literature concerning disparities in treatment retention, highlights a significant barrier to treatment retention for this population, and presents support for an empirical focus on culturally responsive working alliance development as a promising step toward improving retention rates for African American women substance users.

The effects of ethnocultural empathy on level of stereotyping toward college athletes

In the current study the author examined whether ethnocultural empathy affects people's beliefs and expectations regarding athletes, hypothesizing that (1) individuals demonstrating a high level of ethnocultural empathy would be less likely to endorse stereotypes toward athletes, (2) females would be less likely to stereotype toward athletes than would males, (3) athletes would be less likely to stereotype toward athletes than would non-athletes, and (4) behavioral science majors would be less likely to stereotype toward athletes than would non-behavioral science majors. As predicted, participants high on ethnocultural empathy were less likely to stereotype towards athletes, females were less likely to stereotype toward athletes than were males, and behavioral science majors were less likely to stereotype toward athletes than were non-behavioral science majors. However, contrary to the hypotheses, athletes were more likely to stereotype toward their own in-group than were non-athletes.

Gender Differences in Ethnocultural Empathy and Attitudes Toward Men and Women in Authority

The relationship between attitudes toward members of ethnic or cultural minority groups and men and women in authority or leadership positions was examined. The Ethnocultural Empathy Scale and Gender Authority Measure were completed by 317 participants. Results yielded a positive relationship among the attitudinal measures, indicating that individuals who express more empathy toward individuals from diverse ethnic or cultural backgrounds are likely to have positive perceptions of women in authority/leadership positions. Furthermore, gender differences in perceptions suggest that, relative to males, females are more likely to report higher levels of ethnic or cultural empathy and also have higher preference for women in leadership and authority positions.

Impact of Patient Empathy Modeling on pharmacy students caring for the underserved

OBJECTIVE

To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE).

DESIGN

Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student "became the patient," simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper.

ASSESSMENT

Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles.

CONCLUSION

A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise.