3. LOS REGADIOS HISTÓRICOS EN ESPAÑA
3.5. La bibliografía sobre riegos en el siglo XIX
Validation of their emotions is important for the Person/s who typically feels vulnerable and uncertain when consulting a health professional. Validation confirms the existence of their negative emotions, and potentially allows them
to acknowledge and accept the existence of these emotions. Acknowledging the legitimacy of the nega-tive emotions is often difficult for the Person/s because they may feel confused and ungrateful at that time (see the scenario about ‘Eric’ later in this chapter). The process of validation requires the health professional to recognise the emotional cues of the Person/s and accurately name those emotions. These emotional cues are often communicated non-verbally (see Ch 12) and thus require sensitive and respectful validation. This process, if performed sensitively, gen-erally releases the Person/s to acknowledge those emotions with greater acceptance and less confusion.
The Person/s often feels more able to express, under-stand and control their emotions after validation. It is important to note that validation does not indicate whether the emotions are reasonable or appropriate, it simply states the existence of the emotions. Health professionals indicate unconditional positive regard by: (i) separating themselves from their values and judgements (Rogers 1967); (ii) recognising the emotion in the Person/s; and (iii) expressing aware-ness of the emotion – usually by asking a question relating to the particular emotion, but sometimes with non-verbal cues.
CLARIfICATIon wITHIn VALIDATIon
Bergland & Saltman (2002) state it is important to recognise that each individual has a unique communication style. Recognition and understanding of the communication style of the individual ensures positive communication outcomes. Accurate validation of emo-tions cannot occur without this recognition of individual communication styles. Different cultures, different social groups and different families increase the variations in commu-nication styles. Therefore, in recognition of these variations, health professionals might request clarification of their perceptions rather than assume they have accurately recog-nised the emotional cues of the Person/s. A request for clarification of the perception of the emotion is appropriate before recognising and validating an emotion. A question indicates the interest of the health professional in the Person/s and allows that Person/s
•
In groups of four or five, choose five of the following emotions: happy, frustrated, excited, sad, devastated,•
Consider the variations in the ways of expressing each emotion.•
Which of the emotions appeared to be expressed in a similar manner to each other? Why is it important to consider this when validating emotions in the Person/s?•
List the different ways each group member used different parts of their body to express each emotion.•
Decide what each of these answers means for a health professional.108
to decide if they will admit or deny the presence of the emotion. If admission of the emotion follows, the health professional has the opportunity, if appropriate, to empathise and explore the emotion with the Person/s. If denial of the emotion follows then the health professional has lost nothing and is learning about the communication style of that individual. In this situation, it may or may not be appropriate to pose another question asking the Person/s to name the current emotion. The health professional must decide whether to pursue the presence of the emotional cues or to leave the Person/s to consider the question alone. The question may begin the exploration process of the emotions of the Person/s amidst their confusion and fear, and allow verbal exploration later. Strong emotions are inevitable in the lives of health professionals and those around them; denial of these emotions is unwise because of the enormous emotional cost (Davis 2011). Vali-dation of strong emotions is necessary because it begins the journey of acknowledgement and resolution, both of which facilitate understanding and control of often overwhelming emotions potentially influencing intervention outcomes.
Accurate validation requires the health professional to request clarification of the per-ceived emotions to facilitate honest communication. Such communication encourages the Person/s to honestly admit and consider the presence of their emotions. Validation pre-pares the Person/s for empathic exploration of their emotional responses. Honesty is not always easy when considering emotions; however, honesty is essential for the achievement of positive outcomes.
Empathy
As expressing empathy is essential in health practice it requires further consideration.
Empathy is a process (Rogers 1975) that requires a health professional to enter:
… the private perceptual world of the other and becoming thoroughly at home in it
… It includes communicating your sensing of his world as you look with fresh and unfrightened eyes at elements of which the individual is fearful. It means frequently
checking with him for the accuracy of your sensings, and being guided by the responses you receive … To be with another in this way means that for the time being you lay aside the views and values you hold for yourself in order to enter
another’s world without prejudice … (p 4)
This definition reveals the reality of the complexity of expressing empathy. Unlike many definitions of empathy, it makes the health professional responsible for their emo-tional response to the Person/s. It demands that the health professional not only express emotional sensitivity that demonstrates understanding of the emotions (Northouse &
Northouse 1992), but also requires them to separate themself from their values and personal prejudices. The definition requires the health professional to feel with the Person/s in a non-judgemental manner. It requires the health professional to patiently listen and reflect on what they hear in order to respond with empathy. It requires the health professional to avoid giving advice, regardless of their experience or understanding (Cilliers & Terblanche 2000). In addition, it requires the health professional to avoid interrupting, except to either affirm the Person/s without words or to encourage further expression of the emotions. The health professional verbally and non-verbally expresses empathy – by their actual words and how they express those words. Expressions of empathy require that the health professional makes no assumptions about the accuracy of their perceptions of the feelings in the Person/s, only that they request verification of
8 » AwAREnEss of THE ‘PERson/s’
109
those perceptions. It is the seeking of verification that allows the health professional to remain themself while focusing on the Person/s.
In contrast to empathy, sympathy is the expression of the experiences, feelings and perspectives of the health professional and places the focus upon those experiences, feel-ings and perspectives rather than those of the Person/s (see Ch 2). Experiencing events that are similar to those of the Person/s may assist the health professional when com-municating. However, this can also lead the health professional to assume they know exactly how the Person/s is feeling. This ‘feeling’ can assist understanding or it can create an illusion of understanding that limits the expression of empathy. That is, this ‘feeling’
may communicate either authentic understanding or a nonchalance that is inappropriate, depending on how the health professional communicates the commonality of experience.
While in some circumstances self-disclosure may increase satisfaction for a Person/s (Holmes et al 2010), it is often safest to avoid sharing a similar experience with the Person/s because this places focus on the health professional instead of the Person/s.
When communicating with empathy it is important to focus only on the needs and reactions of the Person/s.
Eric, a 28-year-old, and Mandy, his wife of six months, wait quietly in a private room for someone to tell them the results of his tests. To fill the time and stop thinking the worst, they talk about the work they are doing on the house they have just bought and their future plans to travel and have a family.
The specialist doing the tests was highly recommended so they feel confident. He finally comes into the room reading some papers. He smiles quietly and looks up. The tests are all clear. Eric and Mandy visibly relax. The specialist does not notice this, however, because he is not convinced that the results are accurate. He suggests more tests to be sure of the diagnosis.
He feels his hunch is right considering the symptoms that Eric has been experiencing and just wants to confirm this.
A few weeks later Eric and Mandy sit in the same room with a feeling of déjà vu. This time they are not trying to avoid thinking about anything – they feel tired and afraid.
When the pathology report arrives, the doctor and three other health professionals rush into the room. This time the specialist has a big smile on his face. He excitedly says he was right, these tests have confirmed his hunch and Eric does have the chronic condition he has suspected from the symptoms. I was right! he says repeatedly.
Eric and Mandy are crushed – they have no idea of the implications of the condition, but they know their plans will need major changes. Their faces express devastation.
The specialist stops smiling and looks at them, surprised. He simply says You should be happy; it could have been worse – you have at least 10 good years.
Stunned, Eric and Mandy thank the specialist for his perseverance in the search for a diagnosis. Eric is feeling completely confused and afraid. Mandy is horrified and devastated.
Eric does not want to seem ungrateful but this is not his idea of something to celebrate or something to smile about, and he is in shock. In the confusion he thinks these feelings must be inappropriate considering the response from the specialist – and then he notices the tears rolling down the face of the health professional who had spent time with them when they first arrived at the health service. The one who knows they are newly married with wonderful plans for the future.
Eric in his mind thanks that health professional because it indicates that his feelings are appropriate – he is allowed to feel terrible – and he bursts into tears.
(Adapted from Northouse & Northouse 1992)
110
THE IMPoRTAnCE AnD REsULT of EMPATHY foR THE sEEKER of AssIsTAnCE
Empathy has a positive effect on both the health professional and the Person/s. The context of the particular health service, while familiar to the health professional, is unfamiliar to the Person/s seeking the assistance of that service. Each Person/s has a reason for seeking assistance and this reason may be creating confusion and fear in them. There may also be factors and events in the life of the Person/s, past or present, which cause confusion and fear, independent of the current reason for seeking assistance. In such circumstances, the emotional need for understanding and acceptance becomes the dominant need. The needy and fearful Person/s seeks that understanding and acceptance from anyone who will offer it.
•
Consider this scenario from the perspective of Eric and Mandy.•
Consider this scenario from the perspective of the specialist – remember the times you have been preoccupied with something or excited about something and have not noticed the feelings of the people around you.•
Consider this scenario from the perspective of the health professional who had the courage to cry.•
Whose perspective do you find easiest to understand?•
What does this mean about your ability to demonstrate empathy?•
Using the above thoughts, discuss the responsibility of the health professional to focus on the needs of the Person/s regardless of the feelings of the health professional.•
List the reasons why this is the case.•
What can a health professional do to ‘survive’ the process of sharing the perspective of hurting and often fearful people in order to express empathy on another occasion?•
List actions or behaviours that will assist the health professional to express empathy when communicating with the Person/s around them.John lives alone in a dark, cluttered room. His best friend is a bottle of cheap alcohol. He has recently experienced back pain and has come to an alternative health service for assistance.
While he has plenty of money and clothes, he usually wears the same clothes that show little evidence of laundering. John rarely showers so people leave the waiting room whenever he attends for treatment! John does not feel that anyone cares about him, so he does not care about himself.
Sam, the osteopath who treats John, is pleasant but distant. He usually works as quickly as possible and says very little while treating John. After treating John, he sterilises everything and thoroughly disinfects his hands.
Adrian, the cleaner, has lost the ability to smell and often works close to John when he is there, chatting as he cleans. He regularly asks John how he is going and how he is feeling. John has come for treatment for several weeks and Adrian has learnt a lot about John in that time.
Adrian makes it his business to clean the waiting room whenever John is there, regularly expressing empathy towards John, and once bringing him some homemade cooking (Adrian’s
wife is a great cook). →
8 » AwAREnEss of THE ‘PERson/s’
111
Making an effort to enter the perspective of the Person/s without judgement is a sign of respect (Egan 2010). It communicates understanding and acceptance, and allows expression and exploration of sometimes debilitating emotions. It reassures the Person/s that their emotions are not ‘crazy’, and it potentially facilitates management of the confu-sion and fear in unfamiliar and sometimes unpleasant situations. Empathy can empower the Person/s to take control in a seemingly out-of-control situation, thereby facilitating a change in the way they manage the situation and the way they relate to themself. This reality indicates that empathy is a central component of family/Person-centred practice (Davis 2011).