Does establishing good empathy facilitate hypnosis or does hypnosis provide an accelerated path to empathy?

Peter Naish posed this question in an email that generated quite a discussion on the topic, and it intrigued me enough to start putting pen to paper and draft this blog.

Firstly, I guess we need to define terms. Empathy is defined as being able to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.

Psychologists describe three types of empathy: cognitive, emotional and compassionate. Cognitive empathy implies that you can see the other person’s point of view, and is not necessarily accompanied by emotional empathy, which is when you feel the other person’s emotions. Most of us have experienced times, when dealing with anxious or depressed patients, that we start to feel tense or low ourselves through emotional contagion. This is the main reason why those working with distressed people need to be able to shut off or compartmentalise their work to avoid being overwhelmed and burnt out by these feelings. Finally, compassionate empathy is what we usually understand as compassion; the ability to feel someone’s pain and distress, but with the addition of trying to help them.

Grahame Smith remembered Elvira Lang’s interesting paper ‘when being nice does not suffice’ can be counterproductive. She talks about an ‘incomplete empathic approach’ and it appears that ‘non-specific support without providing means of managing acute pain and anxiety may do more harm than good’. This has huge implications for those working in a clinical context; we need to do more than just ‘sympathising’.

As Cathryn Woodward said ‘empathy has to be felt, the other person needs to feel you understand and care. Structured empathy becomes regimented kindness, or even worse, sympathy, not at all conducive to rapport or hypnosis’.

This then starts to feel a lot like rapport. Charlotte Davies mused on the difference between rapport and empathy. Rapport denotes a relationship of mutual understanding and trust between two people and requires the ability to put oneself in the position of another. So empathy is an important skill in developing rapport.

As Peter Naish remarked ‘empathy need only be one-way. I can feel your situation acutely, but you may have no link with me whatsoever. Rapport, in contrast, is two-way and we are attuned. One of the essential elements of rapport is that the patient feels the empathy from the clinician. That, I suspect, is a very important element of any ensuing successes. Perhaps it’s one of the elements absent from most academic research situations. That might lead one to conclude that hypnosis does not depend upon empathy or rapport for its induction, but that more can be achieved if rapport is present’.

So perhaps empathy does facilitate hypnotic induction…. but rapport does better. As hypnosis develops and deepens, the rapport between patient and hypnotist grows. As Les Brann remarked there have been some studies that show the EEGs of client and therapist starting to synchronise during the induction process.

Maybe mirror neurones 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, have some part to play in empathy. There is some evidence out there that seems to imply that some autistic symptoms are due to a lack of these mirror neurones.

So, going back to Peter Naish’s original questions – does good empathy facilitate hypnosis? I think the answer is a qualified yes. Rapport includes empathy together with non-judgmental caring and compassion.

As to whether hypnosis provides an accelerated path to empathy, again I think a qualified yes. Hypnosis training helps us to be aware of what we say and to develop the ability to be aware of the effect on the other of the words we use. As caring health professionals, we need to develop the ability to step into the other’s shoes but maybe to keep on our own shoes at the same time.

An 1848 dictionary definition of rapport talks about it being sympathy, an emotional bond, a connection and interestingly a ‘state in which mesmeric action can be exercised by one person on another’. So, rapport and hypnosis were interlinked even then.

I will finish this blog with Maureen Tilford’s contribution: Carl Roger’s 1980 definition of empathy from his book ‘A way of being’.
Empathy…. ‘means entering the private perceptual world of the other and becoming thoroughly at home in it. It involves being sensitive, moment by moment, to the changing felt meanings which flow in the other person, to the fear or rage or tenderness or confusion or whatever that he or she is experiencing. it means temporarily living in the others life, moving about in it delicately, without making judgements.’