Dr. Helen Riess is Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of Empathy Research and Training in the Psychotherapy Research Group at Massachusetts General Hospital. She is also Founder and Chief Executive Officer at Empathetics, a company that provides science-based empathy and interpersonal skills training for healthcare professionals. Her research focuses on improving empathy and relational skills in physicians.
00:00 Introduction
01:14 Defining Empathy
03:38 Empathy and Burnout
05:00 Care for the Caregiver
07:52 Exquisite Empathy and Burnout
09:18 Building Empathy and Avoiding Overburden
10:45 Developing Boundaries in Clinical Practice
11:45 Training and Teaching Empathy
13:42 Model for Recognizing Emotion in Others
15:11 Becoming Emotion Detectives
19:31 Leadership's Role in Creating Supportive Workplaces
23:22 Benefits of Empathy Training
29:07 Technology and Empathy Training
34:18 Research on MDMA-Assisted Psychotherapy
37:43 Building Empathy and Compassion
40:07 Taking Small Steps Towards Empathy
42:32 Resources for Building Empathy
43:28 Future of Empathy Training
The Empathy Effect (Dr. Riess's book)
The Power of Empathy (TEDx Talk)
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
Dr. Helen Riess is Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of Empathy Research and Training in the Psychotherapy Research Group at Massachusetts General Hospital. She is also Founder and Chief Executive Officer at Empathetics, a company that provides science-based empathy and interpersonal skills training for healthcare professionals. Her research focuses on improving empathy and relational skills in physicians.
00:00 Introduction
01:14 Defining Empathy
03:38 Empathy and Burnout
05:00 Care for the Caregiver
07:52 Exquisite Empathy and Burnout
09:18 Building Empathy and Avoiding Overburden
10:45 Developing Boundaries in Clinical Practice
11:45 Training and Teaching Empathy
13:42 Model for Recognizing Emotion in Others
15:11 Becoming Emotion Detectives
19:31 Leadership's Role in Creating Supportive Workplaces
23:22 Benefits of Empathy Training
29:07 Technology and Empathy Training
34:18 Research on MDMA-Assisted Psychotherapy
37:43 Building Empathy and Compassion
40:07 Taking Small Steps Towards Empathy
42:32 Resources for Building Empathy
43:28 Future of Empathy Training
The Empathy Effect (Dr. Riess's book)
The Power of Empathy (TEDx Talk)
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
NOTE: Transcripts of our episodes are made available as soon as possible and may contain errors. Please check the corresponding audio before quoting in print.
DR. THEA GALLAGHER:
Welcome to NYU Langone Insights on Psychiatry. A clinician's guide to the latest psychiatric research. I'm Dr. Thea Gallagher. Each episode I interview a leading psychiatric researcher about how their work is shaping clinical practice. Today I'm pleased to welcome Dr. Helen Riess to the podcast. Dr. Riess is an associate clinical professor of psychiatry at Harvard Medical School and director of the Empathy and Relational Science Program at Mass General Hospital. In our conversation, Dr. Riess explores the important role of empathy in healthcare, highlighting its positive effects on patient outcomes and clinician well-being. She also discusses empathy training, institutional empathy, and the use of technology to enhance empathic connections.
All right. Dr. Riess, thank you so much for being with us today on the Insights on Psychiatry podcast.
DR. HELEN RIESS:
Thanks for having me.
DR. THEA GALLAGHER:
We're just going to jump right in. As a scientist, researcher, clinician, how do you define empathy?
DR. HELEN RIESS:
Empathy is a capacity. It's not just one thing. Many people think it's just feeling with other people, but it's actually our ability to perceive the emotions and thoughts of others, which motivates a desire to help. And so it's mostly a perception mechanism that allows us to appreciate what other people are experiencing and it provides motivation to do something, but we don't always act on it.
DR. THEA GALLAGHER:
Now, is the assumption that everybody has it at baseline or that has this capacity? Do some people have naturally a greater capacity? Do some people have a lesser capacity? Is it again, something that can be grown or built?
DR. HELEN RIESS:
Those are great questions and you actually just identified the key research question that my research group at Mass General set out to answer, which is can empathy be taught? Because we realized that even people who come to medical professions with a great deal of it, it can be beaten out of people. And so empathy is a capacity. I make the analogy to the pancreas and insulin. Most people have enough insulin to live healthy lives and empathy requires mirror neurons and other shared neural circuits that allow us to have a touch of another person's experience or allow us to take their perspective and imagine what life is like for them. And like insulin, some people are born without it and they need to take supplements and they need to do things to be able to live a healthy life. And some people have a genetic issue where they don't produce it and other people just acquire a deficiency through lifestyle and other factors. So too with empathy. There are people who don't have any, but they are the rare exception. Most people have a bell curve somewhere in the middle. Some people are extremely gifted or burdened with tremendous empathic capacity. And people who are falling off the bell curve because of external factors, they can rebuild it.
DR. THEA GALLAGHER:
I know you're intimating at this idea that it can be beat out of them or that it can be almost over utilized to the point that maybe it's starts to ... You reach a critical mass and then it starts to be associated more with burnout or you can almost give too much and lose yourself. Is that what you've seen in your research?
DR. HELEN RIESS:
Yes. The concept that we also need to give empathy to ourselves. At Empathetics, we've created a self empathy course. It really speaks to the fact that you have to have something within you to give in order to give it. And if you're exhausted, depleted, overwhelmed, it's very hard to give out empathy if you've lost the ability to empathize with yourself and get the resources that you need or ask for the resources that maybe your organization needs to help you get.
DR. THEA GALLAGHER:
And I know you've been specifically focused in a lot of your research on healthcare workers, and I would assume that many people who are in the helping profession have that natural capacity for empathy. And so do you see it often where maybe they are really good at helping others and giving to others but not so good at taking care of themselves? You know the trope of doctors are the worst patients, that kind of idea. Do you see that particularly with healthcare workers being more vulnerable? Vulnerable to burnout or to over giving and not giving back to themselves?
DR. HELEN RIESS:
Absolutely. Until very recently, no one ever talked about care for the caregiver. It was always like your patients come first, you always focus on the patient's wellbeing and no one talked about what you need inside in order to do that. With the pandemic and other massive changes in healthcare, we all know that healthcare burnout, it's a national, if not international crisis. And so the focus on well-being and providing skills and training and resources for physicians and nurses and other allied health professionals is now becoming not just a good idea, but an imperative.
DR. THEA GALLAGHER:
Yeah. An imperative because you're seeing that when it utilized in a clinical context, what are some of the benefits or what are some of the positive aspects to teaching empathy in these clinical contexts or to having empathy in these clinical contexts?
DR. HELEN RIESS:
Well, I first want to address what you mentioned a minute ago, which is if you have too much can it lead to burnout? We are not made to run on empty. And so many people equate now empathy with personal distress and they're not the same. Some people even call it empathic distress. I think that distress comes from feeling so overwhelmed that no matter what you do, you don't feel like you're making a difference. But personal distress is only one possible outcome for having a lot of empathy. And that's if you don't have enough resources or set enough boundaries for self-care. So empathy can be taught and it can be enhanced, but we also teach the difference between cognitive empathy and emotional empathy. And so when we are emotionally depleted, we can learn to still take the perspective of others and learn how to manage the overwhelm through specific techniques and maintain an interest and conveying an interest through other people through questioning curiosity and learning how not to take on too much of the emotional burden.
DR. THEA GALLAGHER:
Yeah. And this is where I feel like it starts to get a little bit labyrinthian because I'm thinking if you're able to engage with empathy when you are burnt out, does that actually start to help the burnout in a way? Again, if your capacity is so overburdened, like you said, there's maybe nothing you can do. But I also wonder ... I work with a lot of healthcare workers and this concept of even taking things personally or seeing it as a failing on yourself as a health professional. It sounds like what you're saying is maybe the more we can almost separate ourselves from the other person, but really try to understand what they're experiencing, it might actually mitigate against those feelings of burnout.
DR. HELEN RIESS:
What you're talking about is what some authors have called exquisite empathy. And that is the burst of dopamine and the burst of well-being that we get when we actually meaningfully connect with another person. And that doesn't mean that we've taken on all of their emotions, but it means that they have felt understood to the point where there's a meeting of recognition. You understand exactly what I'm feeling or what I'm going through. These moments of meaningful connection, they are anti-burnout. And I think that's the point that you're making right now. That empathy where there's a true connection of really understanding someone's plight and wanting to help is experienced with such gratitude by the patient or by the colleague that you're helping that you can't help but feel really good because it feels amazing to feel helpful. So these moments are really moments to recharge. And I think one of the key ingredients to burnout is what we focus on. And if we're all in a mindset of how hard, what drudgery, how repetitive, how overwhelmed that is going to be, how we feel. But if we share stories of what it felt like to help somebody or to get either a note or just a verbal appreciation for what we've done, and we share those, those help to build empathy within ourselves and also with the people who are hearing our stories. So our reality really is what we focus on.
DR. THEA GALLAGHER:
Yeah. And in thinking about that too ... I don't know. I'm thinking of maybe even one's journey as a clinician, a psychiatrist, psychologist. When you start out, I feel like the work feels very heavy. It feels very overwhelming. Maybe you feel like you have to change all these things. And as time goes on, it's not that people's stories get any less heavy, but I think it seems like as you grow, you're able to connect to the story but not to feel enmeshed with the story or contaminated by that. Is that what you also see or are trying to teach people how to connect without becoming overburdened?
DR. HELEN RIESS:
Exactly. I think you've just put your finger on why training to become a psychologist and psychiatrist takes so long. It's not that we come with an inability to care. Mostly we come with an ability to care too much. And then when we meet the needs of so many people in so much distress, it takes years of training to develop the boundaries so that we are there to help either with therapy, with medication, with meditation, whatever we're teaching our patients without becoming overwhelmed by the feelings. And so it's really learning the techniques to help people become more regulated, to be able to articulate their feelings, to process what they've been through. Those techniques enable us to feel helpful and to be helpful without becoming enmeshed or having emotional contagion take place where both people start to feel like they're drowning instead of one person offering a meaningful life raft for the other person to step onto and work in partnership toward their health.
DR. THEA GALLAGHER:
Yeah. And so you began this research journey figuring out that empathy, that it's a capacity and that it can be taught. And so since you've begun this work, what have you learned about how to teach empathy? You mentioned these techniques. Are there pillars that you build these techniques out of? Can you tell a little bit about the process that you have understood to help teach empathy?
DR. HELEN RIESS:
I've been very fortunate to be on a parallel track with belonging to the Emotional Intelligence Consortium for research on Emotional Intelligence and Organizations. And some of the key pillars are self-awareness, awareness of others or social awareness, self-management and relationship management. But I took a deep dive into empathy, which is other awareness because I felt that many people did just not know how do you enhance the skills of being aware of what other people are going through. And so I developed a model of how to recognize emotion in other people through lots of nonverbal signals and then also how to recognize where we catch those emotions in our own bodies. Because you've probably heard the saying, most feelings are mutual. So when we're with somebody who's highly upset or dysregulated, we start to feel that too. And sometimes that comes across within us like annoyance or I don't like this or I don't want to be around this person, this doesn't feel good.
But instead of focusing on our response, if we understand that to be an emotion that we've just caught from the other person and focus on what is causing them to feel so frustrated, annoyed, maybe angry or sad, we can quickly take that information that's been put into our bodies and look at it with curiosity. You know this being a mental health professional. We have to examine what's happening in our reactions as information that's just been conveyed that a person may not even be able to articulate. That's called projective identification just for all the psychiatrists listening to this and psychologists. So the teaching is to become emotion detectives to really take in what is being expressed verbally and non-verbally and to really be curious about our reaction and to put that on the table as I'm sensing a lot of sadness within myself right now. And yet when you tell this story, I'm not really seeing that much emotion. Could there be some sadness around this story? So the empathy is taking these shared neural circuits that we have and making them manifest so people can get more in touch with the backstory or the feelings behind what they're saying.
DR. THEA GALLAGHER:
Yeah. It sounds like almost examining your own feelings that you're probably experiencing to a lesser degree as the clinician, but then speaking them out to the patient. Your work is also saying that people who aren't clinicians, paraprofessionals, it's helpful for them to learn how to do these things. They don't have to go to maybe 12 years of school to learn how to do this. But your work is also in teaching these individuals and paraprofessionals how to maybe access these feelings of empathy.
DR. HELEN RIESS:
Exactly. We started this conversation with the fact that most people are wired for empathy. It is actually the reason that our species is still on the planet. Because without appreciating and perceiving the needs and fears and plights of others, no one would be helping anybody and we'd all be on our own. And we know that without cooperation and collaboration and reciprocity, nobody could survive because we just can't survive on our own. So I think one of the big challenges is to have people learn how to use their own bodies as instruments of information, not just about themselves, but about others. And to develop curiosity ... If I'm getting a pit in my stomach when I'm talking to somebody, I could just focus on the pit and just say, "Oh, I just never want it ..." Or I could say, "Gee, I wonder if that person I was talking to has some pit in their stomach, and what does that have to do with?"
DR. THEA GALLAGHER:
Yeah. And I think we had another guest on the podcast, Richie Davidson, talking about even practicing compassion meditations and thinking about other people and thinking in a way where you're extending that compassion to others. And he was saying his hope is eventually to have this flourishing city where it is about caring for ourselves and caring for others and if we can start in these small ways. And it sounds like what you're saying too, is if we can start in building empathy internally and for others that we are going to see hopefully some systemic changes. Which leads me to my next question. I know you've become very passionate about institutional empathy. So can you talk to us a little bit about what that looks like and what's the burden on both the individual and then the institution? What's that relationship like?
DR. HELEN RIESS:
Absolutely. With the burnout crisis, for many years, the solution from institutions was, let's give out free yoga passes, or let's encourage people to use this app to get their dry cleaning picked up. A lot of external things that either the clinician was expected to do for themselves as if this was just an individual problem or more tactical health like let's create less friction in their daily lives. And these are well-intentioned, but I've heard so many clinicians say, "If one more person tells me to practice yoga when they're not fixing the workflow problems here ... I'm just getting more and more upset by the implication that this is just a personal failing or that I just have to do more self-management." And it made me really look at the responsibility of institutional leaders to create a workplace that actually supports the workers instead of depletes them.
And so many of the new writing about leadership is to get out of the corner office and actually start walking through the halls and spending time in the coffee rooms with people who work for you and hear what they're saying. Because sometimes the distance between people making policies and the people who are actually working on the front lines is so great that it can sound like, okay, let's just give everybody that day off, or let's take the residents on a ski weekend. But that's not really fixing the problem of crowded ERs or patients waiting for seven hours to see somebody. So a distribution of resources to actually meet where the crisis of empathy is being experienced both by the clinicians and the patients is really the job of leadership. Institutional empathy means we need to practice empathy and compassion as an organization if we want to get these practices in place for our patients.
DR. THEA GALLAGHER:
Yeah. And I think if you think about it in their defense, you can understand why maybe at the top tier of leadership there is less empathy, maybe because you just don't even know what that's like to have that experience because the jobs are so different. Thinking of health systems. You're in maybe a position of leadership and you're not working directly with the patients you probably have ... They both have big stressors, but different kinds of stressors. And it sounds like what you're saying that really helps building empathy is really learning and that old adage of walking a mile in their shoes. It seems like there's something to that that actually can be trained or can be ... I don't know what ... Protocolized in a way like you have to see what it's like for people and what their stressors are in order to care and make changes.
DR. HELEN RIESS:
Absolutely. 100%. We all know that people who have suffered in a similar way have more empathy for each other than people who can just only imagine what it might be like to lose a child, for instance, or be in a terrible car accident. So that's why group therapy is so powerful, because if the group is organized around a common suffering, the empathy is there because you have walked in the same shoes. But your point is if leaders are so separated from the effects of their policies ... Like maybe the policy is we've got to improve the productivity and the bottom line. We have to see more patients. And suddenly everyone's expected to see 15 patients in an afternoon or 25. Until they see those waiting rooms piling up and people falling behind and people starting to make mistakes or be rude and short with patients, they may think they're fixing a financial problem, but they're actually creating a bigger problem.
DR. THEA GALLAGHER:
Yeah. And so like you said, you can create that problem when you're maybe micro focusing on one goal and that goal just might not be possible without overburdening the rest of the system, which contributes to burnout. And it seems like what you've found is that there's a lot of benefits when healthcare workers ... And I'm thinking this can probably also extend to a lot of professionals or people in a professional context. That you found that there are a lot of benefits to building empathy or to growing that empathy, enhancing that empathy that isn't just patient satisfaction. What have you found is the benefit of empathy training?
DR. HELEN RIESS:
Patient experience is obviously the goal to create a better experience for patients. What people know less about is that with a better relationship, patients adhere to your recommendations. They keep their appointments. They are engaged as a partner in their care. So you're not just giving recommendations or orders to do stuff, but a patient actually understands why and is motivated to follow through. Outcomes are better. The other thing is 82% of malpractice claims are the result of communication and empathy failures. This means that even when a mistake is made, claims are not necessarily following if there was a strong relationship, an acknowledgement of what happened, a sincere apology, because medical errors are happening every single day to varying degrees. And it can take a really small thing to get someone to want to retaliate against a clinician if they were treated poorly or if their concerns were dismissed.
So that's a side benefit, not just for individual practitioners, but for organizations because one malpractice claim can actually act like poison in a system. So errors are reduced with better communication and empathy. Joy of work improves. People like their jobs when they feel like they're giving and what they're giving is appreciated and received and there's more resilience. So the benefits are huge. And I want to be clear that empathy and compassion are closely related. You can't get compassion out of somebody, which is a visible trait without something internally happening, which is empathy. Being moved by somebody else's plight is an internal experience that motivates compassion. And so these are not dichotomized. They are really part of the loop of getting helping behaviors and caring out of people. And I do strongly believe that when healthcare workers experience caring and concern from their leadership, they're more engaged in their jobs.
I also wanted to say that many of Empathetics' clients are large health system leaders who are taking the training themselves. And it's not just a top down, here's a training that's going to help you like your job better and be more resilient and create a better experience for patients. They're saying, "I took this too and I have been transformed by opening up my eyes to wanting to share what makes people's jobs easier, better, and makes them want to come to work." And so that's why institutional empathy really means that a leadership commitment to a type of organization that is functioning in an optimal frictionless way.
DR. THEA GALLAGHER:
Yeah. And I think this is synergistic with a lot of the research that shows when people feel othered, there's more disconnection. In saying that this is part of our human experience. We might have different roles, different titles, different responsibilities, but empathy and compassion are something that we all need to continue to grow in, to learn about more, to enhance, to figure out what our barriers are. This is something that applies to everyone. And I think that there's something about that that's also really powerful in large healthcare systems, but also I could see being really powerful in corporations and really the world. The more that we can learn and grow how we could really see changes. You turn on the news, we're not seeing a ton of compassion and empathy and that's part of the problem I would imagine.
DR. HELEN RIESS:
It really has become a national, if not international problem. And you're absolutely right about other industries. We provide empathy training for law enforcement. There's some really inspired law enforcement chiefs who see a more empathic way to interact with communities as the key to having a successful police force. And I think that the point about empathic leadership can't be overemphasized. How we're treated has everything to do with how productive we are.
DR. THEA GALLAGHER:
It sounds like in the work that you're doing, you're trying to get in these places and teach this and institutional change. Are there any ways that technologies maybe are going to help facilitate empathy in the future or that maybe are already happening?
DR. HELEN RIESS:
Absolutely. Empathetics delivers the empathy training online. We also offer blended training. So there's a workshop or classroom component. But technology enables this training to be spread throughout an entire organization. And one of the great advances this year was that we also realized that frontline workers like the office people who interact with patients, food servers, environmental services and valet parking, they all are part of the patient experience and their roles are really key to how a patient is going to feel after being in any healthcare organization. And so through technology, we can spread this training to really literally every aspect and every person in an organization. And there's also exciting advances through AI that we are incorporating into our training by customizing and personalizing the learning. I believe we can never completely keep people out of empathy training because after all, human to human is ... There's something really special and magical when people are either witnessing a simulation or a video or being in a room with people. But I do think there are tremendous opportunities for more customized and personalized learning when people can maybe write down responses to what they did and get feedback where they're not going to be publicly shamed or have people say, "What? You said that?" And get training and teaching to improve in that safe way.
DR. THEA GALLAGHER:
Yeah. Almost like tech assisted.
DR. HELEN RIESS:
Exactly.
DR. THEA GALLAGHER:
Which is interesting. One of the themes that's been coming out of this podcast is it's really interesting that we're living in a current ... What we call this loneliness epidemic that the surgeon general spoke about last year. And at the same time, we're living in a world where AI is just booming. And what you're talking about is also this very human experience. And so it seems like we're not going to ... There's something so powerful and magical like you're talking about this human to human connection. But is there a way that for accessibility and for everybody to grow in some of these ways that there can be some tech assisted options to teach empathy, but empathy likely, it's not going to be experienced probably the same way from a robot or from an app to a person. It seems like there could be benefits to growing pieces of it in the training aspect, but not in the disseminating to the patients or to individuals.
DR. HELEN RIESS:
I think there's a fine line there. And the power of even coming together, especially post pandemic Thea has been just tremendous. And part of the success that we're seeing in retaining employees ... One organization head a 170 times improvement in empathy trained employees compared to people who were not given the training and we're quitting because of all the reasons we've been talking about really does show the power of using both technology assisted E-learning formats, but also bringing people together in workshops and having them reconnect with their colleagues and feeling like they're part of a human cohort again. So this blended learning that we really stand by I think is extremely powerful.
DR. THEA GALLAGHER:
Yeah. And it's interesting you're talking about these institutional systemic changes. And I think when we hear institutional systemic changes, we think of protocols. We think of large swath initiatives. And I think what you're talking about is it's like a large swath initiative that starts with the individuals, but individuals at all levels of leadership. And that's really the way that systemic change is going to actually happen. It's about a lot of individuals together changing the system, not just one generic or one broad stroke of a initiative.
DR. HELEN RIESS:
Exactly. I think that yoga passes and take a day off, or you should go on a vacation, it's a tiny spark that's just going to fizzle out. But if you see sparks happening from the top spreading through the organization, there becomes a very warm fire that actually penetrates the whole place instead of this individual do this or that individual do that. But we are all committed to really transforming the organization together.
DR. THEA GALLAGHER:
And as an expert on empathy and thinking about maybe some of these bigger changes, this is a little bit of a nuanced question, but how do you view research on MDMA assisted psychotherapy, which seems to have an element of unlocking the therapeutic power of empathy?
DR. HELEN RIESS:
I think this is a very exciting domain that so many centers, including my home institution at Mass General, are investigating with tremendous rigor and really looking at types of treatments that because of what happened in the 1960s because of some either abuses of the treatments or misperceptions got completely shut down. And now with scientific methods to say, why have we prohibited these modalities? Why don't we explore them? And if you read Michael Pollan's book, you see people opening up to a sense of being part of the greater good or feeling like they're connected to humanity that really gets them out of their self-focus to a much deeper purpose and meaning of their lives. These are just some of the stories, but I think that we're at an age where we have so much access to the scientific method and to people desperate for some solutions that have eluded them for in some cases, most decades of their lives, that we're going to make some breakthroughs in opening up greater channels for healing, for spirituality, for connection to the greater good.
DR. THEA GALLAGHER:
Yeah. And seeing what those options are. But then with most things, I think it could be something that enlightens, but then following up with maybe practical and behavioral consistency also seems to be really important in behavioral health.
DR. HELEN RIESS:
It's necessary.
DR. THEA GALLAGHER:
Yes.
DR. HELEN RIESS:
Yes. I don't think we're going to find a magic bullet that's just going to wipe out mental health illness. I think what we're finding is there are layers. Layers and layers. Some people really respond to cognitive behavioral therapy. Other people need insight-oriented therapy. Still others may need some of these experiences offered through the psychedelics that open a door for them to access these types of treatments. I don't know really of anyone who's had a treatment like this who's now good to go. It's really more like a new key to unlock new potential.
DR. THEA GALLAGHER:
But it sounds like the one thing we all need and can benefit from is empathy and compassion and continuing to grow in that in both our personal relationships, our professional relationships. And so I'm thinking for the clinicians, the psychiatrists, psychologists, therapists who are listening today, what would you advise with regard to these clinicians building maybe their own empathy and compassion and then also maybe teaching that to their patients? What's something that they can take away today that they can utilize for themselves and others?
DR. HELEN RIESS:
Well, I hope that people leave our conversation with a genuine understanding that their empathy can be expanded. That much of it is skill-based. Learning how to pause, learning how to bracket your initial response and put it aside to examine later, but to stay patient-focused and not get all involved in what the person made me feel, but more focus on what are they feeling? And if we need to process or download or vent, we do that with a trusted colleague, but not with our patients. I hope that clinicians can start to practice empathy by showing gratitude to the patients. Thank you for sharing that story with me. I feel privileged to know this about you. Thank you for letting me know that you didn't take the medicine. I'm here to understand why, not to criticize you. Did something happen that made you miss five appointments? Did something happen here with us? Actually acknowledging the relationship and the impact on people and not just the behavior of whether they adhere to the recommendations you made. Treating them like humans. And when we can express gratitude to patients for what they're sharing with us or that they followed through on something, they are more likely to express their gratitude for us. And I know from myself, my husband, and many colleagues, that when we get a letter or just a heartfelt sense of appreciation or expressed appreciation, it is the fuel that keeps us going.
DR. THEA GALLAGHER:
Yeah. And just something that's bringing this to mind, I'm re watching the Sopranos, and there's a lot we could talk about with that therapeutic relationship. But in this one scene, I guess Tony Soprano is saying something. He says, you wouldn't understand. And she just says to him, help me understand. And I think that encapsulates what you're talking about. Is really trying to build that understanding maybe outside of our own experiences. Making sure even as clinicians, that we have places where we can go process our own experiences, but also really being curious and asking to understand more about our patients and their experience. And it sounds like, again, it's not just for clinicians. It can be extended to so many areas. But I think it's a powerful way to think about really trying to understand people seems like it could have this dramatic, systemic, institutional and hopefully global change that we all hope for.
DR. HELEN RIESS:
That was a beautiful example you just shared. Help me understand. And I don't want people to leave this conversation thinking, this is so much work. This is so big. It's not. We can start by expressing gratitude for something today. Or we can decide today I'm going to pause before I just react. We can make a daily intentional commitment to doing something tiny, and I promise you it has huge ripple effects. So we don't have to say, I don't have time to learn empathy. I also want to say that when an institution makes a commitment to offering some training people, they might first say, "Oh, not more training." But when they actually take it, it not only helps their professional lives, it helps them at home. It helps them take the pause with their young kids or their teenagers and just say, "I'm here for you. Tell me more about what you're feeling." Instead of stop that or don't yell, or whatever. All these things we do to try to stop the noise, sometimes we just have to say I want to know more of what you're feeling. And people are shocked by that.
DR. THEA GALLAGHER:
Yeah. And your process feels very like it's not sterile, generic or protocolized. It's really about ... Yeah, we call it a training, which I think for most people now, it's like, ah, that's a dirty word or a bad word. It makes me triggered. But like you're saying, it's really about investing into learning some skills that can help you not only in the workplace, but in the rest of your life and these are skills that ultimately will give back.
DR. HELEN RIESS:
Exactly. We've started calling it empathy education because training sounds a little bit like you just do these things over and over again, and then they're going to be automatic. But it really is like learning about how does my brain work and how can I manage my mind and my body to be the person I really want to be?
DR. THEA GALLAGHER:
And if someone's listening and they want to maybe start at the individual level, would it be starting with your book or resources that you would point them to?
DR. HELEN RIESS:
Well, I have a TED talk, which is only 17 minutes, so you can start there.
DR. THEA GALLAGHER:
Great.
DR. HELEN RIESS:
Called The Power of Empathy. And my book was written because we get so many calls for, can you give this training in my company and in my school? In all these domains. We have done it for law enforcement, but the book was written so that everybody can get an understanding of how empathy works and really the magic and power in it. So it's written for a lay audience, and it also has a chapter on when it's hardest to be empathetic and why. And I think that's a really powerful message today about othering and realizing that our own prejudices and biases really can interfere with empathy if we don't choose to examine them.
DR. THEA GALLAGHER:
Yeah. Absolutely. Any ongoing or future research projects that you're excited about or even just the future of this work that you're looking forward to?
DR. HELEN RIESS:
I'm so excited that this training that started in one hospital is now being used across the country, and it's moving from one department to one hospital to actually whole health systems. So sometimes it's a rough road. It's always a rough road when you're trying to instill really some transformation. But by continuing to monitor and measure our impact, what we're really seeing now is improvements in wellness and most excitedly in retention. And most people know that more than a half a million doctors and nurses have quit their professions since the pandemic. They're gone. They're not changing jobs, they're leaving. And if we can get people to get re-committed and re-really excited about providing healthcare, we're not just saving that doctor or nurse, we're saving all the patients that will benefit from having them in the workplace.
DR. THEA GALLAGHER:
That is very exciting, and it'll be great to, again, see this positive work hopefully have positive changes. Continued positive changes. So thank you so much for our conversation today. Thanks for being on the podcast.
DR. HELEN RIESS:
Thank you, Thea. It's always a pleasure to talk with you.
DR. THEA GALLAGHER:
Thanks so much for that conversation, Dr. Riess. If you enjoyed this episode, be sure to rate and subscribe to NYU Langone Insights on Psychiatry on your podcast app. For the Department of Psychiatry at NYU Langone, I'm Dr. Thea Gallagher. See you next time.