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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Explore the concept of compassion as it applies to the field of healthcare and improving patient outcomes
An Introduction to Compassion in Healthcare Practice identifies the core components of being compassionate and self-compassionate, so that we may be in a better position to attend to our health and to engage in helping others. The foundation of this book is that if we have an intention to help, we are best served by understanding what ‘helping’ really means. This is addressed by reviewing compassion in a range of contexts and environments, including through an evolutionary science perspective. In this view, we are ‘programmed’ to be compassionate—but social forces may throw challenges or obstacles in our way. Also covered in this text are the challenges associated with being compassionate to the self, as well as care encounters with individuals in a clinical context and working in a clinical team.
Some of the ideas explored in An Introduction to Compassion in Healthcare Practice include:
- Artificial intelligence (AI) and compassion, covering ethical theories for AI alongside considerations surrounding consent and the role of touch
- The role of mindfulness in self-compassion, the challenges and benefits of self-compassion, perfectionism, our “inner critic”, and shame
- Complex Adaptive Systems (CAS) in teamwork, lessons in developing compassionate teams, and the theory of Values-Based Practice
- Components of compassion-focused leadership and supervision, and the development of self-efficacy and competence
Providing a core conceptual framework for compassion in healthcare with guidance on how to explore various topics in greater depth, An Introduction to Compassion in Healthcare Practice is an essential reference for undergraduate nurses, midwives, allied health professionals, medical practitioners, and students in related programs of study.
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Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Preface
AN IMPORTANT APOLOGY
REFERENCE
Biography
Acknowledgments
THE COVER
CHAPTER 1: A Compassion Primer
INTRODUCTION
WHAT IS COMPASSION?
COMPASSION AS AN EMOTION
COMPASSION AS A STATE OR A TRAIT?
COMPASSION AS A MOTIVATION
ATTRIBUTES OF COMPASSION
ENGAGING WITH COMPASSIONATE ATTRIBUTES
THE BIOLOGICAL BASIS OF COMPASSION
THE SCIENCE OF COMPASSION
COMPASSION IN THE ARTS
SUMMARY
REFERENCES
CHAPTER 2: Compassion for the Environment: The Consequences for Health Workers and Patients (
with Jess Bunn
)
INTRODUCTION
COMPLEXITY AND COMPLEX ADAPTIVE SYSTEMS
COMPASSION AT THE MACRO LEVEL: THE GLOBAL ENVIRONMENT
COMPASSION FOR THE ENVIRONMENT
COMPASSION AT THE MESO LEVEL: THE WARD/TEAM/PRACTICE ENVIRONMENT
COMPASSION AT THE MICRO LEVEL: THE PERSON ORIENTATED PRACTICE ENVIRONMENT
DIGGING DEEPER INTO POLYVAGAL THEORY
DEVELOPING OUR COMPASSIONATE PRACTICE ENVIRONMENT
CASE STUDIES
REFERENCES
CHAPTER 3: Artificial Intelligence (AI) and Compassion – Can You Have Compassionate AI? (
with Dr Michael Rowe
)
INTRODUCTION
WHAT IS THE ROLE OF COMPASSION IN AI?
ETHICS AND AI
AN OVERVIEW OF ETHICAL THEORIES FOR AI
CONSENT FOR CARE PROVIDED BY AI TECHNOLOGY
CAN AI ROBOTICS DELIVER ‘CARE’?
THE ROLE OF TOUCH IN CARE GIVING
CASE STUDY: WHAT IF AI WAS MORE COMPASSIONATE THAN A PERSON?
CONCLUSION
OUR THOUGHTS ON POTENTIAL BENEFITS AND RISKS OF AI IN THE CASE SCENARIO
REFERENCES
CHAPTER 4: Compassion, Self‐compassion and Being Mindful
INTRODUCTION
DEVELOPING SELF‐COMPASSION
NARCISSISM AND SELF‐COMPASSION
SELF‐COMPASSION
THE BENEFITS OF BEING SELF‐COMPASSIONATE
THE CHALLENGES OF SELF‐COMPASSION
PERFECTIONISM
OUR ‘INNER CRITIC’
SHAME
HOW TO DEVELOP SELF‐COMPASSION
PRACTICING SELF‐COMPASSION
REFERENCES
CHAPTER 5: Compassionate Encounters with Individuals
INTRODUCTION
DEVELOPING AN EVOLUTIONARY UNDERSTANDING OF COMPASSION
PRO‐SOCIALITY
WORKING WITH INDIVIDUALS – EMPATHY AND COMPASSION
ATTRIBUTES WHEN WORKING COMPASSIONATELY: A FOCUS ON MOTIVATION
CASE STUDY: ‘GOING FOR A DRINK WITH DAVE’
REFERENCES
CHAPTER 6: Encounters with Groups: The Compassionate Team
INTRODUCTION
PROFESSIONAL VALUES
DEVELOPING VALUES‐BASED PRACTICE
THE IMPORTANCE OF VALUES IN THE PRACTICE OF HEALTH AND SOCIAL CARE WORKERS
THE THEORY OF VALUES‐BASED PRACTICE
COMPASSION AND TEAM WORKING
COMPLEX ADAPTIVE SYSTEMS (CAS) IN TEAMWORKING
THE ‘MEITHEAL’ AS A CULTURAL EXPRESSION OF COMPASSIONATE TEAMWORKING
COMPASSIONATE TEAMS: LESSONS FROM PROJECT ARISTOTLE
CASE STUDY
QUESTIONS
REFERENCES
CHAPTER 7: Compassionate Support for People: The Role of Supervision
INTRODUCTION
WHAT IS PRACTICE SUPERVISION?
DEVELOPING SELF‐EFFICACY AND COMPETENCE
SUPERVISION AND THE ISSUE OF IDENTITY
A MODEL OF SUPERVISION
SCHWARTZ ROUNDS AND COMPASSION
A REVISED APPROACH TO COMPASSIONATE SUPERVISION
THE COMPONENTS OF COMPASSION‐FOCUSED SUPERVISION
PROMOTING COURAGE THROUGH SUPERVISION
LEADERSHIP AND SUPERVISION
REFERENCES
CHAPTER 8: Compassionate Leadership
INTRODUCTION
AN OVERVIEW OF LEADERSHIP IN HEALTH AND SOCIAL CARE
THE CONTEXT OF HEALTHCARE LEADERSHIP
A REVIEW OF EXISTING LITERATURE ON LEADERSHIP STYLE
A WORD ON THE ‘ALPHA’ NARRATIVE ON LEADERSHIP
COMPASSIONATE LEADERSHIP
LEADERSHIP FROM AN EVOLUTIONARY PERSPECTIVE
COMPASSION, RESILIENCE AND LEADERSHIP
IS PERSONAL RESILIENCE THE ANSWER?
‘REAL‐WORLD’ LEADERSHIP
COMPASSIONATE LEADERSHIP AND SOCIAL RELATIONSHIPS
CASE SCENARIO: COMPASSIONATE LEADERSHIP IN HEALTHCARE
REFERENCES
CHAPTER 9: Teaching Compassion (
with Lyndsay Khan
)
INTRODUCTION
COURAGE
WISDOM
CAN COMPASSION BE TAUGHT?
THE COMPASSIONATE EDUCATOR
AN OVERVIEW OF TRAINING IN COMPASSION
COMPASSION AND CARING
TEACHING MINDFULNESS
STRATEGIES FOR TEACHING COMPASSION
CASE STUDY
CONCLUSION
REFERENCES
Index
End User License Agreement
List of Tables
Chapter 6
TABLE 6.1 The premise, process and point of values‐based practice for compa...
Chapter 8
TABLE 8.1 NHS and social care values table (England, Scotland and Wales)....
List of Illustrations
Chapter 1
FIGURE 1.1 Key evolutionary motives.
FIGURE 1.2 Youth out Loud and the 15 steps challenge.
Chapter 2
FIGURE 2.1 The nature of compassion for our environment.
FIGURE 2.2 How complex systems can work for people in health and social care...
FIGURE 2.3 The UN Sustainable Development Goals.
FIGURE 2.4 The IoM core competencies.
Chapter 4
FIGURE 4.1 Three elements of internally and externally focused self‐compassi...
FIGURE 4.2 You are good enough.
FIGURE 4.3 The factors associated with ‘Burnout’.
Chapter 5
FIGURE 5.1 The six attributes of compassion.
FIGURE 5.2 Addressing negative threat and drive motives.
Chapter 6
FIGURE 6.1 Future medicine and evidence in context. The current evidence‐bas...
FIGURE 6.2 The framework for decision making using VBP.
FIGURE 6.3 The house as a metaphor for values based practice.
Chapter 7
FIGURE 7.1 The A‐equip model.
FIGURE 7.2 Understanding our motivations to maintain a compassionate self‐id...
FIGURE 7.3 The potential drift in practice away from compassion.
Chapter 8
FIGURE 8.1 McKinsey’s 7 S framework.
FIGURE 8.2 The core values of the NHS.
Chapter 9
FIGURE 9.1 Muetzal’s model in compassionate learning relationships.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Preface
Biography
Acknowledgments
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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An Introduction to Compassion in Healthcare Practice
Ian McGonagle
University of LincolnLincoln, UK
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Library of Congress Cataloging‐in‐Publication DataNames: McGonagle, Ian, author.Title: An introduction to compassion in healthcare practice / Ian McGonagle.Description: Hoboken, NJ : Wiley‐Blackwell, 2025. | Includes index.Identifiers: LCCN 2024045767 (print) | LCCN 2024045768 (ebook) | ISBN 9781394220458 (paperback) | ISBN 9781394220472 (adobe pdf) | ISBN 9781394220465 (epub)Subjects: MESH: Empathy | Attitude of Health Personnel | Professional‐Patient RelationsClassification: LCC R697.A4 (print) | LCC R697.A4 (ebook) | NLM W 62 | DDC 610.73/7–dc23/eng/20241203LC record available at https://lccn.loc.gov/2024045767LC ebook record available at https://lccn.loc.gov/2024045768
Cover Design: Niall McGonagleCover Image: © Loïc Fürhoff/Unsplash, adapted by Niall McGonagle
Preface
Compassion is fundamental to effective health and social care delivery. A simple review of complaints about health and social care practice will clearly indicate that ‘not being treated as a person’ or being ‘a number rather than an individual’ is the most cited reason for dissatisfaction with care giving. Therefore, while being compassionate seems obvious, maybe it is a little more challenging than we first think.
There has been a significant interest in “compassion” as being the basis of all formal therapeutic approaches. Additionally, there is an interest in the scientific understanding of compassion and how it affects human behavior. This book is not a book about being a compassion focused therapist or a compassion scientist. There are many fine books that will help with your therapy and scientific endeavors based on compassionate approaches. I hope you will find many key texts referenced throughout.
What this book is about rests on a concern to identify the core components of helping (of being compassionate and self‐compassionate) so that we may be in a better place to attend to our health and to engage in helping others. It is a book that has a focus on our intention to help, and that we are best served by understanding what “helping” means. It is an attempt to view the therapeutic arts and healthcare practice (both art and science) through a compassionate lens.
A note on style: There is a very extensive scientific literature on compassion, and at times, it can be dense. Therefore, I have purposefully sought to try and write this book in a style that is true to the title – “an introduction.” It is intended to be a springboard to additional and deeper reading – and so in order to achieve this I have attempted to present the material in an easy reading, somewhat “conversational” style and to simplify concepts.
AN IMPORTANT APOLOGY
In offering “an introduction,” there is always the possibility of misrepresenting important compassion science concepts. While I have always sought to minimize these and be as explicit as possible, I have tried to make sense of what this word means for me and used my years of practice, in a range of settings to illustrate and contextualize theory. At times I have sought to be integrative and utilize other theoretical models (e.g. polyvagal theory, Values‐Based Practice, and behavior change models such as the COM‐B approach) to illustrate ideas. This integrative approach runs many risks of claiming definitive theoretical links where such links may be tenuous. Again, I have done this to support illustrations or attempt to make sense of the topic. Any errors remain my responsibility.
Effective health and social care rests on compassion being at the heart of what we do. Yet our understanding of compassion as a concept may be quite partial. The word “compassion” is just a word if it is not understood in terms of our practice. The Chief Nursing Officer, I am sure, had good intentions when she identified “Compassion” as one of the 6 Cs. Unfortunately, I never met a nurse who could really tell me what compassion really meant. Usually they tell me, it is a substitute for “being kind” – it isn’t!
This book is aimed at people in healthcare provision, and it is drawn significantly from my practice as a mental health nurse. However, it also informed by many years working with colleagues from different health and social care professions and those who have none. Over the past 10 years, I have spent more time with wonderful students who work in nonprofessionally affiliated roles in health and social care. The whole health and social care sector would collapse without such people!
To support this introductory text for a broad readership, I have drawn on the work of Seedhouse (2009) who noted that we are all “workers for health” and as such we are engaged in a moral endeavor. We should examine our practice and reflect upon it to seek better ways to provide care and support to patients*. Part of this would also entail reflecting on our core concepts, such as “compassion.”
This book reviews compassion from a number of viewpoints. It begins with an overview of one particular frame of compassion, as viewed through an evolutionary science perspective. In this view, we are “programmed” to be compassionate – but social forces may throw challenges or obstacles in our way. It maybe our upbringing creates barriers to being compassionate (enough) when engaged in caring behaviors. It may be our current life circumstances or the work environment and associated stressors. There is much interest in the science of compassion and how being compassionate affects our physiology. The opening chapter is important as it seeks to provide the foundation work for chapters that follow.
My aim is that the reader will examine compassion as a core element of their practice and consider how they can utilize a deeper understanding of the word/concept to care for their own health, the health of their colleagues, and most importantly, the health and need of people who use services.
REFERENCE
Seedhouse, D. (2009).
Ethics: the Heart of Healthcare
, 3e. London: Wiley.
Biography
Ian McGonagle (PhD) is a mental health nurse and an associate professor at the University of Lincoln. He began his nurse training in 1983 at Pastures Hospital in Derby. He has worked in a variety of roles in the NHS as a clinician, manager, and educator. He spent a number of years working on the New Ways of Working programs for the National Institute for Mental Health in England before accepting a position at Lincoln University.
Acknowledgments
We live in the shadow of each other.
(Irish proverb)
No man is an island,
Entire of itself;
Every man is a piece of the continent,
A part of the main.
John Donne (1623)
There are a number of people I would like to acknowledge in helping this book happen. First, to my sons Niall and Ryan, such beautiful people of whom I remain eternally proud. My brothers and sister and their families, who also fall into the category of beautiful people! There are so many of them, but they know who they are (I am acknowledging my bias here).
The BSc (Hons) Health and Social Care students at Lincoln who have endured so many lectures but allowed me to refine my ideas over many years. I have such fond memories of so many students as they make their positive mark on the world. My chapter co‐authors, Jess, Michael, and Lyndsay, and Dave, Dr Lindsey Hampson and Dr Amanda Super for letting me make use of their impressive work, thank you all for your helpful contributions. Thank you to Debbie Craddock from Rauceby Primary School in Lincolnshire, who was a wonderful help and possesses supreme editing skills.
My colleagues at Lincoln University and my close friends and international colleagues in the Udine‐C nursing network, who all have been steadfast, fun, and utterly fabulous over many years.
While working for the National Institute for Mental Health in England, Barry Nixon, Gill Walker, Professors Tony Butterworth, Christine Jackson, and Ian Baguley, all gave me opportunities to develop this work which has continued over many years. Professor Bill Fulford was very welcoming and supportive in developing a deeper understanding of Values Based Practice, which has stood me in good stead. In 1984, I started my mental health nurse training in Derby and was in the fortunate position to be in the same hospital as Professor Paul Gilbert. Paul was always welcoming, informative, and encouraging in my development as a Mental Health Nurse. He was particularly helpful with his comments on Chapter 1 of this book.
I have also been blessed to know expert nurses (sort of), who have provided me with so many laughs and so much wisdom over many years, so thank you Annette, Trisha, and Marcia, I have learned so much about compassion from you. My friend Gary has been a steadfast confidante over many years and along with his family have been sources of wonder and inspiration.
I also acknowledge H, Biggley, Jude, and Hope for being ever gorgeous and kind. Lastly, but not least, to Julia for all her encouragement, cups of tea, and resilience. I would not have been able to complete this without your compassionate love and support.
THE COVER
I have had a long fascination with bridges and stairs as such structures serve the purpose of connecting people. These structures help you move from one place (familiar) to another place that maybe not so familiar. They can take you from where you are to where you might want to be. They can help you learn new things from new people, you can imagine what life is like, ‘over there’ (empathy) but stairs or a bridge can take you there to be alongside people and be a purposeful aid (compassion). Seeking a deeper understanding of compassion means making a connection and travelling with, or to, someone. Sometimes it might be uncomfortable, strange, and unfamiliar. By taking the steps we can learn about being self‐compassionate and experiencing the unfamiliar can only add to our sense of self‐worth and the worth of others.
Footnotes I will use the word patient throughout the text while noting we could be talking about people as service users or clients (but never “customers”!). But everyone seems to be stuck in finding the right word to describe the desired relationship we wish to have with people which accurately defines the partnership in care. In the absence of such a word, I have chosen to use the word “patient.”
Cover design adapted by Niall McGonagle (email: [email protected] / Instagram: nialldraws).
Ian McGonagle
Lincoln, 2024
CHAPTER 1A Compassion Primer
INTRODUCTION
Being ‘compassionate’ is at the core of healthcare work, isn't it? There seems no place in our services for non‐compassionate people. How could anyone possibly function in a hospital or any care giving setting, where their care was not based on the basic tenet of being ‘compassionate’?
However, and sadly, we have too many cases (that continue to grow) where care has been found to be lacking in compassion. How can this happen? How can a healthcare worker go to work with the desire or the intention to be non‐compassionate to patients? I don't believe they do. Yes, there have been professionals who have been found to act criminally and murderously. But while always regrettable and unfathomable, they are rare.
What is sadly less rare, is routine practice that is found to be uncaring.
Consider the following:
Mrs H was a dignified woman who lived in her own home until the age of 88, needing relatively little support. She was deaf and partially sighted and although she could still read large print, communicated through British Sign Language and deaf‐blind manual.
Following a fall at home, Mrs H was admitted to the Elderly Care Assessment Unit with acute confusion. Whilst Mrs H was in hospital she had a number of falls, one of which broke her collar bone, but her niece was not informed. Several additional injuries and falls were not included on her discharge summary. Poor nursing records were kept and no personalised plans for her non‐medical needs were developed and although at low risk of malnutrition at admission, Mrs H lost about 11 lbs during her first three months in hospital.
Communication with Mrs H was difficult, and her specific needs were not met. No activities or stimulation were provided for her. The discharge arrangements for this lady were confused and no effective handover to the care home was completed.
When Mrs H arrived at the care home, the Manager noted that she had numerous injuries, was soaked with urine and was dressed in clothing that did not belong to her which was held up with large paper clips. She had with her several bags of dirty clothing, (most of which did not belong to her), and few possessions of her own. Mrs H was bruised, dishevelled and confused. She was highly distressed and agitated and the following day was admitted to a local hospital due to concerns about her mental state and her physical condition.
Sadly, Mrs H died soon after in August 2010.
Source: Parliamentary and Health Service Ombudsman (2011).
The above is clearly shocking, but this desperate situation needs to be understood at a deeper level. To achieve this, we need to reflect on the reasons why there was seemingly, a lack of compassion or care. Do I believe those involved in the care of this poor lady wanted to be unkind and careless? No, I don't. I do however, think we, as workers for health, may fail to seek what lies behind the experiences of Mrs H. This book seeks to create opportunities for discussion and deeper understanding of how such care can result and to promote compassionate responses to minimise their future occurrence.
The Chief Nursing Officer (Department of Health/Chief Nursing Officer 2012) instigated the 6C's which eventually formed a direct response to the Francis Inquiry into care and treatment at Mid Staffordshire NHS Trust (Francis 2013). These 6C's (Care; Communication; Courage; Commitment; Competence and Compassion) have formed the basis of many healthcare student assignments ever since. They are drilled into the minds of nurses to form part of their value set (and by extension the value set of all healthcare providers, since there is nothing particular to the nursing profession in any of these C's). Following many conversations with nurses and students about the 6C's, I have asked ‘what is “Compassion?”’ I am returned with statements that liken compassion to being kind and being caring. In a general sense, these answers are not wrong – but maybe they are not right either.
We need clarity on what we mean by compassion in nursing and healthcare practice. A clearer expression on this critical concept is essential if we are to be the kind of workers we want to be – that is, (I assume) morally engaged, workers for health (Seedhouse 2009).
This book provides an introduction to a perspective on compassion. It is written in the full knowledge that there are many other texts that offer a comprehensive overview of the science of compassion (see Seppälä et al. 2017) and therapeutic approaches (e.g. Gilbert and Simos (2022)). I am particularly indebted to Paul Gilbert, from the Compassionate Mind Foundation (www.compassionatemind.co.uk) for many years of inspiration in cognitive approaches to helping people, most recently through his work on Compassion Focused Therapy (Gilbert and Simos 2022). I would urge those readers seeking deeper scholarship on compassion, to seek out writers and researchers such as these if you wish to sharpen your understanding of what this seemingly simple (but really rather challenging) word means for your practice.
WHAT IS COMPASSION?
Compassion can be considered to be ‘a state of concern for suffering or unmet need of another, coupled with a desire to alleviate that suffering’ (or need) (Goetz et al. 2010). Therefore, an individual must be aware of suffering (or a need) and engage a range of processes (psychological, biological and social) in order to respond. The biological processes (from an evolutionary perspective) are those that promote care giving and affiliation.
Alternatively, Compassionate Mind Training (CMT) (Gilbert and Choden
2015
) identifies compassion as ‘
a sensitivity to the suffering of the self and others with a commitment to relieve or prevent it
’. What unites these two definitions is that being compassionate consists of: being aware of the need for compassionate care
and
the desire to do something about it.
COMPASSION AS AN EMOTION
Health and social care workers are required to enact compassion as per the asserted moral architecture of the NHS. The published NHS Values expressly point to the requirement for compassion to be displayed.
‘We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person's pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for patients, their families and carers, as well as those we work alongside. We do not wait to be asked, because we care.’
Source: Taken from the NHS Constitution: Department of Health 2023 (Available at: The NHS Constitution for England ‐ GOV.UK (www.gov.uk)
The central premise of this introduction to compassion is based on an understanding that saying we are compassionate and ‘being’ compassionate may be different and challenging. Gilbert (2010) has written that humans are a major source of suffering to self and others and indeed other life forms. Human history is replete with the horrors of torture, holocausts, slavery, sexual violence and much else. Compassion is the motivation that stands against this harmful side of us because it's focused on our understanding of the causes of suffering and seeking to alleviate and prevent it. Of course, in the health and social care services, patient suffering is rarely deliberate, but more typically arises from the failure to provide what individuals need for their relief of suffering. Here the inhibitors of compassion can be linked to broader problems of individual providers having a lack of insight and knowledge of what to do, how to employ empathy and prevent burnout. However, evidence suggests that many inhibitors of compassion are organisational and relate to poor management and overburdening services. Hence here compassion requires us to think about how we can operate within contexts that are highly pressurising commonly frustrating and sometimes unsupportive.
Because compassion moves towards suffering, towards the causes of suffering, then it means we are moving towards things that may be painful, distressing or sometimes stimulating rage in ourselves in the face of perceived (or actual) injustice. Engagement with suffering therefore, is not about stimulating a positive emotion, although positive emotions can arise when compassion has been successful. So, compassion may not always be a kind and pleasant emotion. The world is full of evidence where the suffering of people and circumstances are viewed in the abstract. People in need are called ‘scroungers; bed blockers; attention seekers’, our language can be less than compassionate. People claiming benefits, refugees fleeing persecution or in search of a better future for their family, or people in need of social housing may be on the receiving end of negative discourse from politicians, the media and the general public. We may be in a position to direct our help towards such people, but fail to do so (for a great many reasons).
COMPASSION AS A STATE OR A TRAIT?
A state of compassion is a response to another person at a particular moment in time. This would be true for any disposition such as empathy or kindness. This suggests that we can turn compassion ‘on or off’ like a light switch and when a compassionate response is required, we can enact the required compassionate response.
A trait of compassion would point to a general personal disposition to be compassionate – it is the person's ‘nature’, they are ‘naturally compassionate’ or kind or empathic etc. An obvious distinction might be a view that if compassion is a trait, what are the features of personal development and growth that provide the opportunities to develop such a personal perspective and incorporate this into, ‘who we are’. A trait approach may challenge our view on whether compassion can be ‘taught’.
COMPASSION AS A MOTIVATION
The motivation to provide care or to protect is a primary evolutionary drive. There are neural circuits engaged when caring behaviours are employed (Inagaki and Orehek 2017). Parenting is the most visible example of care giving/protection of people (infants/children) in need or who are suffering. There is an important distinction to make here between a ‘motivation’ and an ‘emotion’ as in some ways the distinction is central to understanding how you can grow and use your compassionate self, effectively.
Our motives stem from our evolved requirements for survival, support and reproduction. These are commonly known somewhat humorously, as ‘the four “F”s’ – Feeding, Fighting, Fleeing and Reproduction! (Sapolsky 2004). Therefore, we can use motives to utilise avoid strategies, or seek‐outbehaviours or even rest/safety behaviours, we perceive to be a necessary as a situational response.
Humans are an evolved social animal and we are given to seek social communication with others, which is reciprocal. This social communication can be focused on co‐operating, competing and finding reproductive partners. We may be engaged in forming alliances with others and forming bonds to instil a sense of belonging within a group. Our pro‐social behaviour may be directed towards the caring and nurturing of the young, or engaged in help seeking or care giving behaviours.
So, in this way, motives are evolutionary driven, deep seated and potentially at odds with each other – such as the personal dilemmas associated with co‐operation versus competition motives.
Figure 1.1 provides a representation on competing evolutionary motives, – a theme that will be applied repeatedly throughout this book, hence the need to engage with this chapter as a ‘primer’.
The Threat System
We have an evolved threat system which has been instrumental in ensuring the best chances of survival. Our basic physiology is geared towards a rapid initiation of the sympathetic nervous system and hormone release. As Sapolsky (2004) identifies, we are unique in the animal kingdom in maintaining a threat response, long after the original threat has passed. In some cases, this maintained threat response/stress, can last years.
The Drive System
This motivational system responds to the evolutionary need to obtain resources which help maintain life, such as food, shelter, partners and affiliates. In modern societies such a drive is associated with gaining money as a resource to enable provision for our family. This drive can work either in concert with, or against the threat system, as achievement of resources may not be easy in competitive economies and can induce significant anxiety‐based responses.
Safeness System
This system is possibly the most difficult to engage. In a hectic world and health and social care practice environment, it is sometimes difficult to slow down and feel that all need has been met. It is time to relax and allow the parasympathetic nervous system to do its work (the rest and digest system).
FIGURE 1.1 Key evolutionary motives.
Source: Adapted from Gilbert (2010)/New Harbinger Publications.
As outlined, motives are drives which are prominent features of our evolutionary past – they have a sense of permanence in our psychological, biological and social lives. An emotion, on the other hand is a short‐term physiological alteration that plays a role in how we think and act in a given situation. Both are linked, since an emotion, such as love for another individual, is clearly connected to motivational drives around survival, support, mate selection and (possibly) reproduction. Without a motive, an emotion cannot arise. So, when we are having emotional reactions to situations, it may be helpful to understand the motivational drive that lies behind the response to them.
ATTRIBUTES OF COMPASSION
In his book ‘The Compassionate Mind’, Gilbert (2009) identifies six attributes:
Care for well‐being:
Sensitivity
Sympathy
Empathy
Approaching people in a non‐judgemental manner
Tolerance of distress
These attributes are united in our expression of warmth to an individual. Much of the work of those in health and social care is about supporting and helping people make changes or adjustments in their lives. We know how hard ‘making a change’ is – How often have your well intentioned and potentially life changing, New Year Resolutions (changes) fallen by the wayside?
Without a sense of warmth in our relationships we will not be in a position to receive information which may be beneficial to our health. A theme that will return in this book is the notion of ‘safeness’ or having a feeling of safety. Porges (2022) identified that humans are programmed to seek safety – we are generally alert to ‘risk’ at all times. Therefore, feeling genuine ‘warmth’ from another person, can facilitate our move towards a sense of safeness.
To help remember these attributes, it may be useful to consider them as six rings on a cooker hob. The rings have some utility when they are not switched on (useful for resting pans etc.) but they have much more functionality when they are used with warmth.
Care for Wellbeing
People entering care giving roles often state they want to ‘make a difference’ to people – to play a part in making lives better for those who are (often) in a more unfortunate position. Therefore, ‘care giving’ is an essential characteristic within the care process. We need to attend to the well‐being of others and make ourselves available to them with the hope (or desire) to enable a sense of homeostasis, to occur.
It is important to note that care for well‐being includes our own well‐being as well as that of others. This issue of self‐compassion is central to the delivery of compassionate care (see Chapter 4). If we do not attend to our own sense of homeostasis and safety, we are not in a position to help others thrive. If you imagine that you are having some troubles in your relationships at home, how focused can you be on the needs of others? How much can you ‘be’ with them and seek to act with them to address their troubles or illness? This also applies to our colleagues as we are all members of interconnected and interprofessional teams. The issues of change, adjustment, safeness seeking are just as relevant to our colleagues as they are to patients/clients or service users.
Sensitivity
This attribute is centred on being attuned to our needs and the needs of others. We are sensitive to the cues around us that indicate either verbally or non‐verbally that there is an unease. There was a famous NHS England programme some years ago called the ‘15 steps Challenge’ (https://www.england.nhs.uk/publication/the‐fifteen‐steps‐challenge‐quality‐from‐a‐patients‐perspective‐an‐inpatient‐toolkit/) which aimed to be sensitive to the culture of an environment within the first 15 steps of walking on a clinical ward. As an alternative articulation of this point, the Youth Out Loud (YOL) initiative in Kingston and Richmond have taken this challenge to their services (https://www.yolweb.info/) and have produced a diagrammatic representation (see Figure 1.2).
It is interesting to note how many important issues for these young people pertain to the concept of compassion (particularly safety and caring and a sense of calm). This issue of compassion for, and within, the environment will be developed further in Chapter 2.
The work of The Values Based Collaborative (https://valuesbasedpractice.org/; Fulford et al. 2012) identified the process of values‐based decision‐making including the sensitivity to unspoken concerns in the clinical team. We need to keep such unspoken concerns in conscious awareness. Failure to do this encourages a failure to perform, and therefore, from both a values and a compassion‐based perspective, we should remain sensitive to these issues.
FIGURE 1.2 Youth out Loud and the 15 steps challenge.
Sympathy
It seems somewhat obvious that we should have sympathy for those in distress. Sympathy involves having some emotional involvement in the concerns of others. Sympathy for others in distress creates challenging emotions in ourselves. If we are not attentive (sensitive), we can easily fall into ‘pity’, which is a feature of ‘looking down’ on another's distress. Sympathy though cements our kinship with others and is not based on pitiful looks or emotions. Whilst being sympathetic is important, it is insufficient as a replacement for compassion. We can sympathise, but have no cause to act – it is the desire to act that distinguishes the two.
Empathy
Empathy is feeling moved by another person's situation. We can consider their perspective and attempt to adopt a frame of thinking where we ‘put ourselves in their shoes’. This is a conscious process where we are purposefully thinking and imagining another world view. It is a process whereby we are planning to be active in the mental discourse.
This is different from affective empathy, which is a more automatic process (Maibom 2017). It relies less on an active cognitive element and more on a deep, immediate shared feeling of another person's plight. It is a real sensitivity toward another.
In a similar fashion to sympathy, being empathic is a very necessary healthcare attribute (but again) insufficient, on its own. We can try and empathise, to view the world as others see it, but we are not required to respond to that awareness. Being empathic demands no requirement to act, to purposefully aid, but it does require energy, humility and time. In empathic responses, we can consider what would be required to alleviate distress, whereas being sympathetic is more passive. Interestingly, empathy is often viewed as a positive emotion; it is ‘good’ to be empathic, but it has a different side, which is less endearing. Empathy might not be paired with a sense of warmth and positive concern for others. People who have been in abusive relationships might suggest that abusive partners know exactly how to emotionally hurt another. They may have a deep sense of empathy for the abused partners and know exactly what is required to create an emotional response (Bloom 2017).
We can think about this distinction if we respond with the statement, “I will be empathic” – which is a planned cognitive desired disposition. Saying that “I am empathic” is of a different order, since it points to an affective
