What is empathy?


Empathy is a term which has proven difficult for academics to define to their satisfaction. Yet doctors, patients, and lay people do not seem to have any trouble understanding what they mean by empathy. The extent to which empathy is a communication skill, an inner experience of the counselor, or the client's perception is also controversial.

What remains uncontroversial in the literature we are aware of is that patient experience and patient outcomes seem to improve when they interact with 'empathetic' practitioners (either practitioners who are rated by patients as being empathetic or practitioners who have been trained to enhance their empathy).



Decety J (2014). Clinical Empathy From Bench to Bedside. Boston: The MIT Press.

Coplan A, Goldie P (2011). Empathy: Philosophical and Psychological Perspectives. Oxford: OUP.

Jeffrey D (2016). Clarifying empathy: the first step to more humane care British Journal of General Practice;66:101-102.

Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al. ‘Let me see if I have this right…’: Words that build empathy. Annals of Internal Medicine 2000;135(3):221–7.

Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Education and Counseling 2009;74(3):339–46.



"When I use a word... a word about empathy" (2016) BMJ Blog about the recent history of empathy and its meaning by Jeffrey Aronson



Empathy is the ability to understand and appreciate another person’s feelings and experience

1946: Self Portrait with Friends: Sel. Diaries Cecil Beaton (1979) xviii. 241

It is her [sc. the Queen Mother's] empathy and her understanding of human nature that endears her to everyone she talks to.

1958: C. P. Snow Conscience of Rich xxxiii. 240  

It was not only consideration and empathy that held him back.

1963: R. L. Katz Empathy i. 8 

It is true that in both sympathy and empathy we permit our feelings for others to become involved.

1983: Guardian Weekly 9 Oct. 10

Some of her [sc. Margaret Thatcher's] opponents snobbishly underestimated her popular appeal and her empathy with middle-class, Middle England.

2012: Jerusalem Post (Nexis) 30 Mar. 8

Sometimes just listening and showing empathy can be helpful—not therapeutic, but helpful to show that you know what he's going through.

Source: "empathy, n.". OED Online. December 2015. Oxford University Press. http://ezproxy-prd.bodleian.ox.ac.uk:2355/view/Entry/61284?redirectedFrom=EMPATHY (accessed January 20, 2016).

2. “Affective empathy” refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety.”

Source: Berkeley Greater Good Definition of Empathy 

3. “Cognitive empathy,” sometimes called “perspective taking,” refers to our ability to identify and understand other peoples’ emotions. Studies suggest that people with autism spectrum disorders have a hard time empathizing.

Source: Berkeley Greater Good Definition of Empathy 

4. ““Compassionate empathy,” which I’ve written about using the term “empathic concern” (see Chapter Six in Social Intelligence). With this kind of empathy we not only understand a person’s predicament and feel with them, but are spontaneously moved to help, if needed.”

Source: Golman D. Three kinds of empathy: cognitive, emotional, compassionate.

5. These different components [of empathy] include:

Affective sharing, the first element of empathy to appear during ontogeny. It reflects the capacity to become affectively aroused by the valence and intensity of others’ emotions.
Empathetic understanding, which entails the conscious awareness of the emotional state of another person.
Empathetic concern, which refers to the motivation to care for someone’s welfare.
Cognitive empathy, similar to the construct of perspective taking or theory of mind is the ability to put oneself into the mind of another individual and imagine what that person is thinking or feeling 
(Decety and Jackson, 2004; Goubert et al., 2009; Singer and Lamm, 2009; Derntl et al., 2010; Decety, 2011; Decety and Cowell, 2014).

Source: Decety, J. and Fotopoulou, A. (2014), 'Why empathy has a beneficial impact on others in medicine: unifying theories', Front Behav Neurosci, 8, 457.

6.  Empathy seems to have deep roots in our brains and bodies, and in our evolutionary history. Elementary forms of empathy have been observed in our primate relatives, in dogs, and even in rats. Empathy has been associated with two different pathways in the brain, and scientists have speculated that some aspects of empathy can be traced to mirror neurons, cells in the brain that fire when we observe someone else perform an action in much the same way that they would fire if we performed that action ourselves. Research has also uncovered evidence of a genetic basis to empathy, though studies suggest that people can enhance (or restrict) their natural empathic abilities.

Source: Berkeley Greater Good Definition of Empathy 

7.  “Given these multifaceted aspects of empathy, there is no single region in the brain that underlies this ability. Rather, the circuits involved in emotional saliency (amygdala, insula and anterior cingulate cortex), central executive network (dorsolat- eral prefrontal cortex, posterior parietal cortex), and caregiv- ing (brainstem, hypothalamus, basal ganglia, and ventromedial prefrontal cortex) constitute independent and tightly coupled networks that support the experience of empathy (Decety and Cowell, 2014). Furthermore, the neural pathways involved empa- thy and caring are facilitated and modulated by neuroendocrine mechanisms. In particular, the neuropeptide oxytocin, which plays a general role in social interactions by reducing stress and anxiety (Anacker and Beery, 2013; Cardoso et al., 2013), and as a result enhances cognitive empathy (Rodrigues et al., 2009) and empathic concern (Shamay-Tsoory et al., 2013; Smith et al., 2014).”

Source: Decety, J. and Fotopoulou, A. (2014), 'Why empathy has a beneficial impact on others in medicine: unifying theories', Front Behav Neurosci, 8, 457.

8. Empathy can be defined ostensively as a series of practitioner behaviours. Several recent trials have trained doctors to enhance their empathic behavior:

“The training was delivered to GP during a 4-hour meeting by 3 pairs of trainers acting as facilitator and expert. Each pair trained a group of 36 GP, who discussed issues in groups of 6. Each group discussed pain evaluation and management in patients with OA and was asked to make 10 recommendations to improve pain management. The trainers had to ensure that recommendations proposed by GP were in line with the 10 items worded by the authors (Table 2). After the training, 8 reminders emphasizing these recommendations and including national guidelines on chronic pain management21 were mailed to the participants. GP were also asked to give their patients a list of 5 statements about pain relief (Table 3).” 

Chassany, O., et al. (2006), 'Effects of training on general practitioners' management of pain in osteoarthritis: a randomized multicenter study', J Rheumatol, 33 (9), 1827-34.

"Knowing: the patient’s history, social talk, Encouraging: back-channelling (‘hmm’, ‘ahh’), Physically engaging: hand gestures, appropriate contact, slight lean towards the patient, Warm: Warm up: Cooler and professional but supportive at the beginning of the consultation; Avoid coolness, dominance, patronising, non-verbal cut-offs (for example, looking away from the patient) at the end of the consultation" 

Little, P., et al. (2015), 'Randomised controlled trial of a brief intervention targeting predominantly non-verbal communication in general practice consultations', British Journal of General Practice, 65 (635).

“The training was comprised of three 60-minute modules spaced over 4 weeks, delivered to groups of 6–15 residents in the same specialty in both inpatient and outpatient settings. The training protocol had the following objectives:

To provide the scientific foundation for the neurobiology and physiology of empathy training;
To increase awareness of the physiology of emotions during typical and difficult patient–physician interactions;
To improve skill in decoding subtle facial expressions of emotion; 
To teach empathic verbal and behavioral responses with self-regulation skills utilizing diaphragmatic breathing exercises and mindfulness practices.

Videos of clinical interactions with real-time physiological responses utilizing skin conductance tracings allowed physicians to see the physiological concordance or discordance between themselves and their patients and the degree to which patient and physician are physiologically activated by challenging attitudes (e.g., arrogance, entitlement, dismissive behaviors).” Riess, H., et al. (2012), 'Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum', J Gen Intern Med, 27 (10), 1280-6.

9. The consultation and relational empathy (CARE) measure of practitioner empathy (patient rated).

Source: Mercer, S. W., et al. (2004), 'The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure', Fam Pract, 21 (6), 699-705.

10. The Jefferson Scale of Physician Empathy (clinician rated). 

Source: Hojat, M., et al. (2002), 'The Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level', Acad Med, 77 (10 Suppl), S58-60.

11. Empathy: The Human Connection to Patient Care

Source: The Cleveland Clini



1. Empathy: The Human Connection to Patient Care
Source: The Cleveland Clinic

2. Introduction to Empathy
Source: Study.com

3. Difficult patient - angry about office wait - empathic 
Source: Physician Health Program British Columbia 

4. Difficult patient – angry about office wait –realistic
Source: Physician Health Program British Columbia 

5. Showing Empathy 2
Source: UK Council of Clinical Communication

6. Empathy 101 Phil-Dun-Empathy
Source: https://www.youtube.com/watch?v=7hFAv8z8xmw