Building empathy: could it be one of the most useful skills in physiotherapy?

“What could I gain from building my empathy?” During a day in practice, conversations follow one another. We listen, ask questions, explain and support. Most of the time, things go smoothly.

And sometimes, a consultation stays with us. A slight disconnect that is hard to name in the moment. The patient who arrives late again. The one whose diagnosis seems clear, robust and supported by science and experience, but who returns the following week without having done their exercises. The one you have explained things to, rephrased for, demonstrated to and encouraged… while nothing seems to move forward.

What do you feel in those moments? Frustration, irritation, a kind of weariness? On some days, perhaps even anger — at the patient, the situation or yourself? And, above all, what do you do then?

These reactions are human. They do not mean you are a bad clinician. They simply show that the therapeutic relationship affects and involves you. Perhaps this is where a useful reflection begins.

Rather than asking, “Whose fault is it?”, we might ask, “What else could I understand, and what could I do differently?”

Empathy: a less obvious skill than it seems

We often think of empathy as a natural quality: something we either have or do not have. Yet empathy can also be practised.

Jean Decety describes it as the capacity to understand and share another person’s emotional state while maintaining a distinction between self and other. This distinction matters: being empathic does not mean merging with someone else or absorbing what they feel. It means getting close enough to understand them better without losing your own position.

This skill is far from abstract. It can develop through very concrete practice.

01 Start with yourself

Before trying to understand patients better, it may help to start closer to home. Think of a patient you find relationally challenging. It need not be the “worst” example: simply someone with whom you notice something tighten inside. What exactly do you feel? Which emotion appears first? What lies beneath it?

Finding precise words for what happens within us is already a first form of empathy: empathy directed towards ourselves. Before claiming to read someone else’s experience carefully, we need some clarity about our own.

This is particularly relevant in physiotherapy, because our desire to help is strong. When a patient does not follow through, change or engage as we hoped, that desire can quickly turn into inner tension. If we fail to notice it, it may shape the way we speak without our realising.

02 Observe others… without assuming you are right

A face, a posture, a look, a scene from a film, a photograph. We often believe we can immediately “see” what another person feels. He looks happy. She seems sad. He appears satisfied. She looks exhausted.

But what is that understanding based on? Observation, certainly. Also our memories, experience and personal interpretation. Understanding another person often begins with a hypothesis: sometimes useful, sometimes less so, but never completely certain.

In healthcare, this matters. A patient who cancels, pushes back, says little or seems “passive” can be interpreted in many ways: disinterest, avoidance, fear, discouragement, shame, a sense of failure, misunderstanding or mental overload. We interpret quickly. Sometimes we interpret wrongly, often without noticing.

03 Dare to check your understanding

The third step is to name gently what you think you perceive, then stay quiet and allow the other person to respond.

This gesture looks simple. In practice, it can change the relationship profoundly. It requires the clinician to slow down, turns a silent interpretation into an open proposal, and gives the other person the power to confirm, qualify or correct it.

The proposal is a person-centred statement, without judgement, followed by silence. No constraining question. No immediate follow-up. Just some space, a pause and room for the other person.

This is when empathy moves from being something “in our head” to something relational and jointly developed. We go beyond believing we understand: we check, refine and adjust. Often, something happens. The patient feels met. They clarify, correct and expand. They finally say what really mattered.

What this changes in a consultation

Imagine the potential benefit: fewer misunderstandings, fewer hurried interpretations and less unnecessary tension. Above all, a relationship in which patients sense that you are trying to understand their experience as well as explain what to do.

This is where empathic reflection, central to motivational interviewing, comes in. A reflection is more than a mechanical paraphrase. It shows understanding by moving towards the other person and offering a hypothesis about what they mean or feel.

When a reflection fits, it helps the patient feel heard. When it is imperfect, it is not necessarily a failure: it often opens the door to clarification. The patient adjusts, specifies or adds something. Either way, understanding can progress.

You do not need to be perfectly right from the outset. You need the courage to attempt understanding with humility.

Could empathy also make practice less exhausting?

We often discuss empathy for its effects on patients. We talk less about what it can change for clinicians. Yet when we stop carrying the consultation alone, stop trying to persuade at all costs and replace some repeated explanation with a better understanding of the other person’s experience, the relationship often becomes more fluid.

There is less struggle, less unspoken confrontation and less feeling that we are pulling the patient behind us. It is as though, instead of pushing, we begin moving alongside them.

Motivational interviewing rests on this idea of partnership rather than imposed expertise, with central attention to empathy, the patient’s perspective and a deeper understanding of their experience.

Building empathy, really?

Yes — provided it becomes more than an empty slogan. Building empathy does not mean becoming more sensitive to everything, feeling everything more intensely, accepting everything or giving up guidance. It means learning to:

• notice what happens within yourself;
• observe others cautiously;
• put a tentative understanding into words;
• allow the relationship to refine that understanding.

It also means accepting that helping does not always involve providing a solution quickly. Sometimes, what moves a consultation forward is not another explanation. It is the moment when a patient finally feels that someone is trying to understand what they are going through.

Why train in motivational interviewing?

Because these skills require more than good intentions. MI offers a framework, reference points and tools to develop this quality of presence and communication. It gives us practical ways to work on reflections, open questions, affirmations, ambivalence and the relational approach that helps patients move forward without being pushed.

For a physiotherapist, this can make a difference by helping us:

• understand barriers to engagement more clearly;
• move beyond consultations that feel like failure or struggle;
• support greater patient involvement;
• sometimes regain comfort in the therapeutic relationship.

Training in MI is about more than learning to “speak differently”. It is about creating consultations in which understanding, alliance and change have a better chance of coming together.