Use of empathy in psychiatric practice: constructivist grounded theory study

Abstract

Background: Psychiatry has faced significant criticism for overreliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and medications with purported disregard for empathetic, humanistic interventions.

Aims: To develop an empirically based qualitative theory explaining how psychiatrists use empathy in day-to-day practice, to inform practice and teaching approaches.

Method: This study used constructivist grounded theory methodology to ask (a) 'How do psychiatrists understand and use empathetic engagement in the day-to-day practice of psychiatry?' and (b) 'How do psychiatrists learn and teach the skills of empathetic engagement?' The authors interviewed 17 academic psychiatrists and 4 residents and developed a theory by iterative coding of the collected data.

Results: This constructivist grounded theory of empathetic engagement in psychiatric practice considered three major elements: relational empathy, transactional empathy and instrumental empathy. As one moves from relational empathy through transactional empathy to instrumental empathy, the actions of the psychiatrist become more deliberate and interventional.

Conclusions: Participants were described by empathy-based interventions which are presented in a theory of 'empathetic engagement'. This is in contrast to a paradigm that sees psychiatry as purely based on neurobiological interventions, with psychotherapy and interpersonal interventions as completely separate activities from day-to-day psychiatric practice.

Declaration of interest: None.

Copyright and usage: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Fig. 1. Components of empathetic engagement with sub-components.

Fig. 2. Relationship of the different components of empathetic engagement.