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Friday, January 20, 2023

Teaching Empathy to Mental Health Practitioners and Trainees

Ngo, H., Sokolovic, et al. (2022).
Journal of Consulting and Clinical Psychology,
90(11), 851–860.

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.

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).

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.

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.