Short information: I am retirement pensioner after being director of Institute of Tocology and Family pschology for many years.. (Tocology. The science of birth/delivery from gr.) I founded the Institute in 1985 after being assistant professor at The Institute of Psychology at the University of Oslo for several years. “Empatic communication” as a method is a result of experiences in my therapeutic work as a psychologist.

By educating professionals in a professional way of communicating based on empathy we have the experience that our courses influence the daily work in a positive way for doctors, nurses, teachers and others in their contact with patients and pupils and also in the way they cooperate in the hospital or in the school. It gives them a feeling of mastering their work by having a kind of meaningful “tool”. Many of our contacts gives us reports that communicating in this way – based on empathy – prevent burnt out in difficult jobs.

My option is that the discovery of mirror neurons is of the same importance for psychology as the discovery of DNA is for biology.

We have evidence for claiming that empathy may be developed by training. That is our main point in arranging the courses. However – we are also aware that some professionals – by example nurses and doctors - may suffer from what we call “empathy-pain”. The compassion is overwhelming in a way. The mirror neurons do not stop firing. In this connection we recommend mindfulness in order to moderate the firing.

I am married and my husband Paul is also a psychologist. We have two children and five grand children. May interests are: reading, writing books, listening to music, physical training programs., being with my family and our good friends. Friendship means a lot to me. I have practiced meditation for many years: TM and mindfulness. I have written 17 texbooks and one novel about the prophet Abraham (the book is called “The Man from Ur”). My last textbook was published in January 2012: “About Consciousness/ Psychology. Mindfulness. Science fiction. Near-death-experiences-. Cosmic consciousness.” Empathy is included in the book. I am inspired by Bill Daytons idea: We are all changemakers and I have two favorite songs while I am training: “Thank you for the music” by ABBA and “What a Difference A Day Make” by Stanley Adams.

In 2011 I received The Gold Medal from his Majesty The King of Norway for my pioneer work in science.

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I am preparing for our dialog May 3 and I like to share with you some general reflections on empathy in case you would like to explore some of my general points.

In Norway the whole country is following the case taking place these weeks after the terrorist attack in 22.juli. We all recognize the reactions taking place by us - the Norwegians as a nation in connection with the attack. The day after the attack the Crown Prince of Norway, Håkon, hold a speech for 20.000 people gathering here in Oslo saying: “What is of importance to us in this country shall nobody take away from us. Tonight the streets are filled with love.” This I have cited in my last book of “About Consciousness”, 2012, where I also quote what the Norwegian King, Harald, said in a memory ceremony 21. August 2011: “As a nation we will remember this period in our hearts, in our experiences – and remember that we have been woken up to a new consciousness about what is of real importance to us.”

And - last week in Thursday 26 April – when terror case was taking place in the court - 40.000 people gathered in a large marketplace in Oslo singing together: “My Rainbow Race” by Pete Seeger (Norwegian:” Barn av regnbuen” – children of the rainbow). Afterwards a procession went into the streets everybody singing Petes song and ending up in front of the Court. No demonstrations or posters with slogans or watchwords of hate or revenge were seen in the streets. The same singing – the same song – was taking place all over the country at the same time. All the 40.000 singers had a rose in their hand. It was all presented on the Norwegian TV.

My situation is that I am invited by different groups as a psychologist to lecture on how we can understand the reactions taking place in Norway for the time being and also after the attack.

Now I am wondering if these reactions may possibly be seen as a result of what we very early learn in the Norwegian schools and which is written about in the Bible, Johannes 8 : “The women Caught in Adultery”:
The Pharisees and teacher of the Law brought up a women caught in committing adultery in front of Jesus – saying that such a women must be stoned to death and asking Jesus: “Now, what do you say?” And Jesus straightened himself up and said to them: “Whichever one of you has committed no sin may throw the first stone on her.” When they heard this they all left one by one, the older ones first. And Jesus said to the women: I do not condemn you either. Go, but do not sin again.”

From an existential point of view this quotation from the Bible may be understood as: We must recognize that we are all human beings with our faults and weaknesses. No one is superior to another person. This recognition is the basis for genuine empathy – as I see it. Equality – as we find it our democratic society is the foundation for developing the empathic process. So perhaps the roses and the singing is to remind us of: after all we are all in the same boat as human beings here on earth. (Perhaps that is what the Crown Prince, Håkon, also meant.)

Another side of our democratic society is , as one of the young offers from the attack said: “ I feel calm and feel safe by knowing that the Norwegian judicial authority is taking care of this on behalf of me”. His personal feelings did not hinder him joining the rose- and singing procession because he knew it was not his duty to judge or condemn.

In our courses in “Empathic communication” we define the relationship between by example the doctor and the patient as: Equal co-creation of new realities by free exchange of ideas and standpoints. Our experience is that much work must be done in the beginning of the course to train the participants in an attitude of equality toward the patient. The doctor is not a more important, superior person than the patient.

About my work: In 2004 I developed the method: “Empathic communication”. This method is now used in hospitals, in schools, family centers and different institutions in Norway.
I have developed a special course of 40 hours for professionals who want to educate others in this method. We are now a group of women and men who are giving courses all over the country in “Empathic communication.”

I have written about the method in some of my books: Positive Psychology, Psychopathy, Courage - Psychology in everyday life. (all in Norwegian). “Empathic communication” as a method is presented also on internet. Here you will find a demonstration of this method in different situations: in the hospital, in school, in a meeting between an employee and the chief, special session for persons in difficult work situation. The internet program starts with an introduction of the method by dr. Jardar Hals and a demonstration of a empathic meeting between a mother of child with cancer and a nurse. Each of this six sessions is ca. 10 min. long.

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Outline of Empathic Communication

Empathic communication is a method consisting of a dialog of four steps. During the three first steps the helpers listen to and focus on:

• 1. The clients narrative.

• 2. The clients emotions and

• 3. The clients reflections. During the last step the focus is on: 

• 4. The helper as an active co-creator in the dialog.

The method is developed by dr. philos., specialist in clinical psychology Lisbeth Holter Brudal, Norway.

The method is based on Aaron Antonovskys theory about the importance of sense of coherence for our psychic health (SOC).   This coherence consists of three components: a feeling of understanding – a feeling of manageability – a feeling of meaning in ones life.

During illness, crises and stress this coherence might be impaired. The individual may find himself  in “Frontier zone” and removed from his “Everyday state”.  The aim of empathic communication is – through the dialog – to build a new experience of coherence in the life of the client including a new understanding and a new feeling of manageability and meaning.

As part of supervision and dialogs within organizations the aim of empathic communication is to strengthen and develop the individuals sense of coherence, their feeling of understanding, manageability and meaning in life.

The essential condition to obtain these aims is that the helpers have the necessary competence in dealing with relationships in a professional setting (relational skill).

The theoretical foundation for empathic communication is:

• Existencial psychology (ex-istere: to be visible, step forward./ S. Kierkegaard).

• Self psychology (focus on affect consciousness – affects are the core of “the true self”./ H. Kohut).

• Developmental psychology (focus on the clients “ reflective function”./ P. Fonagy).

• Positiv psychology (focus on empathy, health, growth and resources./ M. Seligman).

The following courses in empathic communication are on offer:

• Introduction course 1-5 hours.

• Advanced course 15 – 20 hours.

• Training course 30 – 40 hours.

Literature on empathic communication:

• Kunsten å være foreldre. Fagbokforlaget 2003, Lisbeth F. Brudal.

• Positiv psykologi. Fagbokforlaget 2006, Lisbeth F. Brudal.

• Mot. Psykologi i hverdagen. Fagbokforlaget 2010. Lisbeth Holter Brudal.
  
  
   

Curriculum: Empathic Communication
40 Hours Course

Lisbeth Holter Brudal Dr. philos. Specialist in clinical psychology. Author. August 2012

Table of Contents

• Introduction

• The Helper

• The Trainer

• Empathic Communication in Practice

• Five Lessons

• Conclusion

Introduction

Empathic communication is based on the following famous paragraph by Søren Kierkegaard (1813 – 1855): “The Art of Helping Others to Understand”.  Søren Kierkegaard, living in Denmark, was a philosopher, author and founder of modern existentialism.

“The Art of Helping Others to Understand”
If One is Truly to Succeed in Leading a Person to a specific Place, One Must First and Foremost Take Care to Find Him Where He is and Begin There.

This is the secret in the entire art of helping.

Anyone who cannot do this is himself under a delusion if he thinks he is able to help someone else. In order truly to help someone else, I must understand more than he – but certainly first and foremost understand what he understands.

If I do not do that, then my greater understanding does not help him at all. If I nevertheless want to assert my greater understanding, then it is because I am vain or proud, then basically instead of benefiting him I really want to be admired by him.

But all true help begins with a humble attitude.

The helper must first humble himself under the person he wants to help and thereby understand that to help is not to dominate but to serve, that to help is not to be the most dominating but the most patient, that to help is a willingness for the time being to put up with being in the wrong and not understanding what the other understands.

“Learning by doing”
In order to learn “The Art of Helping” we all need training in the existential, humble attitude.  Therefore the course in empathic communication stresses this important motto: “Learning by doing”

“Frontier zone”
During illness, crises, stress and other situations where we might feel helpless we may find ourselves in a “Frontier zone”. The aim of the courses in empathic communication is to teach how to communicate in an empathic way with people in this “Frontier zone”. By using empathic communication it is possible to prevent further development of psychological problems and help the client to retain his “Everyday state”.  An example is the possibility to detect and prevent post partum depression by using empathic communication related to childbirth.

The Helper

The helpers relational skills are essential for practicing empathic communication. The definition of the relationship between helper and client is: A process based on equality and a co-creation of new realities through free exchange of ideas and point of views.

The course consists of a presentation of the theoretical and empirical fundament for empathic communication.  The definition of empathy is: A process which makes it possible to look at a situation from another persons point of view and also recognize his feelings, norms, values and apprehensions.

Further the course focuses on how to practice the method.  The helpers practice in groups.  It is recommended that the helpers also practice empathic communication in between the sessions – at work, together with friends or family members. The experiences from the practicing processes are discussed with the trainer and group members in plenum and analyzed in relation to the psychological theories.

A governing idea in the recommendation of Kierkegaard is that the first task in helping another person is to “take care to find him where he is and begin there”. To learn to know  the other person is  a presupposition for helping and a condition for the clients to attain the helpers “greater understanding”. It is when this aim is obtained that it is possible to “succeed in leading a person to a specific place”, maintains Kierkegaard.

The four steps
During the first three steps in the dialog the helper gets to know the client.

 In step 1 the client is invited to tell his story – to inform us about his situation – using his own words (existential theory – to step forward, be visible.)

In step 2 the client is encouraged to express, with his own words, the feelings he has related to what he has told us so far (self psychology – affect consciousness).

In step 3 the client is challenged to give his reflections on what he has said in step 1 and 2 (developmental psychology – reflective function).

So far the helpers has not interrupted, corrected or commented on what the client has said in the first three steps.

In step 4 the dialog turns.  At this step the helper offers himself as a co-creator in the dialog.  The helper has – through his empathic attitude – attained a valuable knowledge about the client and “where he is”. On this background the helper asks the client if he would like to hear the helpers own thoughts and reflections about what the client has told so far. At this point the helper offers his “greater understanding”.  This understanding might be the helpers own expertise,  professional competence and life experience.

According to the definition of the relationship we may say that step four represents the beginning of the “creation of new realities through free exchange of ideas and views” (Positive psychology – focus on creativity and resources).

By means of the co-creation-process the helper is able to lead the client to a “specific place”- which is his “Everyday state”- where he may experience a new and strengthened “sense of coherence” (SOC). This sense represents an new understanding of his own situation, a feeling of manageability and meaning of life ( See A. Antonovsky (1987): Unraveling the Mystery of Health – theory of SOC).

Some clients find that after they have experienced empathic communication they also want to practice the method on themselves.  This “empathic self observation” in for steps is described in my book Positive psychology, 2006.

The Trainer

Research suggests that empathy may be released by practicing and that trained empathy in connection with empathic communication is a stable skill measured 18 months after the training has taken place.

One important aim for the trainers work is to develop empathy and relational skills amongst the helpers. The trainer must arrange for optimal situations for practicing in groups. The size of the course and practical conditions determine the size of each training group.

It is the trainers responsibility to present different examples of cases  for role-playing in the  training  groups (arranged situations or real cases). The participants swop between playing the role of the client, the role of helper or the observing role.

After each training session the participants meet in plenum to share their experiences and reflect upon the process and their relational skills. The trainer is the leader of this plenum session and has the responsibility of collecting the participants experiences throughout the four steps referred to above.

Research suggests that the trainers own empathy and relational skills is of importance for the learning process.

Each course is arranged in accordance with the participants interests, place of work, motivation and expectations.  The Norwegian internet film : www.helsefilm.no present different examples of situations for using empathic communication (nurse – relative, psychotherapist – client, supervisor – health personal I difficult work situations, teacher – pupil, leader – employee).

In introducing the course the trainer informs about the Norwegian law (2.7.1999) concerning patients rights (“Pasientrettighetsloven”).  The law says that all patients have the right to cooperate in the treatment and to get information about their situation. Empathic communication is in accordance with this law: We invite the patients to cooperate and we offer our information.

To be certificated as a trainer one is supposed to present a short essay with relevance for empathic communication.

Empathic Communication in Practice

When the helper has completed the 40 hours course he/she is qualified to lead courses in empathic communication for professionals within various of the above mentioned fields. The following courses in empathic communication are on offer:  Introduction course 1- 5 hours. Advanced course 15 -20 hours. Training course 30 – 40 hours.

Here is an example of two models for developing empathic communication in the society.

The Stavanger model
An activity center in the city of Stavanger, Norway, consisting of 250 persons (nurses, psychologists, doctors, midwifes and others) wanted to implement empathic communication as a routine in their daily work. A core of 7 employees at the center, including the leader of the center, completed a 40 hours course in 2010/2011. Then - when the certification was obtained this core of representatives from the center offered  courses in empathic communication to the rest of the employees at their workplace.

A follow up 18 months after the 40 hours training course shows that the center in Stavanger has implemented the method as an ongoing routine.

The Drammen model
In 2004 a group of midwifes at Drammen hospital, a hospital in the town of Drammen west of Oslo, Norway, wanted to renew their routines in the birth clinic.  The same year in all 27 employees in the hospital (midwifes and doctors) where trained in empathic communication. A core of 10 professionals (7 midwifes and 3 doctors) was developed out of this group.

This core group was responsible for educating other professionals in the hospital in empathic communication (nurses, doctors, midwifes and office staff). In the training period in all 78 employees was educated by the core group.

An important new routine was developed as a result of the training: The after delivery talk. Today parents at Drammen hospital is offered an empathic communication dialog before they leave the hospital.  The experience today – after many years of practice – is that by means of the after delivery talk and empathic communication the midwifes and doctors have the possibility to detect and prevent post partum depression.

Today different wards in the hospital use empathic communication daily in different connections: in relation to patients, in team work, in supervision, in leadership and in educating students.

In special and complicated situations in their work midwifes have during the years adopted a general motto for solving a problem: “We do it the Brudal way”!

In 2005 and 2006 the Child clinic in the same hospital completed a 40 hours training program for nurses and doctors.

Generally
During the last years a group of trainers in Norway have accomplished different courses for in all hundreds of people in different parts of Norway. An experience so far is – among other things – that empathic communication may be a valuable part in treatment of patients with cancer. These patients often find themselves in “Frontier zone” because many of them struggle with an existential fear of death as a result of this special disease (see E. Becker (1973): The Denial of Death).

In the autumn 2012 I will give a lecture on empathic communication at a congress of 250 health personal in the north of Norway and a day information course for 25 health personal in a hospital south of Oslo. I will also accomplish a training course for members and ministers of The International Churches of Christ in Oslo this autumn.

Five Lessons
Here is a presentation of five lessons in a training as an overview of the content of the whole course. The number of lessons in a training group may vary. The number of days or weeks between the lessons may also vary.

We invite the participants to a course where the motto is “Learning by doing”.

First lesson.
Opening: Presentation of participants. What are the participants expectations?

“The mystery of health”.  Sense of coherence. (A. Antonovsky). Lecture.
“The art of helping”. (S. Kierkegaard). Lecture.
Empathy: Theories. Empiricism. Definition. Lecture.
Empathic communication: Theories. Empiricism. Definition of relationship. Lecture.

Training in groups.
Discussion in plenum. Focus on relational processes and experiences.

Video – demonstration of the method. (Lisbeth Holter Brudal interviews “Jon”.)

Second lesson.
Summary of first lesson.
Participants experiences with the method since first lesson.

Theoretical foundation:
Existentialisme (1). Lecture.

Training in groups.
Discussion in plenum. Focus on relational processes and experiences.

Self psychology (2). Lecture.

Training in groups.
Discussion in plenum. Focus on relational processes and experiences.

The art of listening.  (D. Stern.) Lecture.
Definition of flow.
Definition of mindfulness.
“Moments of meeting.

Third lesson.
Summary of second lesson.
Participants experiences with the method since second lesson.

Theoretical foundation:
Developmental psychology (3). Lecture.

Training in groups.
Discussion in plenum.  Focus on relational processes and experiences.

Positiv psychology (4). Lecture.

Training in groups.
Discussion in plenum. Focus on relational processes and experiences.

 

Fourth lesson.
Summary of third lesson.
Participants experiences with the method since third lesson.

Participants description of their workplace and work situation.
Implementation of empathic communication in general – practical considerations.
Discussion in plenum.

Training in groups.
Discussion in plenum. Focus on relational processes and experiences.

Principles for teaching empathic communication. Lecture.

Training in groups.
Discussion in plenum. Focus on relational processes and experiences.

Fifth lesson.
Summary of forth lesson.
Participants experiences with the method since fourth lesson.

Empathic communication and courage. (R. May). Lecture.

For the participants and the clients the course is an existential challenge that takes courage. Lecture.

Examples:
Existential courage (to be visible, step forward).
Empathic courage (to recognize another person, the other person is the main character).
Relational courage (be co-creator, to listen, to develop “moments of meeting”).

 

Training in groups.
Discussion in plenum.  Focus on relational processes and experiences.

Video – demonstration of the method once more. (Lisbeth Holter Brudal interviews “Jon”.)

Summary of the five lessons.

Plans for the future.

Evaluation.

Literature.

Antonovsky, A. (1987): Unraveling the Mystery of Health. How people manage stress and stay well.
Armstrong, K, (2011): Twelve steps to a compassionate life.
Becker. E. (1973): The Denial of Death.
Keyser, C. (2011): The empathic Brain.
Kierkegaard, S. (1950): The Art of Helping Others to Understand. Opening paragraph, Chapter A2, Kierkegaard`s Writings, Vol. 22.
May, R. (1974): The courage to create.
Nerdrum, P. (2000): Training of empathic communication for helping professionals. Dissertation for Degree of Dr. Psychol. Institute of Psychology. University of Oslo.
Snyder, C.R., Lopez  Shane, J. (2002): Handbook of Positive Psychology.
Stern, D.(2004): The present moment in Psychotherapy and Everyday Life.

Conclusion

Empathic communication is a realization of S. Kierkegaard`s paragraph “The Art of Helping Others to Understand”.

The results from our evaluation programs indicate that most participants who have attained courses in empathic communication consider the method as a valuable component in their work, especially in difficult situations. Several experience that empathic communication is a useful tool which strengthens their feeling of manageability.

The participants all confirm the advantage of “learning by doing” which is a central principle in the courses.

The participants report that their clients appreciate empathic communication to a great extent. They tell that to be affirmed and to be seen, to be accepted and respected during empathic communication is of great importance.

It is also confirmed that to use empathic communication in a workplace to not require more time or cost than the “old way of communication”.

Experiences since 2004 suggest that empathic communication may be an important tool for detecting and preventing post partum depression. An example is empathic communication as an after delivery talk.  In addition it seems that empathic communication may represent a meaningful component in the treatment of patients with cancer.

The results referred to regard the Stavanger and the Drammen model indicate that it may be possible – by means of courses in empathic communication – to develop a culture of empathy.

 

 However I will now suggest the following after discussing the matter with my trainers.

1. Lisbeth Holter Brudal
You and I have a dialog about the method where I present the
four points in the program step by step. 1 hour dialog. Start 6 pm in Oslo. In my office.

2.  Anne Gro Tvedt.
The same day – after our dialog – you make an interview with one of the senior trainers:
 Anne Gro Tvedt. 1 hour dialog. Start 7 pm in Oslo. In my office.

Anne Gro is a Gestalt therapeut, midwife and health visitor. We have worked together for many years and she has among other things given a lot of courses in empathic communication for teachers and health workers, lectured on empathic communication in different part of Norway and supervising employers by using the method. She looks forward to talk to you and ask you to send her questions in beforehand.

E-post: AnneGro.Tvedt=vestreviken.no

3. You take a separate video interview on Skype with
Per Tore Iversen who is also a senior. He is a Gestalt therapeut msc.
He has worked with couples using empathic communication, with groups of different health workers in institutions in different part of Norway and he is also a very clever and popular lecturer in empathic communication at different university colleges among other lecturing settings. Per Tore looks forward to the dialog and to hear from you.
E-post: gestaltpert=gmail.com

4. You will be contacted by a couple who have already had one five hours session with empathic communication:
Katrine and Ronny Yttrehus.
The couple will participate in and is responsible for the coming trainer course for 12 new trainers I shall arrange this autumn. If you agree – I was thinking it may be interesting for your program to interview a couple before the course to hear about the reasons for taking this education. It is of course up to you. Ronny is my support person in Skype. He has his own professional camera and may send you his own version he told me.
E-post: ronny=yttrehus.net.


We hope it will be possible for you to make the interview with Anne Gro and me at Monday 11.6., 6 pm and 7 pm. This is the most convenient day for both Anne Gro, Ronny and myself. If this day is impossible for you – please send me some alternative dates.