As healthcare workers, how often do we come across patients who find it hard to change their health habits? The one patient who can’t seem to quit smoking, the patient who won’t change their diet to keep their blood sugar down, the one patient who won’t seem to do their exercise program… This can be one of the most stressful parts of our jobs (other than charting). 

While we spend most of our healthcare education learning how to identify our patients’ health issues, we spend such little time identifying important factors required to induce change. Yet, being able to identify these factors can end up being more important than figuring out their diagnosis.

The longer I practice as a physical therapist, the more I find that our job as healthcare workers is not far removed from that of a psychotherapist. A psychotherapist digs deep to understand their patients’ problems, then turns the responses back onto their patient to get them to change their behavior.

You might say, “Sure, Stephen. Psychotherapists were trained to do that. They have to be good at that to do their job. But, how do they do it?” Enter tactical empathy.

In his book Never Split the Difference, Chris Voss discusses the term “tactical empathy.” In school, we learned about empathy: the ability to recognize and express another person’s perspective. Tactical empathy goes deeper. It involves not only understanding someone else’s feelings and mindset, but also hearing what’s behind those feelings so that you increase your influence in the moments that follow. It involves recognizing both the emotional barriers to change and the potential ways to promote change.

If you can perceive your patients’ emotions, you can promote change. The more you know about your patients, the more power you have. Here’s the kicker: all of the information you need to know about your patient can be done through simply watching and listening.

When you begin to pay closer attention to what’s behind your patients’ feelings, you start to notice the smaller details of their visit: their facial expressions, their posture, the gestures they make, and their tone of voice. With a more sensitive radar, your brain begins to process your patients differently. You start to align with your patients more accurately in a process called “neural resonance” – you start to more fully understand what they think and feel.

Caution: Don’t mistake empathy for sympathy. Sympathy is where you agree with another person’s emotions or values. Empathy, on the other hand, involves understanding their emotions or values. With empathy, you don’t have to agree with your patients. However, you do have to learn about why they’re thinking the way they do, why their actions make sense to them, and what might move them to change.

The more you practice tactical empathy, the more patients feel heard – and understood. Once they feel understood, they’re more likely to be open to change. Think about it this way: how frustrated would you feel if the person you were talking to just didn’t seem to be listening? How engaged in the conversation would you be once you realized this? Doing the opposite of tactical empathy – ignoring them – only builds up frustration in your patient, making them less likely to change.

I get it, tactical empathy is hard to put into practice (not to mention emotionally draining). Especially when it’s late in the afternoon, you’re meeting with your 10^th patient of the day, and you skipped lunch because you fell behind on time. But the more you’re aware of it and the more you practice it, the better you get.

Want to practice tactical empathy without trying it out in with one of your patients? The next time you’re out in public, pay attention to someone nearby. Listen in to their conversation (I’d tell you to look at their gestures and facial expressions, but that might make you look a bit suspicious). As they talk, imagine that you’re that person. Feel what it’s like to be in their position. Describe (in detail) how it is to feel how they feel about, as if you were actually them. Then, give it a try with your patients. You never know what useful information you might learn about them!

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