“Genuine and fundamentally human”: a qualitative study into Dutch humanist chaplains’ conceptualizations of empathy

Abstract

Empathy has been highlighted as a key concept in chaplaincy care, but its meaning has hardly been explored in depth within this field. This study aims to help develop stronger conceptual clarity by investigating humanist chaplains’ conceptualizations of empathy. Data were collected through semi-structured interviews with twenty humanist chaplains working in health care, military, and prisons. A qualitative design was employed to clarify which components and features constitute empathy in humanist chaplaincy care. Empathy emerges as a multidimensional concept that is “fundamentally human.” Chaplains distinguish between true and pseudo empathy based on different features including authenticity and concern. This article provides a conceptual model that combines the different components and features of empathy in humanist chaplaincy care and the relationship between them in light of empathy’s humanizing quality. It may be used for educational purposes and could function as a conceptual framework for future research efforts.

Keywords:

• Authenticity
• chaplaincy care
• empathy
• humanist chaplaincy
• qualitative research

Introduction

Empathy has been identified as a core concept in chaplaincy care (Baard, 2017; Capretto, 2015; Dijkstra, 2007; Fitchett, 2017; Handzo et al., 2008; Hogue, 2010; Hoogeveen, 1991; Parameshwaran, 2015; Pembroke, 2019; Savage, 2019; Smit, 2015; Underwood, 1985; Zondag, 2007). Despite its apparent importance, research into the meaning of empathy is virtually non-existent in chaplaincy care and the notion of empathy lacks a clear and unifying definition. Conceptual vagueness may complicate empathy research in chaplaincy care and may impede professional reflection, discussion, and education in this field.

This article is part of a larger philosophical and qualitative study into the meaning, functions, and practices of empathy in (chaplaincy) care. The present study aims to help develop stronger conceptual clarity by investigating chaplains’ understandings of empathy, thus grounding the concept of empathy in the data. For this purpose, we interviewed twenty humanist chaplains and used an inductive, qualitative approach inspired by the grounded theory methodology. We choose to interview humanist chaplains since empathy is a key concept in their profession (Bru, 2008; Duyndam, 2018; Hoogeveen, 1991; IJssel, 2007; Mooren, 1999; Van Praag, 1982).

We start with a short overview of empathy in humanist chaplaincy care. After presenting the research design, we discuss the findings in two parts. We first present the main components of empathy as they emerge in the data. Second, we discuss the features of true or genuine empathy. According to Coplan (2011), defining empathy is as much about explaining what a concept is as it is about explaining what it is not. She argues that “any successful conceptual or theoretical framework of empathy will make salient the ways in which pseudo-empathy differs from the process I conceptualize as genuine empathy” (p. 53). Finally, we present a conceptual model of empathy that integrates the different meaning aspects and discuss our findings.

Empathy in humanist chaplaincy care

Van Praag, who is considered to be the founding father of Dutch humanist chaplaincy or counseling (Schuhmann et al., 2021), explicitly mentions empathy in his definition of the profession:

Humanist counseling is a professional systematic approach in an atmosphere of safety and empathy to activate the client’s ability to provide meaning, orientation, and self-determination to his life and, by means of a confrontation with the human potential, according to humanist insights, to enable him independently to design and handle his own view of life (Van Praag, 1982, pp. 146–147).

Van Praag’s definition of humanist chaplaincy is still considered to be one of the most influential in this field (Jacobs, 2001). It is part of the Professional Standard (Bolsenbroek et al., 2019) of Dutch humanist chaplains.

In the 1970s and 1980s humanist chaplaincy was heavily influenced by the client centered approach of Carl Roger (IJssel, 2007). Empathy is a key element of his humanistic psychology. The best known and most used version of Rogers empathy definition is: “To sense the client’s private world as if it were your own, but without ever losing the ‘as if’ quality, this is empathy” (Rogers, 1957, p. 99). This means that people do not actually experience the other’s pain or sadness but recognize that they experience these emotions “as if” they were hurt or sad. Without the “as if” condition, people would enter a state of identification (Rogers, 1975). Rogers definition has been influential in humanist chaplaincy over the past decades (Bru, 2008; Houten & Mooren, 2002).

Empathy has been mentioned in the works of humanist chaplains as well. In “Simplicity and strategy” renowned humanist chaplain Elly Hoogeveen (1991) describes empathy as “the capacity to sensitively understand the other’s state of mind, which is grounded in the structural similarities between people” [Translation by the first author] (p. 68). Joachim Duyndam, a Dutch professor of humanism and philosophy at the University of Humanistic Studies, defines empathy as “the ability to share the feelings of others through imagination” or as “knowing emotionally what another person feels” (Duyndam, 2010, p. 11). According to Duyndam, one of the key characteristics of empathy is its potential character. When empathizing, people do not actually experience the other’s feelings, such as grief, but they experience potential feelings, since the grief belongs to the other person (p. 7).

The three definitions given above highlight different meaning components. We recognize these components in empathy literature, which commonly distinguishes between cognitive and affective empathy (Maibom, 2014). Affective empathy refers to the ability or act of emotionally attuning to or resonating with the other’s experiences. Cognitive empathy refers to the ability or act of mentally reconstructing the other’s experiences, primarily by using one’s imagination. Often, one finds a combination of affective and cognitive elements in empathy definitions. Duyndam defines empathy as primarily an affective experience of shared feelings based on one’s imagination, whereas Hoogeveen’s definition highlights the cognitive experience of understanding the other’s mental state, which involves sensitivity as well.

The authors further stress different key features or characteristics of empathy that help to distinguish empathy from related concepts. For example, Rogers focuses on the “as if” condition of empathy, whereas Duyndam refers to the potential character of the empathic experience as one of its most defining characteristics. Hoogeveen refers to our shared humanity as an essential aspect of empathy.

This concise overview illustrates that humanist chaplaincy lacks a clear and unifying conceptualization of empathy. In our study, we hope to provide an overview and a clarification of the way empathy is conceptualized in humanist chaplaincy care by generating a model of empathy that helps to unravel its meaning aspects in this profession.

Methods

Participants

This study was assessed by The Medical Ethical Review Committee Utrecht, who confirmed that the Dutch Medical Research Involving Human Subject Act (WMO) does not apply, as our empirical study does not concern medical scientific research and as the humanist chaplains participated in their capacity of professionals and were not required to follow behavioral rules or procedures as referred to in the WMO. The researcher obtained written informed consent prior to the interviews. The participants were informed that they had the right to withdraw at any time. They gave permission for recording the interviews and were reassured that identifying characteristics of both the participants and their clients would be changed in the research products to protect their confidentiality.

The research participants were purposefully selected through variation and network sampling (Boeije, 2010). To capture a wide range of empathy understandings and experiences, the twenty participants were recruited from different age groups and from twenty different organizations in the fields of healthcare, military, and prison (see Table 1). At the time of the interviews, the total eligible population working in these three fields consisted of ∼160 humanist chaplains. The field of healthcare included nursing homes, hospitals, rehabilitation centers, addiction treatment centers, and mental hospitals. The participants had at least one-year work experience as a humanist chaplain. All of them received their education at the University of Humanistic Studies (since 1989) or its predecessor, the Humanist Training Institute (since 1964). Consequently, the participants share a similar educational and theoretical background.

Table 1. Participants’ demographics and work settings.

	N	Total number of persons working in this setting
Age
18–29	2
30–39	4
40–49	4
50–59	6
60+	4
Gender
Male	10
Female	10
Work setting
Health care	11	97
Military	5	38
Prison	4	27

Procedure

Data collection yielded a total of twenty interviews. Participants were invited by phone or email. Each of them responded enthusiastically when asked to partake in the research project. One of them declined due to time constraints. The interviews were conducted at a quiet location at the workplace of the participant (16) at the home of the participant (2) or at the university (2). Apart from the participant and the first author, no one else was present during the interviews.

Semi-structured interviews were carried out by the first author, a female PhD student who has a background as a qualitative researcher. She received her education at the University of Humanistic Studies, which was known to the participants. The aim of the interviews was to gain rich, in-depth insights into participants’ conceptualizations of empathy. The interviewer did not clarify empathy and related concepts before the interviews, as we were interested in the definitions of the chaplains themselves. The semi-structured interview method provided structure and guidance, yet allowed the chaplains the opportunity to convey their own views and experiences (Grossoehme, 2014; Patton, 2002). After each interview, the questions were evaluated and finetuned by the first author.

Two high quality audio recording devices were used to safeguard the recording of the interviews (Grossoehme, 2014). No notes were taken during the interviews to ensure that the interviewer could focus on the conversation. The interviews were transcribed verbatim by the first author, using the transcription software Express Scribe. They were not corrected by the participants. The interviews lasted ∼90–120 min. The data collection process ceased when a high level of saturation was reached as no new categories or themes and no substantial new insights emerged and the core categories were well saturated (Saunders et al., 2018).

Analysis

Since the focus of our study is on generating a theory to fill a knowledge gap, we used an inductive, qualitative approach inspired by the grounded theory methodology but without following all its original tenets to the letter. Grounded theory provides a well-described set of guidelines and coding procedures that help to build conceptual and theoretical frameworks from the ground up (Birks & Mills, 2015; Grossoehme, 2014). Because of its thorough, systematic approach, it is one of the preferred qualitative methods in chaplaincy research (Grossoehme, 2014).

The interview data were coded and analyzed by the first author in accordance with the three levels of grounded theory, moving from lower to higher level concepts (Birks & Mills, 2015). The coding process was facilitated by the use of the data-analysis program Atlas.ti 7.5 (Friese, 2014). After engaging in a process of initial or open coding, the codes were classified into categories and themes through a process of constant comparison, alongside data analysis within a larger qualitative study aimed at investigating the functions and practices of empathy in humanist chaplaincy care. Extensive memo writing helped to record the thought process of the researcher and focus the analysis (Birks & Mills, 2015). After the first eight interviews were coded, a preliminary coding system was discussed within the research team.

In the more advanced stage, selective coding was used to identify the core categories (Moghaddam, 2006) and to generate a conceptual model of empathy. For example, the core category of “true or genuine empathy” emerged, which clusters seven themes that help to distinguish between what is empathy and what is not empathy. At this stage, tables, drawings, and concept maps were used extensively to visualize the relationships between code groups and support the analysis (Friese, 2014).

The research design, interview data, coding process, analysis, and findings were continuously discussed within a multidisciplinary research team, which consisted of a care ethicist, a philosopher, and a research methodologist/cultural anthropologist. Sharing perspectives on the analysis, findings, and early drafts helped enrich and clarify the emerging concepts and the conceptual model. Early outcomes of the empirical studies were presented and discussed in a research seminar at the University of Humanistic Studies. Members of the seminar provided advice, insights, and detailed feedback to help improve the research. Member checking was applied by inviting one of the participants to closely read the research findings and provide feedback, which resulted in minor changes to the analysis. To improve the transparency of the qualitative study, we used the 32-item QOREC checklist (Tong et al., 2007).

Results

In this section, we present the findings of the qualitative analysis. Three core categories could be generated from the empirical data: “empathy as a multidimensional concept,” “empathy as a humanizing concept” and “the concept of true and genuine empathy.”

Empathy as a multidimensional concept expresses the idea that empathy consists of a diversity of components, including empathic contact or relations, empathic abilities or acts, empathic experiences, empathic communication, and empathic caring behavior. These different components will be presented in the first paragraph. They are bound together by the fundamental humanizing quality that the participants attribute to empathy. The distinction between true or genuine and pseudo empathy expresses the idea that different features or criteria can help to distinguish between what is empathy and what is not empathy. This core category will be discussed in the second paragraph. In the third and final paragraph, we draw the different components and features of empathy together and propose a conceptual model of empathy in humanist chaplaincy care.

When citing the participants, we refer to their field to provide context: P for prison, M for military, and H for healthcare.

The components of empathy

In general, participants express that they understand empathy as a “key concept” in their profession. When asked to clarify the term, however, some participants initially remark that they find it difficult to provide a definition of empathy. Generally, they draw on two sources when defining empathy: their educational or theoretical background and their experiences with empathy in daily care practices. Regarding their educational background, several participants refer to elements of Rogers definition of empathy:

Empathy means taking the perspective of the other without losing oneself. (…) I believe this definition is Rogerian, but I am not certain. When one has worked for so many years, you do not remember where it all came from. (R6H)

When talking about their experiences with empathy, chaplains possess a rich vocabulary to describe what empathy means in the context of their daily care practices.

Six categories can be generated based on the analysis of the interview data. They will be presented in the following sections.

Empathy as contact

Many chaplains refer to empathy as primarily a form of contact or connection: “Empathy and contact are a bit of the same stuff.” (R12H) Another participant explains: “It [empathy] is another word for true contact.” (R16H) Through empathy, chaplains connect with their clients’ inner world of thoughts and feelings, based on their clients’ stories and non-verbal expressiveness. A participant argues that empathy is a form of contact “with the other through something of the other” (R1P) in which “something” refers to the experiences and feelings that are expressed by the client. According to the participants, the empathic connection presupposes closeness. It is a connection “from heart to heart.” A participant expresses: “The first thing that comes to mind is an image: empathy is making contact from the heart. (…) Empathy is about the relationship.” (R15H)

Empathy as ability or act

When asked to clarify or define empathy, most chaplains refer to empathy as an ability, capacity, or act. They often do not restrict themselves to naming one type of ability or act but distinguish different types:

[Empathy is] being able to feel what the other person feels. This is easier when you are a sensitive person. On the other hand, you can do it cognitively. You realize: “If someone has been through that, this is how he must feel” (…) But you can also see it, or directly sense it, without having to imagine what it must be like. (R7H)

Four subcategories emerge in the data: empathy as an emotional, an intellectual, a perceptual, and a physical ability or act.

First, empathy refers to the emotional ability or act of feeling into or feeling (along) with others, based on one’s emotional sensitivity and receptiveness. Chaplains practice this type of empathy by tuning into their clients’ emotional world, or by opening up and allowing themselves to be emotionally touched by their clients’ expressiveness and by actively listening to their stories: “You hear their story and everything they have been through, and they portray who they are, and where they are at and what they are feeling. I think you only have to open up to that.” (R8H)

Second, empathy refers to the intellectual ability or act of imagining what it is like to be in the other’s position: “Empathy means (…) that you genuinely try to imagine what it is like to be the other or what it is like to be in the other’s situation. (…) So, it means truly taking the other’s perspective, to be able to think along with the other.” (R11M) Gaining insight into the other’s situation and experiences can be accomplished through imagination alone or through a combination of imagination and attentive listening, in which the imagination is guided by the clients’ stories:

If you truly listen to their stories and you just move along, step by step, then you can imagine (…) I am not an aggressive person at all (…) but thinking along with the situation and with the person who sits across of me, I can sometimes imagine some of it. (R3P)

Most of the examples of imaginative empathy are receptive in nature like the example above. Thus, empathy as an intellectual ability can be described as a practice of “thinking along” with the client based on a combination of open and attentive listening and having one’s imagination guided by the client’s narratives.

In addition to an emotional and intellectual understandings of empathy, a third subcategory can be identified that is perceptual in nature. According to some participants, they may directly sense or see what their clients are going through by being attentive to their clients’ posture, facial expressions, or gestures: “You can see it, or directly sense it (…) through facial expressions, through the movements that people make, through the way they sit. Everything. As a chaplain, you are sensitive to that.” (R7H) Chaplains use their perceptiveness to directly sense or see what their clients are experiencing. This perceptual type of empathy gives them a general impression of their clients’ mental state, well-being, and of the situation that people are in.

A fourth subcategory focuses on the use of one’s body and on embodied experiences. Participants who mention this physical ability explain that they use “all of their senses” when practicing empathy and that their “whole body functions as a sense organ.” (R7H) By being aware of their own physical response to the other’s experiences, chaplains try to grasp what a client is going through:

I use my body a lot to resonate (….) I feel this [points to her throat as if she is feeling tightness]. It gives me a feeling of being smothered. I sense it, mirror it and then I ask: ‘I experience tightness in my throat. What is it like for you?’ (R9P)

Empathy as experience

A third category of empathy components consists of the experiences that result from the chaplain’s act of feeling into/along with, imagining, perceiving, or physically sensing the other’s situation or experiences.

First, empathy can refer to emotional sharing or resonance. Empathy may involve resonating with the clients’ emotions or coming to “feel with them”: “Empathy means that you feel his dilemma or his problem. Or you feel his relief.” (R3P) Another participant expresses: “Things start to resonate. I can get tears in my eyes, or I feel that I have to fight back my tears. I can get happy or enthusiastic.” (R16H) Participants emphasize that empathy concerns both positive and negative emotions: they not only focus on hardship but also share in their clients’ happiness.

Second, empathy can refer to intellectual understanding or awareness. It may involve gaining insight into the clients’ perspective and experiences. Empathy helps chaplains to grasp what clients are going through: “It [empathy] is some sort of exercise you have to do to really understand: what is going on? What is at stake?” (R15H). This understanding can be the result of either emotional, intellectual, or perceptual acts of empathy or a combination. For example, perceiving their clients’ facial expression may provide chaplains a direct, general insight into their clients’ experiences. Imagining their clients’ situation or feeling along with them, may result in an awareness and deeper understanding of what clients are going through.

Empathy as communication

Empathic communication emerges as a fourth category. It refers to the verbal and non-verbal expression of the chaplains’ empathic experience. Giving words to these experiences is a crucial element of empathy and of humanist chaplaincy in general: “Empathy is helping to give words to feelings: ‘You were really angry’ or ’you were really sad’. If clients recognize these words, they feel acknowledged.” (R4H) Chaplains mention that they also express their empathic experiences non-verbally, for example through gestures, such as touching the other’s hand or by showing emotions through facial expressions.

Empathy as communication includes evaluating directly or indirectly whether the chaplains’ empathic experiences accord with the clients’ experiences and whether it is received and recognized by them as an accurate representation of what they are experiencing. Chaplains do not always explicitly ask for a response. Sometimes, they must assume:

I do not necessarily have to literally express it. Sometimes, you continue, implicitly assuming that what you have sensed is correct. (…) When you notice that the other moves along with you, it probably means that you have sensed it correctly. (R6H)

Empathy as caring behavior

The data indicate that (the process of) empathy may involve caring behavior:

It [Empathy] is about caring for the other. It means caring about the other’s situation, it appeals to your ability to mean something for the other. And what you can mean for the other can imply different things: from giving attention to running an errand for someone. (R15H)

The caring behavior of chaplains includes concern, attentive listening, and a commitment to move far along with the client’s experiences. When asked about the meaning of empathy, a participant responds: “It means taking an interest in the other’s story. The commitment, I guess, to feel with, to move along with the other’s story, to deeply explore it.” (R14M) Empathic caring behavior may also involve doing something for the other, based on an empathic insight into the other’s needs. It may consist of a wide variety of actions, such as going for a walk together, helping the client write a letter, looking at photo’s together, running an errand for someone, accompanying a client to an important appointment, or performing a ritual.

Empathy as humanizing quality

The sixth category refers to empathy as a form of basic human connectedness or shared humanity in six different ways that can be related to the above-mentioned categories (see Figure 1). First, empathy is “contact from human to human” or “as a fellow human being” as many of the participants express. According to them, empathy involves being present as a fellow human being to the other.

Figure 1. A model of empathy in humanist chaplaincy care.

Second, the ability to empathize is perceived as “fundamentally human” or as an ability that “makes us human.” Thus, empathic abilities or acts form a defining feature of humanity according to the participants: “If you look at the declaration of principles of the Humanist Society [Dutch: Humanistisch Verbond] it says that we try to understand life with our human capacities. Well, I think that empathy is an example of such a human capacity.” (R13M)

Third, empathy is an experience of what it means to be human. It involves basic human experiences that “can happen to all of us,” because we share the same human condition: “[Empathy is] the realization that it can happen to everyone, that it is fundamentally human. (…) It is sharing that you are human and that this can happen to you.” (R4H)

Fourth, empathy involves expressing human experiences and feeling part of humanity because of this. In expressing human experiences, clients may feel acknowledged and included as fellow human beings: “Empathy means giving words to [their experiences] (…) And if these words are recognized by the client, they feel acknowledged. You would feel the same: it is a fantastic feeling.” (R3P)

Fifth, empathy is grounded in a love for human beings, as some chaplains express. The love and concern that chaplains experience for their clients and for humans, in general, is a source of strength and inspiration for them and is, in their view, an important aspect of empathy.

Sixth, empathy as a humanizing quality means acknowledging that one is “(only) human oneself,” which involves acknowledging that one is fallible and vulnerable and that being a professional caregiver does not mean one is all-knowing or impeccable. Professionals share this inherent vulnerability and fallibility with their clients, based on our shared humanity.

The features of true or genuine empathy

In the interviews, chaplains are keen to distinguish between true or genuine empathy and pseudo, failed, or fake empathy. In general, the latter tends to be shallow and self-referential. According to several participants, it is because of pseudo empathy that the concept has a “bad reputation” among some people: “The other is some sort of projection. Therefore, empathy is criticized as being a form of projection, but it is actually failed empathy.” (R1P) Chaplains mention a wide variety of phenomena that they consider to be “false” or pseudo empathy, such as projection, pity, or feigned empathy.

Based on the data analysis, seven features of true empathy can be distinguished.

Moving toward the other and making a connection

Participants describe true or genuine empathy as a “movement toward the other, to connect with the other.” (R16H) In their view, empathy is a dynamic orientation toward the other’s experiences with the aim of having or maintaining contact or a connection: “It is a type of approaching the other, of being truly focused on the other (…) I move toward the other, I stay connected.” (R11M) In contrast, when employing pseudo empathy, people are withdrawn, avoidant or tend to be more self-centered. They shy away from making contact instead of engaging with others and their experiences.

Being able and committed to deeply engage with the other’s experiences

Empathy is not only a movement toward the other, but it also entails the ability and commitment to move far along and really engage with the other: “Empathy involves the question: ‘Do I truly want to hear this, do I truly want to see this?’.” (R4H) In line with the first feature, true or genuine empathy is characterized by the ability and dedication to engage with others’ experiences on a deeper level, to move far along and to endure these experiences without abandoning people when it gets hard: “I have learned that I am very faithful, that I go far along with the other. The contact will not be broken by the chaplain, it will not happen. I truly commit myself to the other.” (R18M) Pseudo empathy lacks this commitment and often remains superficial or short-lived.

Being aware of the “as if” condition

The participants explicitly and implicitly mention the “as if” condition of empathy that was originally brought forward by Rogers (1957, 1959, 1975). For example, a participant argues: “Empathy has to do with entering the other’s experiences. And I immediately hear ‘without losing the ‘as if’ quality. That is and remains a fundamental addition.” (R5H) Without the “as if” condition, the empathic experience may turn into projection or identification in which the focus is no longer on the other’s experiential world but on one’s own experiences.

Keeping in touch with one’s own position and experiences

Chaplains emphasize that one should not lose touch with one’s own experiences in the process of empathizing: “It is vital to empathy that one does not lose oneself in the other but feels oneself clearly.” (R16H) When people lose themselves, they also lose the connection or relationship that is fundamental for empathy: “This is an active process, staying with the other without losing oneself. Rogers said that nicely: if you lose sight of your own story, you cannot stay with the other.” (R6H) Thus, the preservation of a sense of self is necessary to maintain an empathic connection with the client.

Being received and recognized as (genuine) empathy by the client

For empathy to be true or genuine, the expression of empathic understanding or affect needs to be received and recognized as such by the client: “Your feeling is in line with theirs. I only know afterward if I was empathetic. And I am only truly empathetic, I really feel the same, when that recognition [from the client] comes.” (R3P) When someone expresses empathic understanding or emotions and this is rejected by the client, chaplains argue that it is not empathy proper. Thus, the role and validation of the other is fundamental in evaluating whether empathy is “true” instead of an assumption, interpretation, or a projection.

Being interested in others and their well-being

Empathy involves genuine concern, a sincere and profound interest in others and in their wellbeing: “It [empathy] has to do with caring about the other’s situation (…) I really want to know what you have been through and how you are doing.” (R10H) In contrast, pseudo empathy or false empathy may be motivated by other reasons, such as a willingness to please, to be polite, or to come across as understanding, instead of being truly interested in others and in what they are going through.

Being an authentic human being as a professional

Being an authentic human being is a final key feature of true empathy. Apart from acknowledging one’s own vulnerability and fallibility, this entails being real, honest, and sincere: “It has to do with being honest. (…) Being honest to the person sitting in front of you.” (R18M) It further means that one does not simulate or feign empathy as a professional. The participants notice that clients appear to sense it whether caregivers can engage with their clients’ experiences in an authentic way: “I could easily connect with the family or the partner that was left behind, without having to say to myself ‘Try to be empathetic’ and people sense that.” (R13M) In contrast, pseudo empathy may be an act, a feigned attitude, or a communication trick.

A model of empathy in humanist chaplaincy care

Drawing together the different components and features of empathy, we present a model of empathy within the context of humanist chaplaincy care (see Figure 1). This model brings together the components of empathy in relation to the overarching humanizing quality of empathy and in relation to the seven features of true or genuine empathy. It is our hope that this model can function as a conceptual framework for empathy education, professional reflection, and for future research efforts in the field of chaplaincy.

Discussion

This study examined chaplains’ conceptualizations of empathy through semi-structured interviews with twenty humanist chaplains that were analyzed using a grounded theory methodology. The findings offer a conceptual clarification of empathy in (humanist) chaplaincy care and were used to generate a model that describes the components and features of empathy and that explains the relationships between them. Three core categories could be generated based on the analysis: “Empathy as a multidimensional concept,” “empathy as a humanizing concept” and “the concept of true or genuine empathy.”

Empathy as a multidimensional concept

One of the main outcomes of this study is that empathy in the context of humanist chaplaincy care is a rich and multidimensional concept. It may refer to: (1) Contact; (2) Abilities or acts; (3) Experiences; (4) Communication; (5) Caring behavior; (6) A humanizing quality (see Figure 1). Moreover, empathy is multidimensional or hybrid in the sense that it may involve emotional, intellectual, perceptual, and physical elements.

Chaplains understand empathy as not only an individual ability or experience but as a form of contact or connection as well. In empathy literature, there have been several initiatives to include the relational dimensions of empathy (Freedberg, 2007; O'Hara, 1997; Raudonis, 1995). Relational empathy in chaplaincy care is an important finding and will be further explored in a future article by the authors.

As an individual ability or experience, the concept of empathy encompasses both emotional and intellectual components or a combination of both. This hybrid use of the word empathy accords with prominent theoretical constructs in academic literature that traditionally distinguish between affective and cognitive empathy (Maibom, 2014). This finding is also consistent with qualitative research into the ways people use the word empathy in daily conversations in which we find a similar distinction between affective and cognitive empathy (Kerem et al., 2001). In humanist chaplaincy care, it is important to note that chaplains ground these abilities or skills in being receptive to the other’s expressiveness. They “feel along” or “think along” with their clients, based on being open and attentive and listening carefully to their clients’ stories.

In addition to the emotional and intellectual aspects, participants brought forward the perceptual and the physical dimensions of empathy. Both have been mentioned in academic literature but are far less commonly recognized. Phenomenologists and humanistic psychologists acknowledge that empathy is only to some extent a verbal phenomenon. In their view, empathy involves perception and the use of one’s body as well. For example, Schmid (2001) explains: “‘sensory awareness’ is included in the wholeness of an empathic dialogue. This means with all the physical aspects and dimensions of empathy: gestures, postures, movements, mimics, timbre, intonation, etc.” (p. 65).

Some participants in our study explained that they try to gain insight into their clients’ well-being by paying attention to their posture, gestures, facial expressions, and the environment. In academic literature, this lesser-known type of empathy is called perceptive empathy. It refers to the ability to directly perceive what others experience, based on observing their facial expressions, gestures, and behavior or by bearing witness to what people are going through (Meneses, 2011).

Regarding the physical or embodied element of empathy, chaplains explained they use “all of their senses” and their own physical reactions to gain insight into their clients’ experiences. They also draw on their own bodily reactions to get a sense of the clients’ (unverbalized) emotions and thus to better understand them. This type of physical empathic ability has received far less attention than the affective and cognitive components of empathy (Finlay, 2016). It has, however, been mentioned by a few authors in the field of psychotherapy. For example, Sletvold (2015) offers a “body based approach to empathy” (p. 82) and speaks of “embodied empathy.” When drawing on this empathic ability, people not only resonate physically with others’ experiences but use their awareness of this physical resonance to better understand their client’s inner experiences. This involves an awareness that these physical reactions belong to the other. Thus, it is an indirect way to gain empathic insight into others. In the field of care ethics, the embodied dimensions of care and empathy have been studied more extensively as well (Hamington, 2004). It would be of interest to further investigate embodied empathy in chaplaincy care against a care ethics framework.

Empathy as a humanizing concept

The humanizing quality of empathy emerges as an overarching characteristic of empathy in the context of humanist chaplaincy. To the participants, empathy is fundamentally human, an example of human connectedness, and therefore an essential practice in their profession. In essence, the participants understand empathy as a deeply human and humanizing concept: empathy draws on human experiences, a shared human condition, and on basic human abilities or capacities. It is grounded in a love for humans and represents a relationship “from human to human” by professionals who acknowledge they are “only human themselves.” The humanizing quality of empathy has been mentioned by a variety of authors, particularly in relation to empathy education (Marcus, 1999). Educating and practicing empathy is considered to be an important way to humanize healthcare professions because of empathy’s humanizing quality (Hanna & Fins, 2006; Hojat, 2016).

True or genuine empathy

One of the most compelling findings of our study is the way in which the participants distinguished between true and pseudo empathy. They differentiate between true or genuine empathy and pseudo empathy in two closely related ways: 1. It is genuine in the sense of being true or proper empathy and not something else, such as pity or projection, and 2. It is genuine in the sense of being authentic, committed, and sincere. The participants often used the words “truly,” “really” or “honestly” to express the weight and importance of their commitment to engage with others’ experiences, to be authentic, and to express themselves in a sincere way.

Empathy can be described as a movement toward others with the aim of making “real contact” with people and their experiences. This is in line with empathy literature that emphasizes the other-oriented character of empathy as one of its key features (Zahavi, 2014). Furthermore, genuine empathy is grounded in a concerned commitment to move far along with clients’ experiences, without abandoning people and without avoiding distressing experiences. In this movement toward and far along with others, chaplains are careful not to lose touch with themselves. Furthermore, they actively try to focus on preserving the “as if” condition that is crucial for empathy. To practice genuine empathy, chaplains also need to be in touch with their humanity and vulnerability and connect with others as authentic human beings.

Overall, being honest, authentic, and sincere is an overarching feature in humanist chaplains’ conceptualization of empathy. The relationship between empathy and genuineness has previously been mentioned in humanist chaplaincy literature (Bru, 2008; Hoogeveen, 1991; Rogers, 1975). For example, Hoogeveen (1991) explains:

To genuinely empathize with the very sad, shocking, or traumatizing situations that the other speaks about, means that one has to be committed to genuinely share in these experiences. Empathy calls for the commitment to have emotional attentiveness and emotional courage. The courage to enter the sadness or happiness of the other and to open up to it, to let oneself be touched by it [Translation by the first author] (p. 68).

Empathy theorists have discussed different examples of pseudo empathy in chaplaincy literature. Duyndam (2010) addresses the risk of “gruesome sham-empathy.” He explains that “gruesome empathizers” adopt the actual feelings of others, wallow in them, and “use” these feelings to recharge themselves. In contrast, true empathizers aim to experience what people are going through as a potential experience, instead of adopting these experiences. Smaling (2008) mentions the risk of “faulty empathy” in which empathizers lose touch with themselves in the process of empathizing with others. If one loses oneself in the other’s experiences, the “as if” quality of empathy disappears and one enters a state of identification (Rogers, 1957). Bru (2008) warns against the use of empathy as an instrumental or feigned attitude or communication strategy.

Implications

This study has implications for the education and professionalization of chaplaincy. Fitchett (2017) argues that “it is important for the profession to be clear about the competencies chaplains should possess and how they should be assessed” (p. 165). A clearer understanding of the meaning of empathy is helpful in this regard. As our findings suggest, empathy is not “one thing” but involves a myriad of components and features. This means that empathy education and supervision need to address a wide range of skills, such as interpersonal skills, reflection skills, and expressive skills. Advanced empathic competencies not only involve imagination and sensitivity but also include perception and body awareness. The seven features of genuine empathy provide key areas of concern when teaching empathy and may provide guidance when struggling with challenging experiences of empathy or when discussing these experiences in supervision or peer group coaching.

Limitations

A limitation of this study is that it focuses solely on the empathy understandings of humanist chaplains. Further research is needed to evaluate whether the conceptual model of empathy resonates with chaplains from other ordinations as well. In addition, it could be further explored what factors determine the empathy understandings of chaplains and whether other attributes, such as personality types, influence individual chaplains’ affinity toward specific dimensions of the model.

The first author autonomously carried out the interviews, transcriptions, and coding process, which is not uncommon in grounded theory (Birks et al., 2019), particularly in the context of dissertation projects. The research was conducted under the supervision of an experienced team. One of the disadvantages of a sole interviewer and coder is that the primary researcher’s biases may have influenced the results to some degree. A second or third researcher might have reduced this potential bias. The first author regularly wrote memo’s to articulate assumptions, which helped to identify biases (Birks & Mills, 2015). Additionally, the risk of bias was addressed and critically reflected on within the research team, which was closely involved in the research process.

This paper proposes a definition and a model of empathy in humanist chaplaincy care. Additional research is needed to validate the model. One participant was involved in member checking to confirm the accuracy of the findings. Additional member checking would have improved the credibility and validation of the research.

Conclusion

This qualitative study provides a conceptualization of empathy within the context of chaplaincy care based on semi-structured interviews with 20 humanist chaplains. Our study brings to light that empathy is a multidimensional and humanizing concept that encompasses a rich variety of components and features. Our conceptual model of empathy provides an expanded understanding of empathy and of the distinction between true and pseudo empathy. This model helps to provide conceptual clarity and may contribute to professional reflection and discussion about empathy in chaplaincy care, support empathy education, and function as a conceptual framework for future research efforts.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.