Posts tagged: sympathy

Support Subtypes

Business Logo for Psychological and Neuropsychological IssuesTo support someone is to render assistance.  The person in need of assistance may be overwhelmed with physical tasks, cognitive demands or emotional reaction(s).  The act of supporting another person may be divided along these lines.  To assist others with physical labor speaks for itself.  It is the most observable of the support subtypes, and the outcome lends itself to measurement.  To offer cognitive/thinking assistance is typically less obvious than direct physical support.  It is still observable and the outcome is measurable.  The offer of emotional support is the least observable and its effect is typically difficult to measure.  This begs the question whether the subtype of emotional support is of less worth than physical and cognitive support.

The difficulty in observing and measuring emotional support may account for its discounted importance.  If you help a neighbor erect a barn, that barn will stand as a monument to your physical support for many years.  If you assist an aged relative with their finances, their continued independence is a monument to your provision of cognitive support.  If you spend hours wiping away the tears of a recently widowed neighbor, rendering them emotional support, how will you know if it was helpful?  Perhaps it did not help them work through the grieving process, whatsoever.  Perhaps the emotional support merely encouraged them to wallow in self-pity.

This is a similar issue as those who suffer with chronic pain.  Unless others are able to physically visualize the damaged body part, they will tend to progressively discount the suffering of the afflicted over time.  Even if someone spends a thousand percent more time lending emotional over physical support, most people will only be aware of and reward the results seen with their own eyes.  This is to be expected and has good face validity.  There is a greater level of confidence if something is seen rather than inferred or communicated symbolically.  It is as if the world states,”It’s nice you held their hand, but what did you really do for them?”

Perhaps it is less the global worth of each support subtype, than what type of support would be most helpful at a given moment in time.  After a bout of incontinence, it is better to clean the person’s undergarments than hold their hand.  It may be helpful to hold their hand after the garments are cleaned, but the primary need for physical support is quite clear.  On the other hand, if a relative is already placed in a nursing facility, the act of giving physical support may be discouraged by the facility.  The relative worth of a nursing center is realized in its ability to provide physical support.  Most nursing centers encourage significant others to provide cognitive and emotional support.  The provision of cognitive support is typically managed by a relative acting as a power of attorney.  This type of support is cannot be provided by an institution, since it would be a conflict of interest.  The role of social work is to offer both cognitive and emotional support, but all to often, nursing facilities lack a sufficient number of social workers to offer emotional support.  Their hands are full with admission and discharge paper work, which is of critical importance, but limits the time they may employ in what is regarded as support of a secondary nature.

Modern nursing facilities often look to activities therapy staff to provide emotional support, or at least distraction from emotional issues.  This is not the task most of these staff were trained to perform, and it may distract them from the primary mission of providing cognitive stimulation.  It is as if emotional support were a bastard child that is placed with increasingly distant relatives.  Because of these complications, the role of emotional support tends to fall squarely on the shoulders of friends and family.  The most common mistake of the family is to offer physical support in lieu of emotional.  Many family members are critical of the physical support received by their loved one, and often jump in to change or clean the resident of a nursing facility.  This is commonly the result of a guilty conscious.  The caretaker is unable to provide effective care for their loved one in their own home.  In this situation, the relation is providing physical support in an effort to achieve personal emotional support for their own guilt.  Offering physical support to an institutionalized person is rarely appreciated by the person, and is actively discouraged by the nursing center.  It is not the type of support needed from friends and family of an institutionalized person.

The act of providing emotional support is largely measured in the negative.  For example, the resident is not depressed or the resident is not acting-out aggressively.  If the resident is compliant and seemingly happy, it is presumed they are receiving adequate emotional support.  Conversely, if an institutionalized person is depressed or hostile, a lack of familial support is often assumed by the staff.  Emotional support is typically measured by the absence of emotional problems.  This is an inaccurate and sometimes dangerous inference.  All too often smiling friendly people fall to tears after a five minutes of unstructured conversation.  A person’s facial expression and behavior are important clues into their emotional life, but are not by any means a road map.

Unlike physical and cognitive support, do not expect others to acknowledge or appreciate the provision of emotional support.  It typically lacks the emergent and observable nature of physical and cognitive support.  The importance of emotional support assumes a back seat to physical and cognitive support when a person lives in the community.  It moves to the front seat when they reside in an institution.  The individual needs of a person will define the subtype and possible worth of a supportive intervention.   The nature and magnitude of their needs are highly dependent on the environment.  Regardless of the particular environment, though, it is rarely wrong to offer emotional support.  Managing the finances of a independent clear thinking person is usually wrong.  Changing your mother’s bandage in the hospital is always wrong, and may result in the prohibition of further visits.  Offering sympathy is rarely rewarded, and it may not be critically necessary, but it is almost always correct.  How can something be considered of little worth if it always has some value?

Empathic Listening

Business Logo for Psychological and Neuropsychological IssuesEmpathy may be defined as the identification with the thoughts, feelings and attitudes of another person.  It sounds like something people experience every day, but it is more an exception than the rule.  If empathy was the rule, the norm, the world would be a much different place.  Empathy runs counter to the human need for people to differentiate themselves from other people.  It runs counter to the need for groups to differentiate themselves from other groups.  It is the proverbial act of putting oneself in the shoes of another person.  Psychotherapists often label the active process of  this identification as empathic listening.

The meaning of empathy is not synonymous with sympathy.  Sympathy is to be in agreement with the thoughts and feelings of another; even to share similar thoughts and feelings as the other person.  This is not the goal of most psychotherapeutic schools, since it may bring a loss of objectivity.  For example, a depressed person may engage in many thoughts and beliefs that enable the depression to flourish.  A sympathetic psychologist may become lost in the many instances of bad luck or even tragedy that befall the person.  Sympathy will render the psychologist blind to the maladaptive aspects of the patient’s behavior, since they are actively and uncritically ingesting the depression of their patient.  Similarly, an anxious patient may experience many negative outcomes as a consequence of their anxiety.  A psychologist that chronically feels sorry for their anxiety is certainly sympathetic, and this may serve to validate the patient’s perceptions, but it is unlikely to alleviate their anxiety in a meaningful fashion.

The act of identification with the patient’s feelings and thoughts will often produce an emotional or intellectual reaction in the psychologist.  A true professional has performed enough personal discovery to understand what their reaction signifies.  For example, many psychologists comment that they become uncomfortable with borderline personality disorder patients.  A well-trained psychologist is aware of their emotional triggers in order to use this information in the service of their patient.  Perhaps the disassociation between the patient’s facial expression(s) and speech reminds the psychologist of their mother.  To become sympathetic to this symptom, or worse enraged, will occur if the psychologist lacks the personal knowledge to understand the historical nature of their reaction.  An empathetic listener identifies with the borderline patient’s thoughts and feelings, but does not lose the critical awareness of their own reactions.  It is the process of understanding and entering into the patient’s thoughts and feelings without falling into a pit of subjectivity.

Empathic listening is less a trait possessed by gifted people than a skill that is learned in a rigorous fashion.  Training to become a psychologist requires many hours of clinical supervision.  Students bring in tapes of psychotherapy sessions and the professors rake the students over the coals of their psychopathology.  It is not uncommon for many students to cry or become angry at the professor’s comments, since they may strike at the heart of what makes us a person.  No one likes to hear someone they respect say, “Why the hell did you say that?”  It is even more threatening when the professor gives a short description of the student’s pathology, and how their mistake will derail the psychotherapy.  It is a highly uncomfortable and valuable process when performed diligently.  It more comfortable and less useful if the professor seeks to spare the student’s feelings-to sympathize with their plight.  Empathic listening is a skill that every competent psychologist must acquire.  Empathic listening is a major factor that differentiates psychotherapy from ordinary conversation.  As a general rule, friends are sympathetic and shrinks are empathetic.

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