Professional carers’ empathy
towards people with intellectual
disabilities
Dr Kirsten Collins
Oxleas NHS Foundation Trust
Kirsten.collins@oxleas.nhs.uk
Dr Caroline Gratton
Ms Celia Heneage
Professor Dave Dagnan
1
A quick guide to empathy
• Cognitive vs. affective empathy
• Strong evidence that empathy…
a) influences caregiving/helping- Batson’s empathyaltruism hypothesis.
b) is associated with improved health & social care
outcomes.
Carer empathy is important
• People with intellectual disabilities (‘service users’) value
empathy (Clarkson et al. 2009; Dinsmore & Higgins, 2011; Roeden et al. 2011)
• Staff offer key emotional support (Forrester-Jones et al. 2006) given
small relationship networks. Relationships with staff become
important (McVilly et al. 2006).
• Winterbourne: carer values in preventing abuse
• Difficulty communicating internal world = reliance on carers
using empathy to interpret needs & feelings.
Empathy associated with attachment
security (Mikulincer & Shaver, 2007) & Bowlby’s
(1982) mental representations of
caregiving (Reizer & Mikulincer, 2007).
Attachment style influences caring
interactions with service users (Schuengel et
al. 2012).
Could empathy link
situational and
dispositional models of
caregiving behaviour?
Attribution theory (Weiner, 1980) applied to
challenging behaviour: mixed evidence.
Strongest correlation between sympathy &
helping (e.g. Dagnan & Cairns, 2005).
Could empathic stance increase model’s
predictive power (based on Betancourt, 1990)?
A new empathy measure
Aims
• Develop a new measure of carers’ empathy towards people with
intellectual disabilities.
• What does this say about the nature of empathy towards service users?
Measure development
• “What comes to mind when you think of professional carers’ empathy
towards people with an intellectual disability?”
• 31 responses → Thematic analysis → 12 themes → 60 items
• Experts rated items → 28 item draft questionnaire
• Pilot study → minor language adjustments
• 5 questionnaires to 800 staff (194 returned, 13 employers, 74% female)
Quantitative study
1.
EMP-ID (the new measure)
2.
Demographics and nature of work
3. Interpersonal Reactivity Index (IRI): dispositional empathy measure
-contains cognitive and affective subscales
4. Mental Representations of Caregiving Scale (MRC)
-perceived ability to recognise others’ needs
-appraisal of others as worthy of help
-perceived ability to provide effective help
-altruistic and egoistic motivations for helping
5. Marlowe-Crown Social Desirability Scale (SDS)
Exploratory factor analysis
• Two stage factor analysis → 21 item scale with a 3-factor structure
• Proximity: sense of psychological closeness and of having shared/common
psychological experiences to people with intellectual disabilities.
• Active attunement: deliberate effort to tune in to service users’ internal
worlds
• Challenge: whether it feels difficult to empathise with service users.
• All loadings > 0.32 (minimum to claim loading)
• Majority of loadings > 0.45 = ‘fair’
Psychometrics
Support for construct validity
1. Highly significant correlations (i.e. many at 0.001 sig. level) with
MRC subscales. Pattern of correlations supports our
interpretation of factors.
2. Significant correlations (mainly at 0.01 sig. level) with IRI
subscales.
3. Some factors relate to gender and whether pps know a person
with an intellectual disability outside work.
Subscales have acceptable internal (0.73≤ α ≥0.76) and test-retest
(0.56≤ r ≥0.86) reliability.
What does this mean?
• Factors do not map to the cognitive/affective structure.
• Factors fit with other empathy research
1. Proximity/ imagine self/ similarity cluster
2. Active attunement/ imagine other/ nurturance cluster
• Logical that similarity and nurturance become salient when
the ‘subject’ of empathy has an intellectual disability
• Challenge: how easy it is to actively attune
Conclusions
Cognitive and affective processes are not the most salient feature
Instead…
Empathising with people with intellectual disabilities exacerbates
particular processes used in empathising more generally:
a) carers’ sense of themselves as psychologically similar, and
willingness to be psychologically close, to people with an
intellectual disability (proximity).
b) carers’ active efforts to tune in to people with intellectual
disabilities’ internal worlds (active attunement).
Study gives evidence that carers’ mental representations of
caregiving relate to their empathy towards service users.
Some limitations
• A self-report measure
• Accounts for 34% variance i.e. other unmeasured influences on empathy.
• Challenge items all negatively worded: did they cluster because of wording?
• Correlations are highly significant but weak i.e. small effects.
• Variance in Active Attunement scores could result from individual
differences in tendency to respond in a socially desirable manner.
• 25% response rate i.e. do findings generalise if very empathic carers participated?
Future research
• How does self-reported empathy relate to actual feelings/demonstrations
of empathy ?
• Clarification of the nature & determinants of the empathy clusters.
• How do attachment styles influence carers’ empathy & caregiving
behaviour?
• Does an empathic stance influence attributions, emotions and helping
behaviour towards PWID?
• How can organisations can help carers maintain empathy?
Implications
Care providers
Psychologists
•Consider job applicants’ empathy
•Exercises/therapy/reflective practice to
increase use of empathy skill clusters
•Organisational ethos: attuning is
valuable
•Attachment representations are
likely to influence empathy and
caregiving for service users. Enhance
‘felt’ security e.g. regular, reflective
supervision with a consistent
supervisor & work in one location.
•Explore impact of beliefs that empathising
with service users is challenging
•Recognised empathy interventions e.g.
internalised-other, mentalization.
•Help providers to enhance ‘felt’ security
via consultancy on how providers enhance
security or training/supervision to
managers within care organisations
A (partial) recipe for empathy?
… a secure base hierarchy
… empathising-understood
reciprocal roles?
Person with
an
intellectual
disability
‘Felt secure’ staff
team, being
empathic to a…
‘Felt secure’ LDT &
psychologists, being
empathic to a…
Politically stable NHS Trust,
supporting and being mindful of a…
Questions, comments, reflections…