A Health Affairs post points to a study that higher levels of physician empathy predicted better outcomes for diabetes patients.
A 2012 study from Italy analyzed the health outcomes of more than 20,000 patients with diabetes, who were assigned to three different groups of physicians (pre-evaluated for their levels of empathy). The physicians who demonstrated the highest degrees of empathy achieved the best results with their patients; the patients had statistically significant lower levels of diabetic complications than the groups whose physicians had scored lower in empathy.
It makes a lot of sense that this would be especially important in chronic disease management (or, recovery management) , where the goal is long term engagement to monitor their illness/recovery, support the patient through difficult behavioral changes and re-intervene quickly when symptoms recur.
Who would want to call their helper about problems in their recovery or a relapse? This isn’t an easy call to make under the best circumstances. Even more so if you don’t believe your helper understands, cares or worse, judges you. Under these circumstances the patient is more likely to put it off and put it off as the problem grows and becomes more difficult to manage.
I continue to be convinced that addiction treatment providers have a lot to learn from chronic disease management and that we have a lot of experience to offer them. This will be important to follow as the chronic disease burden continues to get more attention.
Miller and Moyers make the case that low therapist empathy is toxic with a review of some research on the topic.
In one study, a single in-session therapist behavior predicted 42% of the variance in clients’ 12-month drinking outcomes: the more the therapist confronted, the more the client drank (Miller, Benefield, & Tonigan, 1993).
Client resistance increased and decreased as a step function in response to counseling style. Teach/Direct (Information/Advice) increased client resistance by 70% in contrast to empathic listening. Resistance dropped back down with resumed listening and jumped backup with a return to Teach/Direct.
In a randomized trial comparing therapist styles with problem drinkers receiving feedback regarding the severity of alcohol-related assessment results, client resistance responses were 70% higher with directive as compared to client-centered counseling (Miller et al., 1993).
And, that high therapist empathy should be treated as an evidence-based practice:
It appears that therapist empathy can predict meaningful proportions of variance in addiction treatment outcome (e.g., Miller et al., 1993; Valle, 1981) that are an order of magnitude larger than the between-treatment differences typically observed in clinical trials (Imel et al., 2008) and typically fall within the range of what addiction treatment providers regard to be a clinically meaningful effect (Miller & Manuel, 2008). In psychotherapy research more generally, therapist empathy may account for as much or more outcome variance than therapeutic alliance or specific intervention (Bohart, Elliot, Greenberg, & Watson, 2002; Imel, Wampold, & Miller, 2008). It could be argued that providing accurate empathy in addiction treatment is an evidence-based practice regardless of theoretical orientation and that its absence will reduce the likelihood that clients will change their substance use.
Does this speak to the power of one addict talking with another?
If we’re going to find our way back to each other, we have to understand and know empathy, because empathy’s the antidote to shame. If you put shame in a Petri dish, it needs three things to grow exponentially: secrecy, silence and judgment. If you put the same amount of shame in a Petri dish and douse it with empathy, it can’t survive. The two most powerful words when we’re in struggle: me too.