The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences Hardcover – November 27, 2018

As a physician I was so impressed with the clear depth of knowledge of Dr. Riess on the subject of empathy. Somehow I thought it was going to be mostly neuroscience. It is not, but the first chapters discuss the basic science of how and where empathy resides in the brain. Fascinating...The book is so rich in describing the many facets of empathy in a scholarly way and also in a very practical and clinical way. Just lovely…In this time when so many physicians and other professionals are experiencing burnout, reading this book many very well offer a prescription, without side effects, for that ailment.Dr. Riess' sharing of her own stories as a child, her family’s, and her patients’ stories make the book a powerful read.I thank her for putting in SO much time and effort. I am impressed and touched.

The Empathy Effect offers hope for transformational change and happiness in and out of the classroom, the board room, our homes, and other spaces that shape our lives. As someone who has worked in higher education for 38 years as a faculty member and administrator, as well as the parent of six children, I believe this book presents research that will assist the field of higher education in its pursuit to decode the complex education system, including closing the opportunity gap and positively affecting the culture of student success. Dr. Riess, in a brilliant and conversational way, shares with readers the fact that empathy can be learned, the science behind this claim, and practical strategies that can be used to make adjustments to our personal and professional lives so that we are more empathetic, effective, and happy. About 70% of organizational change initiatives are not successful (Harvard Business Review). This brilliant book is a 'must read' for teachers/faculty, students, executive leaders, managers, parents, friends, those in relationships, those not in relationships-- in short, anyone seeking a meaningful solution to problems that plague our daily lives, as well as complex (education, health care, business, other) systems. This book is a gift for those seeking to improve relationships and make a meaningful difference within the institutions and organizations of which they are a part.

This is one of the most important books out there. Not only for a healthcare provider (I'm a Physical Therapist by training), but also for every single human. Something like Chapter 5- Who's In & Who's Out should be required reading for all of us after all that we've seen unfold in 2020. I cannot recommend this book enough!

I am a physician and I tried to sign up for their empathetics training on their website, this was @ the end of 2021 nobody has gotten back to me 9 months later

The force of empathy is strong with Helen Riess, MD, and her team. Unfortunately, so is the neuro-hype, mindless brain science.The most important point that Dr Riess makes in the concise opening three chapters is that empathy is learnable. Empathy can be taught. The empathic capabilities of the human being can be expanded by practice and training. This is the set up for the introduction and promotion of the proprietary empathy training program, “E.M.P.A.T.H.Y.”®, offered by the for profit enterprise, Empathetics, of which Riess is the CEO. The training based on intellectual property developed at Massachusetts General Hospital and Harvard University. More on that shortly.The work contains many personal reflections amid a fully buzz-word compliant narrative on the psychology and neuroscience of empathy. Dr Riess lets slip that she was in second grade when the 1963 Community Mental Health Act set in train consequences, some planned, most unintentional, that resulted in the emptying out of the Psychiatric Institutions (“Asylums”) that served for the long-term incarceration of those diagnosed with severe mental disorders.This means that Dr Riess was young enough to have benefited from the innovations in empathy of Carl Rogers, PhD, and Heinz Kohut, MD, who, prior to the second psychopharmacological revolution, were responsible for putting the term “empathy” on the treatment intervention map of humanistic and self psychology.Though not explicitly discussed by Riess, for practical purposes, the “second psychopharmacological revolution” is dated from Peter Kramer’s Listening to Prozac (1993). It took the legs out from under virtually every form of talk therapy then in the market, including Cognitive Behavioral Therapy (CBT, however, has demonstrated staying power for many reasons, not the least of which is that insurers are willing to reimburse for a dozen (or so) sessions).Riess is conversant with Paul Ekman’s innovative research in coding (and decoding) the micro-expressions of the human face, an emotional “hot spot,” to discern what a person is “really” experiencing and feeling. Though Ekman does not use the term “empathy,” his approach to micro-expressions implies a definition of empathy distinct from that of Riess’ proprietary approach, which, in turn, aligns with David Hume’s “delicacy of sympathy and taste” (1741). If one person literally perceives a micro-expression of which another is unaware, then the one person’s “delicacy of empathy” (my term, not Hume’s) is more expansive that the other’s.Thus, Dr Riess calls out the contributions of Rogers and Kohut such as “unconditional positive regard” and “vicarious introspection,” respectively. She appreciates the deep history of empathy (“Einfühlung”) in German aesthetics, in which empathy emerged from the projection of human feelings onto beautiful nature and art, something we humans seem to be cognitively designed to be unable to stop doing.Riess appreciates that the distinction “empathy” is significantly different than “compassion,” “sympathy,” or “projection,” and she helps the reader distinguish among them. She “gets it” that empathy, like so many phenomena, is on a spectrum and that some people are naturally endowed with less of the capacity (think: disorders of empathy such as autism or at another extreme psychopathy) and some people have more of it (think: the natural empathy, who is acutely sensitive). Riess understands that empathy can misfire or breakdown: empathy faces obstacles and roadblocks, which, paraphrasing now, extend from sentimentalism, spoiling, codependence, projection, all the way to burnout, compassion fatigue, and empathic distress.In every case, practice and training can expand the empathic competence of the individual and the empathic response in the face of the challenges of unempathic people and circumstances. Riess refers to turning “the dial on … emotional empathy” (p. 19), which is why training is needed. Thus, empathy is more like a dial or tuner – turn it up or down – rather than an “on-off,” all-or-nothing switch.This brings the discussion round to the details of Riess and Empathetics, Inc.’s innovative, proprietary empathy training. She begins by citing research that demonstrates medical doctors are often trying to deliver one message and their patient’s are getting another one or nothing at all. The antidote? “E.M.P.A.T.H.Y.”®!It turns out there is a “secret sauce,” a proprietary application of biofeedback technology. I have a report that if you, as a hospital or medical group practice, actually pay the $50K [I am making this number up] to train your medical doctors en masse at Mass General, then patented biofeedback metrics are used to judge the arousal of the subject and, hence, the effectiveness of the empathy induction. Though I am not sure, it sounds like they put the little Velcro-cuff on one of your fingers to measure the galvanic skin response.While galvanic skin response is a blunt instrument and does not distinguish between emotions such as fear, anger, sadness, high spirits, much less subtle states such as envy or indignation, it does provide a measure of physiological stimulus and arousal. Useful. Might be worth a try.This add something to that old joke that when a therapist meets a new patient, there are two anxious people in the room; and it is the therapist’s job to be the least anxious. It adds something, but what? Still, it might be worth a try, especially given the emotional numbness of the survivors of the boot camp approach to medical school and the sleep deprivation regime of medical residency.Meanwhile, the technology is wrappered in a conversational training that aims at expanding the empathic capabilities of the trainee. There are seven “keys” to empathy:The empathy training works on: (1) Eye contact: the eyes are the window to the soul. Look the other person in the eye to expand connectedness, but do not stare without blinking, which communicates aggression. Riess does not mention, but might usefully have done so, that Simon Baron-Cohen calls out lack of eye contact as one of the indicators of a person being on the autistic spectrum.Training in making eye contact to expand empathy leads naturally to including: (2) Facial expressions as a whole: the human face is an emotional “hot spot,” and while humans can fake many facial expression, there are some micro-expressions that are disclosive of an emotional depth that cannot be faked.Here the decisive innovations and work of Paul Ekman and his team are critical path. Ekman spent some seven years mapping all the muscles of the face and their contribution to the expressions of emotions. The bottom line? People can consciously control many of these muscles – but not all of them. The muscle around the eyes participate in an authentic smile, and when they do not do so, the smile is perceived as off – as fake.Riess says: “You don’t have to be an expert to pick up on the minute micro-expressions described by Ekman and others.” Actually you do. Significant practice and training is required, and even then one may know that the other person is not being entirely straight with you, but the micro expression does not provide any insight into the underlying motive(s). Is the motive sinister or is the person suffering from shame, guilt, or post trauma upset? One has to have a conversation. The “M” is for “facial expression” – okay, actually “muscles” or “micro expressions” in the face.The face, in turn, leads to: (3) Body language as a whole. Amy Cuddy’s “power pose” does not increase testosterone in the saliva, but significant anecdotal evidence indicates it does expand a person’s self-confidence. In short, look at how a person is standing or sitting and attend to one’s own posture. It can reveal a lot about how one is feeling. “P” is for “body language,” or, to be exact “posture.”Riess acknowledges the distinction between cognitive and affective empathy – top down and bottom up empathic understanding and receptivity. A future version of this training might incorporate “perspective taking” or “point of view,” in the place of the “P,” the folk definition of empathy, which is otherwise missing from the list of keys. I make no representation as to how such a gesture would require adjustment or amendment to the intellectual property or whether it is even possible to claim as one’s own property something that is arguably the proper possession of all of humanity. One thinks of Kohut’s notion of empathy as oxygen for the soul. Who owns the oxygen? Presumably, humanity, not Harvard.Next (4) empathy is all about “affect” and the communication of affect. People are not born knowing the names of their emotions. We have formal training in kindergarten in naming colors and numbers. It is not too late to practice experiencing one’s emotional experience and naming it.(5) The “tone” of voice is richly communicative. If is a person is telling what should be a sad story of loss, injury, or set back, yet the person sounds happy, then something is going on beneath the surface that warrants further inquiry. The pace, rhythm, pitch, delivery, and prosody of a statement make a big difference in its reception and processing. Not to be overlooked: “A surgeon’s voice peppered with dominance and delivered with a lower register of concern was predictive of a malpractice claims history” (p. 54).(6) Listening to the whole person is the point at which the training has to go beyond the tips and techniques that have dominated this list. This one is easier said than done and may require a deep engagement with spiritual disciplines of mindfulness, Tai Chi, or a couple of years of one’s own therapy in order to be available to the other person. “H” is for listening to the whole person – and hearing him or her – presumably within the fifteen minute encounter that is budgeted for the initial medical inquiry.(7) Empathy without responsiveness is like a tree that falls in the forest without anyone being there. It does not make a difference. Regarding empathic responsiveness, I would have appreciated an example of giving the other person’s experience back to her in a form of words that demonstrate that one “got it” without the exchange being so explicitly compassionate.Recognition, acknowledgement, and alignment are ways of responding that do not require agreement or altruistic intervention. Yes, of course, it is helpful to be appreciated in one’s struggle and effort, and that is different than having someone jump in and actively provide compassionate support.By all means, if someone is bleeding apply a tourniquet while awaiting emergency services. But here one has actually to “dial down” one’s empathy in order to be effective. The point is that both empathy and compassion are often in short supply in the world and the world needs both more compassion and expanded empathy. However, empathy and compassion are distinct.I may have misread Dr Riess if she wants to build into the human capacity for empathy, a compassionate response – whether her own proprietary version or empathy writ large. I offer this caveat because the vast majority of the examples of empathic response she gives are instances of pro-social helping, altruism, charity, or other aspects of being a Good Samaritan.Once again, the world needs more Good Samaritans. The world needs both more compassion and expanded empathy; but the two are distinct. The exceptions in the text to examples of compassion are largely those of being over-whelmed or nearly over-whelmed by trauma and counting one’s breaths in order to stay centered in the face of hospital emergency room style dismemberment.The irony of this book, which promotes linking empathy to its underlying neuroscience, is that the empathy is strong but the neuroscience, weak.Since this is not a “softball review,” a few examples will make this clear.For example: “Scientists can see the electrical impulses spread through the brain using fMRI (functional magnetic resonance imaging) brain scanning technology” (p. 28). False.The fMRI makes visible the blood oxygenation level data (BOLD) of between five thousand and fifty thousand neurons in its unit of measure, the voxel (depending on the variable size of the neuronal cells). The inference is: when the neurons get active, because the person is having an experience such as thinking a thought or attending to an event, then the neurons require more blood-rich oxygen to do their job.Perhaps Riess was thinking of the EEG: The spread of “electrical impulses through the brain” can indeed be monitored by an electro encephalogram (EEG), a fundamental tool for evaluating disorders of consciousness such as epilepsy and sleep disturbances, but even with an EEG the overall, high level activity of the brain is what is being monitored not individual or even small numbers of neurons.A similar slip occurs early on: “Scientists first viewed the brains of their subjects in a brain scanner as the subjects had their fingers stuck by needle to determine the precise neurons involved in pain perception” (p. 17). Here “precise” would mean between five thousand and fifty thousand neurons, which is not my definition of “precise”. The level of granularity of the fMRI is an order of magnitude off from that required to “see” an individual neuron. Thus, fMRIs do not see or monitor mirror neurons (if they exist). Period. Once again, the fMRI does provide evidence that the parts of the brain that are busy processing experience receive enhanced blood oxygenation level data (BOLD), and that is the data captured by the fMRI.Another problem item: “Mirror neurons are specialized brain cells in specific areas of the brain called the premotor cortex, known as the F5 area…” (p. 18). The problem is that the F5 area is part of the brain of the macaque monkey. There is no F5 area in the human brain. Thus, the battle is joined, whether mirror neurons even exist in human beings.The neurohype around mirror neurons is well represented; but what about the alternative point of view that such an entity as a mirror neuron does not even exist in humans and that the neurological infrastructure has a different configuration and explanation?The neurohype continues as the author moves from the neurologically misleading and false to the superficial. Using the example of addiction to alcohol: “New findings in Neuroscientific studies have redefined addiction from a condition of flawed character to a model of biology and disease. We now know that the brains of people who become addicted are different from those who do not” (p. 174). The brains of people who study French are different than those who do not, so we are on thin ice here in terms of a compelling analogy or contribution.The good news? If a person has a disease such as pneumonia, modern medicine can cure him even if he is in a coma. That is not the case with the “disease” of addiction. In contrast, overcoming addiction requires the participation of heart and mind – and conscious commitment. The choice between a “moral flaw” and “neuroscience” is a false one once any physical dependency on the abused substance has been attenuated.This brings us to the mereological fallacy, which is pervasive in Riess as indeed in many works of this kind. The mereological fallacy attributes the function of the whole to the part (and vice versa). Brains are a part of a person; and neurons are a part of the brain. Brains are all about neurons; and, in so far as neurons are a necessary condition for the functioning of the embodied person, persons are neurons “all the way down.” But the neurons then start generating phenomena such as consciousness, meaning, language, intentions, joint intentionality, personality, community, and culture.Thus, social neuroscience is born. Yet brains do not think; people think. Brains do not express emotions; people express emotions. Brains do not intend this-or-that; people intend this-or-that. Brains do not become addicts; people become addicted. Brains do not empathize; people empathize. The mereological fallacy is a growth industry in social neuroscience. My brain made me do it? Hmmm. Human choice and commitment suggests your brain was definitely participating, but it is far from the whole narrative. The task is to avoid or contain the mereological fallacy, even while allowing social neuroscience to make its contributions in the areas of its strengths. This has not happened in this text.Nevertheless, in spite of weakness in the main selling point promoted in the subtitle and that of which the author is most proud – neuroscience – the force of empathy is strong in this text. If one can survive the neurohype of Part I, the reader is rewarded in Part II – presumably the nucleus accumbens is lighting up like a Christmas tree at this point (but so what?) – with applications of empathy to early child development, education, the hazards of social networking, art and literature as ways of expanding empathy, leadership and politics (and the lack of empathy in them), tough issues in mental illness, criminality, sexual identity, and so on, as well as the benefits of empathy for self-soothing, distress tolerance, and emotional regulation.Perhaps after the boot-camp of medical school, the rigors of residency, and the corporate transformation of American medicine (relying as it does on “hitting the numbers”), empathy is at such a low water mark in the medical doctor’s consciousness that “tips and techniques” are the best we can do. Indeed the “H” stands for “listening to the whole person and hearing the individual,” so the intention is present.Yet using empathy to “dial down” stress, aggression, and narcissistic injuries, does not map in any obvious way to “E.M.P.A.T.H.Y.”®, which becomes a pair of golden hand-cuffs for the trainer. The neuro-hype continues. The tough question: how to distinguish the neuroscience from the neuroscient-ism?! The ultimate irony is that the only obstacle in the way of expanding empathy – the distinction, not the propriety gimmick – is precisely “E.M.P.A.T.H.Y.”®.Please note this is an abbreviated review – Amazon does not support footnotes or references and with such a technical book I had a couple of those - so for the full review see the my separate blog posting, for which I regrettably cannot provide the direct link since Amazon seems not to appreciate doing so. However, I am grateful for the opportunity to be self-expressed about Dr Riess' contribution.

As a practicing physician I found the insights into how empathy works and the techniques provided in this book critical to delivering effective patient-centered care.Utilizing the techniques described in this book has made patients more engaged and they have provided positive feedback about their care. In addition, it has also increased my satisfaction and enthusiasm for patient care. "The Empathy Effect" is a must read for all physicians.

The Empathy Effect is must for physicians because of the research based underpinnings of the poiwer of empathy in the doctor/patient relationship. However, as a nonpractioner, I found Part II even more valuable. The book highlights how empathy improves parenting, education, and leadership, etc. All areas in my life that I continually aim to improve. It's written in accessible and helpful language with tangible examples. Love this book!

A great read, providing some underlying physiologic descriptions of the empathetic response while also noting specific behaviors which can assist the development of an empathetically based relationship.

Such an important book given everything going on in the world today! This book explores a seven-step system for understanding and increasing empathy based on a training program developed by the author (E.M.P.A.T.H.Y.). As a Harvard-affiliated researcher and academic, she could have easily lost readers in academic jargon. Instead, Reiss has written a highly accessible and practical book. Highly recommended.

Very interesting book