A Comparison of the Construct Validities of Four Measures of Empathy

Three types of ambiguity in coding empathic interactions in primary care visits: implications for research and practice

OBJECTIVE

To describe three methodological challenges experienced in studying patients' expressions of emotion in a sample of periodic health exams, and the research and practice implications of these challenges.

METHODS

Qualitative analysis of empathic cues in audio-taped and transcribed periodic health examinations of adult patients (n=322) in an integrated delivery system. The empathic and potential empathic opportunities methodology was used.

RESULTS

Identifying emotional cues that constitute "empathic opportunities" is a complex task. Three types of ambiguity made this task particularly challenging: 1) presentations of emotional cues can be "fuzzy" and varied; 2) expressions of illness can be emotionally laden in the absence of explicit "emotion words"; and 3) empathic opportunities vary in length and intensity.

CONCLUSION

Interactional ambiguities pose a challenge to researchers attempting to document emotional cues with a binary coding scheme that indicates only whether an empathic opportunity is present or absent. Additional efforts to refine the methodological approach for studying empathy in medical interactions are needed.

PRACTICE IMPLICATIONS

The challenges discussed likely represent the same types of situations physicians find themselves in when talking with patients. Highlighting these ambiguities may aid physicians in better recognizing and meeting the emotional needs of their patients.

Biopsychosocial elements of empathy: a multidimensional model

Empathy is a topic of growing concern in a variety of disciplines. Although considerable empathy research is reported, often single dimensions of a multidimensional and multiphasic construct are actually being studied. Empathy is a unitary construct involving biopsychosocial components and is particularly well suited for nursing study because of its theoretical congruence with nursing philosophy and concerns. Empathy's importance goes beyond the usual emphasis on helper empathy. Although commonly associated with prosocial behavior, empathy involves underlying processes which may be used for either positive or negative social purposes. Recent technological improvements in research methodology, concerns regarding social violence, and conceptual shifts have led to greatly increased interest in the phenomenon of empathy and an expanded research thrust. One major recent change in empathy research is the tendency to view the phenomenon as multidimensional and consequently to include a variety of measures to capture different elements of the construct. This paper reviews the major approaches to measurement of empathy and classifies these approaches according to the dimensions of empathy that they measure. Physiological change in association with empathy is less frequently measured, but because empathy is commonly assumed to include an emotional response to another, concomitant physiological changes should accompany the emotional aspect of empathy and indicators of physiological response may be appropriate measures to include in nursing studies of empathy. A conceptualization of empathy is presented that considers empathy to be a multidimensional phenomenon, with emotional, cognitive, communicative, and relational components. Because empirical approaches can only examine the most easily measured aspects of empathy, phenomenological approaches are also needed to begin to capture the total construct.