- To effectively communicate, listen, keep your own interests on hold, and use person-centered skills.
- Person-centered skills include open-ended requests, repeating another’s statement, inquiring about emotions, and responding empathically.
- One expresses empathy by naming the emotion, expressing understanding and respect, and verbalizing support.
Many have advocated using person-centered skills since the seminal work of Carl Rogers,1 but few describe the specifics, especially, for being empathic.
Our Michigan State research in medical education generated strong evidence for precise ways to be person-centered. I’ll outline them here as they apply in typical, everyday conversations.2
Exchanging meaningful information and establishing a relationship go hand-in-hand—good communication begets a good relationship, a good relationship begets good communication. Identifying and responding to another’s emotions mediates the process.
Try the skills I’ll describe with someone you scarcely know as well as, say, your spouse, children, or boss. It will surprise you. For example, after using person-centered skills with his wife, one of my students revealed his astonishment at her response: “That’s the best conversation we’ve ever had, it seemed like you were really listening and cared about what I said.”
The key is listening attentively but not passively. In general, keeping your own ideas to yourself, pay special attention to comments the other person makes about themselves and issues important to them. What they say may not seem particularly exciting, maybe not even very interesting, but it’s important to them, so don’t interrupt with your story. If someone is worth speaking to, they’re worth listening to.
To actively listen, first show interest by making eye contact and leaning slightly forward. Then initiate the conversation with some variation of, “How are you doing?” or “How’s it going?” Next, draw out concerns and ideas you hear them state, perhaps saying something like, “Tell me more about your (job, classes, retirement).” Or simply restate—echo—what they just said, for example, “Your job’s not going well,” or “Your classes suck,” or “You’re being forced to retire.” These comments let the other person know you’re interested, following what they’re saying, and that you want them to keep going on the same track.
Finding the other’s emotion is the pinnacle of the interaction.3 Therefore, continuing the conversation using similar encouraging comments, keep your ear attuned for information that might have some underlying emotion. Then focus the person on these comments, for example, stating, “Tell me more about your dog dying / losing your gym privileges / not being asked your opinion.” A caveat: People often mention a possibly emotional topic and quickly shift to another subject, perhaps “testing the water” to see if you will respond and want to hear more about important emotional issues for them. So listen carefully and take them back to possible emotionally charged issues.
After you reach the more tension-laden material and have probed a bit further to develop some understanding of the situation, it’s time to identify the emotion or feeling that accompanies it; for example, “How did that make you feel when your dog died?” or “What was the feeling when you could no longer exercise at the gym?” or “What emotion did you experience when you’d waited and they didn’t ask for your recommendation?” Next, try to better understand the feeling they express: “Tell me more about being depressed when she died / angry about the virus shutting down the gym because people won’t get their shots / upset about doing all the work and being ignored.”
Sometimes, however, it’s not that easy. The person will not express an emotion when you ask. They might respond, “I don’t know, nothing I guess, our family just didn’t talk about feelings.” But you still probe a bit more, for example, saying something like, “If that were me, I might be upset,” of course saying this only if true. When digging deeper in this way, use a less extreme emotion, like “upset” or “distressed” rather than more scary-sounding terms like “angry” or “depressed” that can put people off. Alternatively, instead of indicating how this would affect you, you might refer to someone else, perhaps commenting, “My brother was really upset when he had a check bounce and had to pay,” again, only if it’s actually true.
If you still have not gotten an emotion and if someone appears distressed, it is okay to observe something like, “I can tell by the look on your face that you were upset.” The efforts I’ve described usually will elicit one or more emotions; once again, ask them to elaborate so you develop a better understanding of the context of their emotional issue. On the other hand, if you still haven’t identified an emotion, that’s okay. Let it go. Don’t make someone uncomfortable by pressuring them.
Now you likely have someone expressing being, for example, upset, sad, happy, angry, or depressed. What do you do? You make verbal statements of empathy. This maximizes your connection with the other person. Here are some examples using an easy-to-remember mnemonic—NURS. It stands for Name, Understand, Respect, and Support:
Name the Emotion:
- “So that makes you feel sad (depressed, angry, upset, afraid, relieved, happy).”
Understand the Emotion:
- “I can understand how you would feel that way.”
- “I see you how feel.”
- “Anyone would be (upset, sad, happy) by this situation.”
Respect the Emotion:
- “This has been a difficult time for you.”
- “It sounds like you’ve got a lot on your plate.”
- “You’ve been through a lot.”
- “That was tough.”
- “You have certainly worked hard on this.”
- “You show a lot of courage.”
- “You handled it well.”
- “You worked hard, did the best you could.”
Support the Emotion:
- “Let’s see what we can do.”
- “I am here to help.”
- “You’ve got a good group working with you, and I know they’ll do everything possible.”
- “I am really impressed at the support you have from your (religion / family / friends).”
Everyone always tells us to “be empathic” or “show empathy,” but they seldom say how: Using NURS tells you what to say. You can remember these are empathic skills by adding an "E" to form the word "nurse." Nurses are empathic, the E stands for empathy.
Include the NURS statements frequently throughout the now evolving conversation, using just one or two at a time. For example, you might initially say, “That’s upsetting (naming), I can certainly understand (understanding);” after hearing the person’s response for 30 seconds or so, you might then respond with, “You’ve had a tough time" (respecting by acknowledging plight); after another 30 seconds or so, you might respond, “Good for you for talking about it” (respecting by praising), or “Can I help?” (supporting); and so on. Continue to sprinkle NURS comments throughout your interaction.
I’d avoid continuing the conversation beyond 10 to 15 minutes; you’re not expected to be a therapist; 3-5 minutes often suffices to effectively communicate in a way that furthers your relationship by making the other person feel supported and understood.
A common concern arises about these recommendations that needs to be put firmly to rest. For example, you may have learned of someone’s awful situation, for example, a divorce, a lost job, or a serious illness. And you worry that you’ve opened a can of worms because there’s nothing you can do to fix it. This may be true, but listening to their plight and “NURSing them” makes people feel better whether you have a solution or not—as does simply sitting with them in silence in particularly difficult circumstances, perhaps touching their arm or holding their hand. Many people in difficult, even dire situations, report that someone just listening to their story with empathy offers considerable relief. They want to feel understood, respected, and supported—nothing more. Using NURS and other person-centered skills does not make you responsible for solving problems. If it’s appropriate and feasible, you may choose to explore how you might help. If not, that’s okay.
Rogers CR. Client-Centered Therapy. Boston: Houghton Mifflin Company; 1951.
Fortin VI AH, Dwamena F, Frankel R, Lepisto B, Smith R. Smith's Patient-Centered Interviewing -- An Evidence-Based Method. 4th ed. New York: McGraw-Hill, Lange Series; 2019.
Barrett L. How Emotions Are Made -- The Secret life of the Brain. Boston: Houghton Mifflin Harcourt; 2017.