Teaching Empathy to Mental Health Practitioners and Trainees

Ngo, H., Sokolovic, et al. (2022).

Journal of Consulting and Clinical Psychology,

90(11), 851–860.

https://doi.org/10.1037/ccp0000773

Objective:

Empathy is a foundational therapeutic skill and a key contributor to client outcome, yet the best combination of instructional components for its training is unclear. We sought to address this by investigating the most effective instructional components (didactic, rehearsal, reflection, observation, feedback, mindfulness) and their combinations for teaching empathy to practitioners.

Method: 

Studies included were randomized controlled trials targeted to mental health practitioners and trainees, included a quantitative measure of empathic skill, and were available in English. A total of 36 studies (37 samples) were included (N = 1,616). Two reviewers independently extracted data. Data were pooled by using random-effects pairwise meta-analysis and network meta-analysis (NMA).

Results:

Overall, empathy interventions demonstrated a medium-to-large effect (d = .78, 95% CI [.58, .99]). Pairwise meta-analysis showed that one of the six instructional components was effective: didactic (d = .91 vs. d = .39, p = .02). None of the program characteristics significantly impacted intervention effectiveness (group vs. individual format, facilitator type, number of sessions). No publication bias, risk of bias, or outliers were detected. NMA, which allows for an examination of instructional component combinations, revealed didactic, observation, and rehearsal were included among the most effective components to operate in combination.

Conclusions:

We have identified instructional component, singly (didactic) and in combination (didactic, rehearsal, observation), that provides an efficient way to train empathy in mental health practitioners.

What is the public health significance of this article?

Empathy in mental health practitioners is a core skill associated with positive client outcomes, with evidence that it can be trained. This article provides an aggregation of evidence showing that didactic teaching, as well as trainees observing and practicing the skill, are the elements of training that are most important.

From the Discussion

Despite clear evidence on why empathy should be taught to mental health practitioners and how well empathy interventions work in other professionals, there has been no systematic integration on how best empathy should be taught to those working in mental health. Thus, the present study sought to address this important gap by applying pairwise and network meta-analytic analyses. In effect, we were able to elucidate the efficacious “ingredients” for teaching empathy to mental health practitioners as well as the relative superiority of particular combinations of instructional components. Overall, the effect sizes of empathy interventions were in the moderate to large range (d = .78; 95% CI [.55, .99]), which is comparable to previous meta-analyses of randomized controlled trials (RCTs) of empathy interventions within medical students (d = .68, Fragkos & Crampton, 2020), health care practitioners (d = .80, Kiosses et al., 2016; d = .52, Winter et al., 2020), and mixed trainees (adjusted g = .51; Teding van Berkhout & Malouff, 2016). This effect size means that over 78% of those who underwent empathy training will score above the mean of the control group, a result that clearly supports empathy as a trainable skill. 

The research is here.

Technology and culture: Differences between the APA and ACA ethical codes

Firmin, M.W., DeWitt, K., Shell, A.L. et al.
Curr Psychol (2018). https://doi.org/10.1007/s12144-018-9874-y

Abstract

We conducted a section-by-section and line-by-line comparison of the ethical codes published by the American Psychological Association (APA) and the American Counseling Association (ACA). Overall, 144 differences exist between the two codes and, here we focus on two constructs where 36 significant differences exist: technology and culture. Of this number, three differences were direct conflicts between the APA and ACA ethical codes’ expectations for technology and cultural behavior. The other 33 differences were omissions in the APA code, meaning that specific elements in the ACA code were explicitly absent from the APA code altogether. Of the 36 total differences pertaining to technology and culture in the two codes, 27 differences relate to technology and APA does not address 25 of these 27 technology differences. Of the 36 total differences pertaining to technology and culture, nine differences relate to culture and APA does not address eight of these issues.

The information is here.

What is New In Psychotherapy & Counseling in the Last 10 Years

Sam Knapp and I will be presenting this unique blend of small group learning, research, and lecture.

It has been estimated that the half-life for a professional psychologist is 9 years. Thus, professional psychologists need to work assiduously to keep up to date with the changes in the field. This continuing education program strives to do that by having participants reflect on the most significant changes in the field in the last 10 years. To facilitate this reflection, the presenter offers his update in the psychotherapy and counseling literature in the last 10 years as an opportunity for participants to reflect on and consider their perceptions of the important developments in the field. This focuses on changes in psychotherapy and counseling and does not consider changes in other fields, except as they influence psychotherapy or counseling. There will be considerable participant interaction.

Blue Cross expands benefits for end-of-life care

By Priyanka Dayal McCluskey
The Boston Globe
First posted on December 28, 2015

Here is an excerpt:

And while the primary goal is not cost control, the effort also has the potential to lower health care spending by giving patients more options to replace hospital care with less expensive — and often preferable — alternatives, such as hospice and home care. Medical care at the end of life can be expensive; a 2010 study found that 25 percent of all Medicare payments go toward the 5 percent of people in the last year of their lives.

“The industry is now starting to take this seriously,” said Dr. Lachlan Forrow, director of the ethics and palliative care programs at Beth Israel Deaconess Medical Center. “The industry now not only understands the issues [around death and dying], but understands there are concrete things they can and need to do, and Blue Cross is showing us how to get started.”

The article is here.

Dealing With the Depressed or Dangerous

SAN FRANCISCO — How far can colleges go to stop students who are threatening to commit suicide?

It’s a fundamental question for college and university officials who work in the fields of student affairs, counseling and mental health -- and for the lawyers who may have to deal with the aftermath, and sometimes see mental health issues as a minefield of potential litigation.

At a session Tuesday here at the annual meeting of the National Association of College and University Attorneys, experts in legal affairs and mental health urged colleges to do all they can to get students who are threatening to harm themselves into treatment, or to get them off campus if the situation continues to deteriorate.

In the past decade, the number of college students with severe mental health issues has climbed. The development is often attributed to better early intervention and psychiatric drugs that enable students to function normally and attend college who wouldn’t have been able to do so in the past. “That’s a wonderful thing,” said Paul Lannon, an outside lawyer for several New England colleges who moderated the session.

But the increase has also been accompanied by several high-profile lawsuits, and the conclusion colleges and universities draw from those could be “damned if you do, damned if you don’t.”

After a Massachusetts Institute of Technology sophomore, Elizabeth Shin, committed suicide by setting her dorm room on fire in 2000, her family sued MIT for $28 million. They argued that the university’s counseling system failed Shin, who had a documented history of depression and threats before she killed herself. The suit was eventually settled confidentially.

In 2006, Jordan Nott, a former student, sued George Washington University, claiming that he had been forced to withdraw from the university after seeking help for depression. Nott also reached a confidential settlement.

The federal government has intervened in some similar cases through complaints students filed with the Department of Education’s Office of Civil Rights, which has come out against universities who force students to leave campus because of mental illness, including a case at Bluffton University, in Ohio, in 2004.

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The entire story can be found here.

Thanks to Ken Pope for this article.