Have borderlines empathy

In the shoes of others ...

Basics, principles and risks of developing empathy


Situation characteristics

target group

  • Carers / learners themselves


  • related to several or not specified

Learning sequences

Sequence 1 - Laughter in the subway - Approaching a phenomenon

0.5 hours (of which communication: 0.5 hours)

didactic assignment of content

The students...

  • observe and describe the behavior of people (facial expressions, body language),
  • observe and describe your own (physical) reactions in encounters with other people,
  • seek explanations for observed behavior patterns in themselves and others on the basis of their previous knowledge,
  • explain the terms "mirror phenomenon" and "resonance".

didactic methodical course

The students...methodology
1... see a sequence from "Laughing in the U-Bahn" (link see literature reference)Video reception as an introductory impulse, the duration of the sequence shown should be at least long enough that a resonance phenomenon can also be observed in a larger proportion of the learners
2... describe their observations on themselves and on the people in the film sequenceStep 2-4: Teacher-student conversation, if necessary repeat excerpts from the film
3... activate their previous knowledge and form hypotheses as to how these reactions can come about
4... collect examples of comparable mirror / resonance phenomena
5... get to know neurophysiological explanations for this phenomenon (on a popular scientific or generally understandable basis without the requirement of in-depth neurophysiological knowledge)Teacher * invortrag

Sequence 2 - "Empathy" - Definition of terms and their systematization

2 hours (of which communication: 2 hours)

didactic assignment of content

The students...

  • name and explain definitions and explanatory models for the term "empathy" and related terms,
  • explain significant results from empirical empathy research,
  • systematize different dimensions of empathy with the help of categories of selected explanatory approaches,
  • assess their personal empathy and the importance they attach to this competence.

didactic methodical course

The students...methodology
1... read (in a division of labor) various definitions of and explanations of empathy (and related terms) and formulate what you have understood about itText work - individual development and bringing together in small groups
2... bring their knowledge together in a mutual exchangestructured method for exchanging the individual work results, e.g. B. Gear method
3... define for themselves on a scale how empathic they consider themselves to beStep 3 and 4: Individual work (if possible with internet access)
4... answer a test for empathy, e.g. B. Saarbrücken personality questionnaire, and evaluate it for yourself (anonymously)
5... define in an exchange how important they rate empathy for themselves personallyz. B. with the help of a comparative scale query and a discussion in the plenary, subsequent documentation of the scale and the positions represented in the learning group, so that both are available for reflection at the end of the training (-> Huntington's disease)
6... hear / read relevant results of empathy research from different studiesTeacher lecture or summary texts and discussion questions
7... develop on the basis of this preliminary work an order of the concepts developed up to this point for the dimensions of empathy (see table)Development of a table in the teacher-student conversation (see example table in the appendix) or structuring in small groups, then comparison of results / evaluation in the teacher-student conversation

Sequence 3 - Risks in dealing with empathy in a professional context

1.5 hours (of which communication: 1.5 hours)

didactic assignment of content

The students...

  • explain terms and manifestations of phenomena such as "empathic stress" / "empathic trauma" using examples,
  • explain the phenomenon "emphatic short circuit", identify it in its various forms using examples and give explanations and reasons for its occurrence (M. Rosenberg),
  • derive theoretical options for a reflected approach to empathy against the background of the terms developed.

didactic methodical course

The students...methodology
1... listen / read explanations of the phenomena 'empathic stress', 'empathic trauma', 'empathic short circuit'Teacher-student conversation or text work
2... find comparable examples from their observations in practice and identify moments of empathic stress in their own previous experiences Elaboration on the basis of a work assignment in partner work with subsequent publication of selected results in the plenary
3... name starting points (rules or principles) for a reflected approach to empathyTeacher-pupil conversation with results saved (blackboard, wall newspaper, class-specific learning platform)

Sequence 4 - Empathic Nursing Practice? - Professional and personal requirements and limitations in the development of empathy skills

2 hours (of which communication: 2 hours)

didactic assignment of content

The students...

  • agree on the importance of empathy for their professional behavior in nursing and the personal consequences that they draw from the knowledge of the risks associated with empathic reactions at this point of training,
  • identify contrasting, pointed positions in dealing with empathy in the field of care and reflect the respective meaning for yourself and the people to be cared for.

didactically methodical course

The students...methodology
1... discuss the meaning that the term empathy has for nursing and nursing training by comparing and weighing the findings from Sequence 2 and Sequence 3Pro and contra discussion, comparison and prioritization of arguments, pointed positions: "Nursing staff must be particularly empathic" -><- "pflegende="" müssen="" sich="" in="" erster="" linie="" gut="" abgrenzen="">
2... activate their understanding of the concept of profession (cf. prerequisites) with the help of the distinction between diffuse and role-like relationship design (Oevermann 1996) and relate this to the dimensions of empathy identified in sequence 2 Teacher-pupil conversation, if necessary with recourse to teaching material that has already been processed and teaching results developed (see prerequisites)
3... formulate requirements for their own handling of empathy and empathy requirements in the context of practical training - "personal practical assignment"Have a practice assignment formulated, if necessary publication of individual results
4... write a letter to yourself for the end of the third year of training in which you refer to this practical assignmentIndividual work - personal letter that is locked with a copy of the practice order and kept for -> Huntington's disease

Notes on preparing lessons

  • For sequence 1, step 1: possibility of presenting a You-Tube-Video.
  • For sequence 2, steps 3 and 4: Internet access for the learners, the recommended link should be checked beforehand.

Requirements, continuations, alternatives


  • There should be an in-depth examination of one's own emotional world and the perception of practical situations from the perspective of the trainee / carer, e.g. B .: -> My first day ..., -> The 4 eyes, -> Unravel the confusion of feelings, -> Sit down at his bed.
  • The distinction between diffuse and role-like relationship design (Oevermann, 1996) should be worked out, see -> Sit down at his bed, sequence 5 (work material), possibly also -> In other households.
  • The dimension of cognitive empathy through conscious change of perspective should be familiar, e.g. B. -> My first day…, -> understand family as a system.


  • Timely, e.g. In some cases in advance, the learner should be asked to empathize with the roles and situations of the people to be cared for and their caregivers and to consciously change their perspective, i.e. to specifically understand the dimension of cognitive empathy - e.g. B. -> Ingo's diary / blog, -> In other households.
  • The learning situation is an important prerequisite for -> person-centered communication and this in turn is the last component in order to establish -> collegial advice and supervision as a regular, increasingly self-organized reflection element in training.
  • In the further training course of the model curriculum, elements to promote the various dimensions of empathy development and differentiation from the people to be cared for are continuously integrated into the learning situations. B. -> Like a heavy sack of potatoes, -> Henriette Schulz, -> My pancreas can get me, -> A girl, -> I can't even look, -> Frau Feldmann, -> The white noise, -> Me I can't take it any longer !, -> I don't understand my husband anymore, -> A very difficult patient, -> Monday morning.
  • With -> Huntington's Disease, practical and theoretical aspects of developing empathy in nursing are taken up again in a targeted, reflexive and in-depth manner at the end of the training.



  • The learning situation was developed for the sample curriculum in the project team and tested as a model school by the Weingarten Health Academy.


Didactic comment

The competence to shape interaction empathically is seen as fundamental and meaningful for the social and health professions and thus especially for nursing (e.g. Ward et al., 2012; Scheu, 2012; Arens, 2006). The experience of an empathic relationship design or the experience of compassion should have a positive effect on the quality of life of the people to be cared for and thus, among other things. help determine the healing process and the patient's outcome (Ward et al. 2012; Hojat, 2007; Spiro et al., 1993). B. theoretically justified by H. Peplau for care (ibid. With Verw. A. Peplau, 1997; Smith / Leir, 2008). Regardless of all technical developments and scientific-technological justification and optimization lines in clinical care, according to the ideas of various authors, empathy forms “the core” or “the heart” in the encounter between patients and caregivers (Ward et al., 2012; Kelly, 2007). The received findings and normative settings are connected with the educational goal of promoting the competencies of nurses in empathic interaction. According to the understanding of the authors, this claim should be emphasized all the more strongly against the background of ever-shrinking time windows for nurse-patient communication (Ward et al., 2012; Ward et al., 2009). When it comes to nursing, the term “emotional work” is used (Scheu, 2012; Bischoff-Wanner, 2002).

Curricular classification

Following the development logic stored in the sample curriculum for communication in nursing (- "from I to YOU ​​to WE to SYSTEM" -), the classroom discussion of questions of empathic relationship is initially - in the first one to two semesters - dealing with one's own emotionality upstream of the learner (-> my first day…, -> the 4 eyes, -> confusion of emotions, -> sit down at his bed times). Only when a certain degree of security has been achieved in the perception and verbalization of one's own feelings should the view be directed to the feelings of the people to be cared for and the connection of emotionality in the working alliance. This change of perspective is initially initiated theoretically in this learning situation. Empathy also forms one of the three basic variables for building a trusting relationship and thus a basis for a person-centered interaction design (Rogers, 1973/1981; cf. also Schirmer / Schall, 2015), which comes into focus in -> person-centered communication. On this basis, in further case-related learning situations and in learning tasks for practical assignments, the competencies in the design of the nursing relationship, in the development of an understanding access to the people to be cared for from different target groups as well as in an understanding-oriented conversation on various aspects can be gradually established and consolidated . An examination of the “dark sides of empathy” (Breithaupt 2017) or the social implications of “empathy [as; d. A.] social promise of salvation [...; in a; d.A.] strongly individualized [n] society "(Voss, 2017) should then take place in the reflection of the training experiences in the last year of training.

Content-related context

From a historical perspective, the term “empathy” was invented in 1909 in the English-speaking world by Edward Bradford Titchener, an American experimental psychologist who did his doctorate in Leipzig, as a translation of the German term “empathy” according to Theodor Lipps (Breithaupt, 2017, 45f, 80 [1]).

In the literature relating to nursing, agogic and therapeutic action, what is assigned to the term empathy is understood and justified in very different ways. A distinction is often made between cognitive and emotional empathy. The cognitive-empathic ability then refers to the ability to understand others with their experiences, worries and opinions from their perspective and to be able to communicate this understanding. The aim is to perceive the other person in a descriptive way as objectively as possible and to mentally grasp the subjectivity of the other person in order to develop feelings and needs consciously, intellectually or rationally, which requires the ability to verbalize observations and assumed backgrounds. Such an attitude can be consciously created and, assuming the cognitive skills and the corresponding motivation, can be specifically learned, practiced and trained (Schirmer / Schal, 2015; Bischoff-Wanner, 2002, 256).

Since the boundaries between emotional and cognitive empathy tend to be blurred, it makes sense to speak of components or dimensions of empathy that work together. In addition to the emotional and cognitive ones, other authors are also supplemented by various authors. So differentiate z. B. Morse et al. (1992, quoted in Müggenburg / Broda, 2017) a moral component (which relates to the use of empathy and takes up altruistic components that motivate empathy) as well as a behavioral component (which describes the communicative skills through empathy for Can be expressed). Davis (1980, quoted in Müggenburg / Broda, 2017) distinguishes four subdimensions of empathy: "Taking perspective" (PT) forms a cognitive component, "Fantasy" (FS) describes the tendency to turn into fictional characters and to relocate their emotional world, draws on both emotional and cognitive abilities, "empathic concern" (EC) and "personal distress" (personal distress - PD) relate to emotional components from different perspectives, on the one hand more foreign-oriented other person-related tendencies to develop feelings, such as pity and worry, and on the other hand to feelings that arise in the person himself in difficult social situations, such as B. Feeling unwell and restless.

In scientific studies, e.g. B. Also in educational research, empathy is mostly determined and quantified empirically with the help of questionnaires. A personality test, the "Interpersonal Reactivity Index" (IRI), has found widespread use worldwide, so that when it is used, a large base of comparative data can be used [2]. This test is based on Davis' self-assessments of the 4 listed sub-dimensions and was evaluated for the German-speaking area in the Saarbrücken personality questionnaire (SPF) translated (Paulus 2016; ders. No year). As such, it will be available in January 2018 on the homepage of Saarland University as a test that can be carried out directly online with immediate feedback from the test evaluation. It was also used by Müggenburg and Broda (2017) for a sample survey with an exemplary character among nursing trainees at a nursing school. The statements of this study can be used as reference points in the classroom - even if not significant due to the sample.

Ward et al. (2012) use the Jefferson Scale of Empathy for a longitudinal study of nursing students, which is specifically geared towards medical staff.As a result of their study, they state that the ability to empathize decreases significantly in the course of the training and that this decline primarily correlates with the frequency of practical experience with patient contacts during or before the training. ("... significant decline in empathy was observed among students with varied patient exposure and clinical experiences during nursing school, F (2,211) = 4.2 P <.01. [...], we noticed that prior work experiences in clinical settings were associated with a significant decline in empathy, F (1,212) = 10.3, P <.01 ”loc. cit., 37). These results show clear parallels with comparable studies in medical training (Ward et al., 2012; Benbassat / Baumal, 2004; Hojat et al., 2009). For this area, various reasons for the established “empathy riddle” of a growing rejection of empathy as a result of increased patient contacts are recorded. B. the lack of convincing / appropriate role models, observed negative attitudes, an intimidating educational environment, experiencing one's own weakness, difficult educational or medical tasks and the negative mood that the patients contribute (Ward et al., 2012). Ward et al. (2012) point to further investigations into the interrelationships in the change in the ability to empathize. Sometimes the results are contradictory and there is a need for further research, also because the sample of the study is limited to academic training institutions in the central Atlantic region and quantitative research, so that in-depth qualitative data cannot be used. In their discussion of the results, the authors call for a less distant training in nursing that is oriented towards the acquisition of technical tasks and "managed care" in favor of training based on clinical experience and an atmosphere for clinical practice that is aimed at imparting the theoretical basics promotes the implementation of empathic skills.

The central question therefore also appears to be to what extent empathy can be taught and learned (Scheu 2012; Arends 2006). It is clear and understandable against the background of educational research that the mere imparting of psychological, empathic-related knowledge within the framework of theoretical teaching does not contribute to the promotion of empathic skills (Scheu, 2012). On the other hand, a variety of exercises and training courses for adopting perspectives are recommended, which are often aimed primarily at cognitive educational goals, i.e. knowledge and conscious experience or cognitive understanding (ibid .; Bischof-Wanner, 2002; but also Breithaupt, Ireland example).

With reference to Arnold (2004, 23–36 and 2003, 29), Arens (2007, 294) pointed out the fundamental importance of emotional competence and emotional self-reflexivity for the development of empathy. In addition to the mentioned ability to verbalize, to which Schirmer and Schall (2015) also refer, he sees the need for the learners to first have “emotional litercy”, i.e. a knowledge of the “abundance of possible emotional states”. These would have to be converted into behavior appropriate to the situation by mastering suitable 'techniques'. A consciously reflected approach to or a reduction in negative extreme feelings and a conscious build-up of positive emotional states should be developed. It would convey the experience of a wider range of feelings and the possibility of emotional reinterpretation. The focus is on the ability for self-reflection and a controlled handling of emotional patterns acquired in childhood, which can no longer be used appropriately in adult life and especially in professional activity. Self-perception, mindfulness [3], self-awareness, control, regulation and control as well as self-motivation precede the development of empathy, social competence and communication skills. Even if the processes of self-reflection cannot be regarded as complete, the basic didactic structure of the sample curriculum can also be found here, which only places a conscious requirement on the development of empathy in the second half of the first year of training. The learning situation proposed here is based initially on the theoretical awareness and classification of terms, concept and attitude and on the classification in the planned competency development in connection with previous learning situations on emotion psychology. Such a rather distant approach seems necessary at this point in order to show the learner the need to consciously deal with empathy in its various dimensions and to enable an assessment of the risks described. For the further course of the training, Arens' contribution contains a wealth of methodological tips that can be taken up in the context of various learning situations and case studies. The learning opportunities should focus on the more rational-reflexive adoption of perspectives as well as on a conscious and targeted temporary empathy and resonance with the emotional impulses of the people to be cared for [4]. The authors of the sample curriculum also see the teachers here in the role of learning guides in this process.

In addition to the demand for the development of empathic skills, there is often a reference to the risks that arise above all when empathy tends towards the affective side and participation in the feelings of the other (“emotion sharing”). On the one hand, there is the risk of being inundated and affected by the feelings of the other, which, in the case of difficult social situations, can lead to “secondary traumatisation” (Rixe et al., 2014). In addition, as a defensive reaction, as it were, there is behavior that is described by the representatives of nonviolent communication as an “empathic short circuit” (cf. Altmann 2015, 26). Both symptoms should be known to nurses in the future in order to integrate these two “risks” into a conscious handling of their empathic reactions and skills.

[1] with reference to Ahoda, G. (2005): Theodor Lipps and the Shift 'Sympathy' to 'Empathy'. In: Journal of Hixtry of the Behavioral Sciences 41, pp. 151-163 - Lipps understood “... by empathy a basic process in the direct understanding of expressive phenomena. Empathy is an inner participation, an imagined imitation of the experience of the other ”. (quoted in Wikipedia with reference to a diploma thesis by Christa Dunst) - he is thus following David Hume's definition of sympathy.

[2] Davis, M. H. (1980): A Multidimensional Approach to Individual Differences in Empathy ”, quoted in Breithaupt (2017)

[3] To justify a deepening of self-awareness as a prerequisite for developing empathy, see a. Köhl / David (2010)

[4] in the scenic play (e.g. Scheller 19) reference is made to the theater-pedagogical discussion between Stanislawski and Bert Brecht's acting theory: While Stanislawski demands "empathy" from the actor (putting himself mentally, psychologically and physically in the role, living it from the inside out and experiencing the unfamiliar also emotionally) Brecht calls for the more distant attitude that actors “demonstrate” and show the situation on stage. A targeted integration of both theater-pedagogical moments in nursing lessons (which does not necessarily only mean role / theater play) offers starting points to promote the development of skills in both dimensions and to show the learners ways, their scope for action in social processes, how they interact with nursing Representing people to expand.


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Video: Laughing in the subway - video documentation of an experiment (e.g. https://www.youtube.com/watch?v=EeauvE1M7qc or https://www.youtube.com/watch?v=GMsfSab5zPc)

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