USING ROLE PLAYING IN TEACHING EMPATHY Adam Blatner, M.D.

(This is a revision of a paper presented as part of symposium on the Arts in Medicine at the American Psychiatric Association Annual Meeting, May 5, 1992) (Posted eptem!er ", 2##2) $ne of today%s significant challenges in the training of mental health professionals and people helpers of all &inds is the development of effective interpersonal s&ills, and among these is the capacity for empathy' An operational definition ( li&e to use has t)o components* +irst, empathy is an a!ility to imagine )ith some degree of accuracy )hat it%s li&e to !e in the predicament of the other person, and secondly, empathy entails the a!ility to communicate that a)areness so the other person feels understood' -mpathy entails a different &ind of learning' .ust reading te/t!oo&s )on%t develop this s&ill' 0or is it a visual1motor s&ill, li&e getting the &nac& in golfing or !as&et!all' 0or is empathy a matter of simple good )ill, caring, or an intention to !e sensitive' ome !oo&s or papers a!out empathy descri!e it as a sensitivity to nonver!al communication, !ut ( thin& this is only a small component' 2ather, ( vie) this s&ill as a matter mainly of focused imagination, picturing in the mind )hat it might !e li&e to !e in the other person%s predicament' This s&ill also involves an integration of remem!ering, rational thin&ing, intuition, and feeling, all of )hich support the active imaginative process' -mpathy is teacha!le, !ut it re3uires e/periential learning, practice' ( challenge the cliche that 4you either have it or you don%t'4 5ertainly there is a varia!le distri!ution of talent for this endeavor, !ut 6ust a!out anyone can improve )hatever level of innate a!ility )ith practice' +urthermore, the natural vehicle for the e/periential learning of an interpersonal s&ill7in this case, teaching empathy7, is role playing' (t uses all of the aforementioned s&ill components' 2ole playing is a natural vehicle of learning !ecause it%s an e/tension of the imaginative, pretend play of childhood (8latner 9 8latner, 199:)' (t should !e noted that this approach is often neglected in the course of traditional education, !ecause it addresses a different type of learning than that )hich can !e easily tested on e/ams' 2ole playing !uilds a deeper type of understanding and a more fle/i!le type of thin&ing, 3ualities )hich )ill !ecome increasingly important in the coming years' ;o)ever, )hat most &ids learn involves memori<ation and calculation, logical composition, and other more didactically taught s&ills' 2ole playing involves an e/periential type of learning' (n teaching empathy, ( have students )or& in dyads, )ith one ta&ing a role, such as the role of one of their clients, or some vocational or social role that )ould challenge the imagination' The other student then simply intervie)s the partner1in1role' The tric& is to get the &nac& of thin&ing more li&e an actor than li&e a te/t!oo&' =ifferent se/es, ages, and educational or cultural !ac&grounds are also considered' >e e/plore the psychosocial

net)or&, too* >hat%s it li&e to !e the parent, child, si!ling, or spouse of a person )ith a given type of condition? >e !egin )ith more elementary roles, and students are invited to associate to the components of the roles' 2ole ta&ing is a s&ill that has to !e !uilt up 6ust as playing !all !egins )ith simply learning to thro) and catch' tudents are taught ho) to )arm themselves up to the process' 0ot &no)ing a!out the concept of )arming1up accounts for )hy many teachers use role1 playing incorrectly and )hy many students have !een turned off to the techni3ue' $ne cannot 6ust assign the roles and e/pect a spontaneous performance' >ithout a )arming1 up process, students in role playing situations often feel su!6ected to an e/cessive degree of demand and inade3uacy' 2ole playing re3uires a !uild1up of spontaneity in its participants (8latner, 2###)' 0o), actors &no) that spontaneity re3uires a process of )arming1up, )hich means a gradual !uild1up of sense1images, associations, physical connections, and affects so that the comple/ity of a character can !e !rought to life' Another component of )arming up is the esta!lishment of a some)hat playful conte/t )hich ma&es room for e/perimentation and ma&ing mista&es' The activity of )arming1up one%s imagination is similar to the process of actors during the early parts of rehearsal )hen they are delving into the su!tleties of their role' (n modern theater, influenced !y the )or& of tanislavs&y, actors see& to understand and feel into their assigned characters rather than rely on superficial gestures and artifice' $ne !egins to )arm up !y ta&ing on the more superficial, o!vious, almost clich@d parts of a role' As more associations are made, the more 3uestions are ans)ered, the more the person finds that une/pected ideas arise out of the su!conscious11)hich is the essence of the creative process' ( !egin the process of teaching the !asic feel of role ta&ing !y using a techni3ue (%ve called 4the Tal& ho) ;ost Aame4 (8latner 9 8latner, 1991!)' Most people have seen this genre of entertainment on television' The idea is for a person to imagine a role, and to !e intervie)ed in that role' (f it is a classroom, ( have the students pair up* $ne of the pair ta&es the role of intervie)er, a television tal& sho) host' The other, the guest on the tal& sho), as ( mentioned, is the person ta&ing some role* A patient )ho is facing a !one marro) transplant, a spouse of a person )ith Al<heimer%s disease, the supervisor of a program for mildly mentally retarded teenagers' The intervie)er should not try to !e helpful, therapeutic or diagnosticB (The intervie)er in this e/ercise is not the one practicing the s&ill of empathyB 2ather, it is the person !eing intervie)ed, using the dynamic of !eing as&ed 3uestions to )arm up the flo) of images and ideas in the interve)ee%s mind') The goal is to for the 4host4 to dra) out the 4guest4 in communicating to an imagined television or studio audience some of the e/periences, feelings and attitudes associated )ith that role' ( also use a variant of this approach )hen ( supervise or consult )ith other mental health professionals individually' After )arming1up !y discussing the !asic elements of the case

and clarifying the 3uestions, there may !e a time )hen the person !eing supervised )ants to understand his or her client7in that case, (%ll invite the therapist to ta&e the role of their clients, and gradually as&, at first, more general 3uestions, and then more pointed ones' 0ot only do they fre3uently come to some enlightening insights a!out their clients, !ut they also get practice in learning the s&ill of role ta&ing and empathy' ( offer cues in the form of 3uestions )hich (%ve found to !e especially effective in )arming up people to a role' +or e/ample, ( avoid 4)hy4 3uestions and )or& to)ards helping students picture specific scenes and situations rather than to use a!stract generali<ations' (n the tal& sho) host game, the host intervie)s the guest for a!out five minutes, and then ( announce, 4commercial !rea& in one minute'4 After one minute, ( announce 4commercial !rea&4 again, and 4come out of your roles, sha&e off your roles if you )ant to' 0o) change parts' The host )ill no) !e a guest* choose a ne) role' The guest !ecomes the tal& sho) host' Cou have si/ minutes'4 After this period, ( stop as !efore, and give the students a fe) minutes to process )ith each other ho) they felt a!out the e/ercise' The concept of role is itself a useful tool in helping students to !ecome empathic (8latner, 1991a)' The idea of role is a po)erful metaphor )hich suggests a familiar )ay of thin&ing a!out the elusive and comple/ )orld of mind and social interaction* Thin& in terms of the roles !eing played, as if in a drama, and then you can analy<e the different parts, the components of those parts, and the )ays those roles and su!1roles are defined' The role concept thus !ecomes an instrument of analysis, and it%s also a value1neutral 4user1friendly4 language )hich circumvents the &inds of psychological 6argon )hich many students find confusing' Di&e a good analytical techni3ue, the role concept !rea&s a holistic system, a family or the comple/ity of a person, into managea!le parts' +or e/ample, if ( as& you, 4>hat%s it li&e to !e your mother?,4 there are so many facets of her !eing that it%s impossi!le to &no) )here to start, or )hat could !e said that could capture the fullness of her e/istence' 8ut if ( as&ed, 4>hat%s it li&e in terms of her relation to money?4 you could pro!a!ly remem!er a num!er of images or things she%s said or done' And, continuing the )arming1up process, if ( as&ed 4>hat%s it li&e in her relation to religion?4 or 4'''in relation to house&eeping?4 or 4'''in relation to a special ho!!y or interest?4 you could gradually !uild up a composite picture )hich !egins to have enough memories and associations so that )ere the intervie) of your mother (played !y you) to continue, you%d !e )armed up enough to discover some surprising ne) thoughts a!out Mom )hich )ill spring into your a)areness from your su!conscious' The role concept has many advantages* (t is uni3ue in its capacity to interpret phenomena at many levels of human organi<ation11intrapsychic, interpersonal, family, organi<ation, and even interactions )ithin the larger culture' (ts association )ith drama and the arts and its roots in the play of childhood gives the e/ercise of this s&ill some of the e/citement and challenge of a game, adding motivation to the learning process' And finally, its association )ith a techni3ue )hich can !e used for !oth education and therapy ma&es it especially heuristic'

2ole playing is a derivative of psychodrama and utili<es a )ide range of other techni3ues )hich enhance the process (8latner, 199E)' +or e/ample, if students are e/ploring the pro!lem of telling family mem!ers that a patient has died, the first and most o!vious techni3ue is to role play the predicament of the family mem!er, say, the spouse' The unspo&en as )ell as e/pressed thoughts are !rought out' >or&ing from the position of )hat )ould !e the !est and )orst things for the chaplain, therapist, or doctor to say from the point of the !ereaved, the group mem!ers could ta&e turns trying out a variety of approaches' The techni3ue of 4replay4 allo)s participants to correct mista&es, and the techni3ue of 4mirroring4 gives those )ho play a role some feed!ac& as to ho) they )ere perceived !y others in the group' Another techni3ue )hich can enhance the effectiveness of a role playing learning situation is to have the students read up on the psychosocial aspects of the condition(s) to !e discussed in the ne/t session' This adds an element of intellectual discipline, !ut it%s the actual role ta&ing )hich !rings out the nuances and the feel of the situation )hich can never !e gleaned from the 6ournals or te/ts' That%s )hy it%s called e/periential education' The ne/t component of empathy is that of communicating one%s a)areness of the other%s situation so that the other person feels understood' The &ey here is to state the a)areness in a hum!le, open1ended fashion, as an 4(1Message'4 4(%m not sure if this applies to you, !ut if that )ere happening to me, ( might feel (thus and so)' (s that true in your case?4 =erived from the psychodramatic techni3ue of 4dou!ling4 and applied in this fashion, ( call this 4active empathy'4 (t is to !e contrasted )ith 4interpretations4 phrased as 4( thin& you feel'''4 or 4Cou must !e feeling'''4 Ma&ing 4(4 statements instead of 4you4 statements tends to allo) patients more of a sense of colla!orative freedom and reduces the distance !et)een therapist and patient' (t is empo)ering and reduces the su!tle negative transference patients have )ith authority figures )ho have in the past seemed un)illing to !e corrected' (n other )ords, this more mutual )ay of e/pressing empathy, communicating a )illingness to !e corrected, thus enhances the treatment alliance' Another advantage of active empathy is that it moves the intervie) along, !eing more time1efficient than the traditional non1directive techni3ues and yet more personal than medically1oriented directive 3uestioning' +inally, the activity of role playing fosters a more fle/i!le type of thin&ing in the clinician' hifting roles !uilds a ha!it of !eing a!le to move easily among different frames of reference' There%s a deepening as )ell as a !roadening of mind in this type of e/periential learning' pontaneity relies on a receptivity to the su!conscious, and this in turn develops a more vi!rant relationship )ith the creative unconscious' 2emem!er that traditional schooling actually suppresses this relationship, !ut role playing re1opens channels to the 4inner child4 and the vitality )hich is associated )ith those comple/es' As a result, practitioners !ecome more self1a)are and more en6oying of their capacity for interpersonal relations' A !asic dynamic in psychology )hich (%ve !een noting is the repression and denial of activities or issues a!out )hich one feels vulnera!le or inade3uate' Applied to the fields

of health care, one of the ma6or reasons people aren%t more interpersonally sensitive is not !ecause professionals don%t care or haven%t got the potential, !ut !ecause they don%t &no) ho) to !e empathic, they don%t have the infrastructure of s&ills and ideas )hich allo) them to feel competent and effective in this area' -/hortation cannot suffice' The s&ills of communications, emotional pro!lem1solving, self1a)arness and empathy must !e learned through e/periential vehicles such as role playing, and students must !e given opportunities to practice until they achieve a gratifying sense of mastery' Then )e )ill see a more personali<ed form of medical, nursing, and therapeutic practice' References 8latner, A' (1991a)' 2ole =ynamics* A 5omprehensive Theory of Psychology' Journal of Group Psychotherapy, Psychodrama & Sociometry, 44 (1), FF1"#' 8latner, A' 9 8latner, A' (1991!)' (maginative intervie)s* A psychodramatic )arm1up for developing role1playing s&ills' Journal of Group Psychotherapy, Psychodrama & Sociometry, 44(F), 115112#' (This paper no) on this )e!site* http*GG)))'!latner'comGadamGpdnt!&Gtal&sho'htm 8latner, A' (199E)' Acting-In: Practical applications of psychodramatic methods (Frd ed)' 0e) Cor&* pringer' 8latner, A' 9 8latner, A' (199:)' he art of play: !elping adults reclaim imagination and spontaneity' 0e) Cor&* 8runner12outledge' 8latner, A' (2###)' pontaneity' (n, "oundations of psychodrama: !istory, theory & practice ("th ed')' 0e) Cor&* pringer, pp' EF1:"'