Empathy and neuroscience: powerful tools for social workers

Neuroscience has revealed that social work skills can help rectify developmental damage to children’s brains. Professor David Shemmings explains

It is a well researched fact that social workers attain better results with families when they demonstrate a willingness to see things from everyone’s perspective but manage to maintain authoritative practice. In other words we need to empathise with a family before we are able to help them resolve some of their own problems which might otherwise lead to a child being taken into care or harmed.

While social workers might think they are showing empathy, research by Professor Donald Forrester at the University of Bedfordshire in 2008 demonstrated convincingly that professionals were struggling with this particular skill.

I often undertake a similar exercise (using a short vignette used by Forrester in his research) with social workers on my current training courses.

“You are on duty. A referral is received concerning a mother who often appears drunk when she picks up her eight-year-old child. You visit, and explain the nature of the referral to the mother. The mother says: ‘That’s not true. I am on anti-depressants and they make me seem drunk’. What should you say next?”

I ask social workers to discuss which of the two following responses they prefer (each represents typical responses from Forrester’s research).

● “This is contradictory to what the school is saying; the school feel you have presented drunk and this is why we’ve got the referral and we’re concerned. If you’re saying it’s the anti-depressants, you need to go back to your GP and adjust the dose as it’s clearly a problem.”

● ”Can I see the bottle of anti-depressants? Where does it say that on the label?”

Participants debate the merits of each response and opt for one or the other. However, they rarely protest that there is a problem with both responses yet both assume the parent is being dishonest.

While it is of course possible that the parent is trying to deliberately mislead the worker, it is unlikely that either of these two responses will lead to a productive outcome: the parent will either become aggressive and argumentative or, worse still, feign compliance by appearing falsely co-operative.

When social workers are invited to consider alternative responses they usually conclude that the preferred way forward, both in terms of co-operation and honesty, is to encourage the parent to speak a lot more than the worker. If there are doubts about whether she is telling the truth, the worker is more likely to pick this up by a) noting discord between non-verbal and verbal behaviour and b) noting discrepancies within the replies.

The evidence-base of the power of communication skills is unequivocal: the best way to encourage a person to speak at length is by attentively and actively listening punctuated with empathic responses.

But while practitioners know what I mean, they often struggle when I ask them to compose an empathic response to the mother’s assertion “the anti-depressants make me appear drunk”. The closest they give is a sympathetic response, such as “Oh, that sounds awful”.

A minimally empathic response would be something like this: “You feel (annoyed/angry/irritated) because, for you, you’ve been accused of something you didn’t do.”

Adding “for you” indicates that the worker is not necessarily agreeing with the parent, simply that they understand the parent’s position. This kind of response is radically different from the two forced choices, and is likely to encourage the parent to say more. The role of the social worker is to encourage them to do so because it’s essential for building a trusting relationship and it also enables the worker to discover more, about all sorts of things.

The development and maintenance of empathy in relationships is important for many reasons, some of which we are only just beginning to appreciate through recent discoveries in neurobiology and attachment-based research.

This research indicates strongly that maltreatment is often associated with low levels of “mentalisation”, a concept very similar to empathy. Mentalisation is the ability to appreciate and show by our behaviour that we understand that others have different experiences from our own. Here is an example of low mentalisation:

A father is feeding his baby son in a supermarket café with solid food warmed up in the microwave provided. He blows it, licks the bottom of the spoon and feeds it to his son, who immediately winces and screams as it has burned his lip and tongue. Dad scoops some more food out of the hot jar, puts it to his own mouth and says, with irritation and incredulity: “Look! It’s not hot: I’m eating it!” He then forces more food into the baby’s mouth and burns him again.

How do we understand such behaviour? Recent discoveries from neurobiology tell us that parents who do such things are likely to show significant under-activity in two areas of the brain: the amygdala and the hippocampus (measured by low electrical activity and blood flow). Each area is known to be involved centrally in regulating and enabling, among other things, mentalisation and empathy.

In his recent book Zero Empathy: A New Theory of Human Cruelty, Simon Baron-Cohen outlines how low activity within what he terms the “empathy circuit” fails to produce fully mentalised responses.

Of what relevance is this to social work?

What emerges is that low activity in the empathy circuit is more likely to be the result of early caregiving experiences than from a genetic predisposition.

But the real breakthrough in research relevant to professional practice is that these areas of the brain can be rewired when workers offer precisely the kind of experience missed during the early years, ie empathy and understanding.

Intervention programmes aimed at increasing mentalised experience between parents and their children are proving to be very promising. In these programmes the worker films sessions of a child and parent/carer interacting. The parent and worker then watch the short films back together and the worker will speak for the child, but only about positive exchanges between parent and child.

For example a mother might be playing with her son and she snaps her hand like a crocodile. The child laughs.

At that point in the tape the worker might say: “I loved that mummy. You made me laugh. You made me happy.”

This helps the parent see that their child needs them, something they often fail to recognise. But the medium for the change is not that of teaching or showing the parent what to do. It consists almost entirely of empathising with the parent and helping them empathise with their child.

Professor David Shemmings is chair of social work at the University of Kent

FURTHER READING

● Baron-Cohen, S (2011) Zero Degrees of Freedom: A new theory of human cruelty, Penguin Books, Allen Lane.

● Shemmings, D. & Shemmings, Y. (2011) Understanding Disorganised Attachment: Theory and Practice for Working with Children and Families, Jessica Kingsley Press.

● McCrory, E., De Brito, S. A. & Viding, E. (2010) “Research Review: The neurobiology and genetics of maltreatment and adversity”, Journal of Child Psychology and Psychiatry, no. doi: 10.1111/j.1469-7610.2010.02271.x (accessed online, February 2010)

● Forrester, D., Kershaw, S., Moss, H., & Hughes, L. (2007). “Communication skills in child protection: how do social workers talk to parents?” Child and Family Social Work, 13(1), 41-51.

● Forrester, D., McCambridge, J., Waissbein, C., & Rollnick, S. (2008). “How do child and family social workers talk to parents about child welfare concerns?” Child Abuse Review, 17(1), 23-35.

● Juffer, F., Bakermans- Kranenburg, M., & Van IJzendoorn, M., (2008). Promoting Positive Parenting, And Attachment- Based Intervention. New York: Taylor & Francis Group.

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This article is published in the 3 November 2011 edition of Community Care under the headline “Empathy: Social workers’ most powerful skill”