Dr. Helen Riess on Empathy and the Science of Emotion (Part 1 of 3)


Helen Riess


I’m Alan Alda and this is Clear and Vivid, conversations about connecting and communicating.

Helen:                          13:18               Most people choose medical professions because they want to help people. And there is an innate reward when we help people. It’s been described as exquisite empathy, like that moment where what you say to a patient and where they recognize that they are really understood and being helped, that the benefit is both to the patient and to the physician.

There may not be a time in our lives when it’s more important to know we’re being understood by another person – than when we’re in a doctor’s office.

It’s not an exaggeration to say our lives could depend on it. If we’re going to follow our physician’s advice, there has to be a level of trust.  And we need to know we’re being heard.

Relating and communicating in the doctor’s office seems to us like an important enough subject to devote a devote a special series of three shows to it. Our first conversation is with Helen Riess whose research has answered some important questions. Questions like: How important is empathy in the doctor-patient relationship? Can empathy be taught?

Her answers are encouraging and exciting.

We met for our talk at our studio in New York…


Alan:                            00:00               Helen, I really love this chance to talk with you on the podcast, because we have a history together. You were in my book, and I’m in your book.

Helen:                          00:09               That’s right.

Alan:                            00:10               The book that just came out that you published, The Empathy Effect. The byline is Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences. That’s a subtitle almost as long as mine.

Helen:                          00:27               It’s almost as long as the book.

Alan:                            00:30               It’s funny how the publisher always wants to put the whole book on the cover.

Helen:                          00:34               Right.

Alan:                            00:35               But the Empathy Effect is really at the heart of so much. In a way, I think it’s at the heart of communicating. How did you know? I love origin stories. We all do. The Bible starts with the origin story, and we all are drawn to them. How did you realize how important empathy was in your work? As I remember, your graduate student came to you and said, “I want you to get hooked up to your patients.” Was that right? What was your reaction to it, if that’s he said?

Helen:                          01:54               Well, yes, it was one of the psychiatry residents who wanted to do a study to see if we could measure empathy between doctors and patients. His theory was that if we hooked up people to physiologic monitoring, like heart rate and skin conductance, that we could see whether people actually harmonize in sync when they feel empathized with and if they don’t when there is no demonstration of empathy. When he first approached me about this I said, “I’m not sure I want to do that.”

Alan:                            02:35               What was your resistance?

Helen:                          02:37               Well, it’s one thing to have yourself videotaped with any patient, which in psychiatry is a very foreign concept. But then to also have a lie detector test going on while you would-

Alan:                            02:48               Yeah, because that skin conductance … Is that what you called it?

Helen:                          02:48               Yeah, yeah.

Alan:                            02:51               Is really measuring, in a way, how much you sweat in the micro way-

Helen:                          02:57               Yes. That’s right.So we both wore these noninvasive leads on our fingers that measured these micro-amounts of sweat, and that’s called skin conductance monitoring. We’re always releasing sweat whether we realize it or not. But the degree that we release it is directly linked to our physiologic activity.The reason it works in a lie detector test is that most people, when they’re lying, are in a state of cognitive dissonance, which creates anxiety and stress.

Alan:                            04:17               So you finally agreed to be hooked up to the patient?

Helen:                          04:20               Yes. He said, “Please, I need 20 subjects. Will you please?” I realized like, “This is such a great opportunity to learn something.” I and almost 20 other people agreed to do it, and it was fascinating.

Alan:                            04:33               What the nature of the problem you were working with the patient?

Helen:                          04:39               So, with-

Alan:                            04:40               And it was a regular psychiatric interaction. Right?

Helen:                          04:42               Yes, it was one visit. It was with a person who had been trying to lose weight, and we weren’t having much success with that goal. But we were having success with her learning to be more assertive and to set limits on people who were ridiculing her about her appearance. When we did this study, I recognized that there were times when her activity was far more intense than mine.

Alan:                            05:17               There were moments where you were not in sync.

Helen:                          05:19               Yeah, where we were clearly not matching. I went back and looked at the video to see what was happening during that time. This person was making subtle movements that I had just not been paying attention to.

Alan:                            05:19               Like what?

Helen:                          05:37               Like flicking her hair or making a funny sort of chortle like, hah, hah, hah, like that. It was like all these pieces of evidence were hiding in plain sight.

Alan:                            05:48               When she was making these gestures that you were missing, her tracings showed-

Helen:                          05:53               Activity.

Alan:                            05:54               … activity and yours didn’t because you weren’t picking up on what you were seeing?

Helen:                          05:57               Right, and so when I realized that there were these patterns to the manifestations of anxiety that I had been missing, in our continued work I would say, “What were you feeling just then?” Instead of this going right by, I would learn that she was feeling uncomfortable or maybe a little ashamed, and we got to a much deeper level. The results were that that year this person who had never lost one pound and only had gained, actually lost 40 pounds that year.

Alan:                            06:31               Wow. That really stemmed from your paying attention to what you were seeing?

Helen:                          06:38               It was from tuning in at a much more perceptive level, which I believe is the first step in empathy. First we have to open our eyes to what’s there. We can’t empathize with things we can’t perceive.

Alan:                            06:53               Is that when you began to realize you could train other doctors to do this?

Helen:                          06:57               That’s exactly right. When I saw the tracings and I realized not only how much I learned about this one relationship, but how transferable this awakening could be for other physicians, I realized doctors like science. If you can actually show a tracing that shows when you’re in sync and when you’re not, that is way more powerful than saying, “When you see a patient, look them in eye and shake hands.”

Alan:                            07:26               Yeah, yeah, right. You’re not just saying, “Trust me. This makes you more empathic.” You can show them the tracings.

Helen:                          07:35               Yes.


Alan:                            07:37               You work with all kinds of physicians, not just psychiatrists. Is that right?

Helen:                          07:46               Yes. In fact, I got pretty excited about this because my own patients in my practice were really complaining about feeling unseen, unheard, and treated like a number in their visits.

Alan:                            08:02               The visits to their?

Helen:                          08:03               To their doctors and their surgeons.

Alan:                            08:05               Right.

Helen:                          08:05               It was becoming a very pervasive theme in my practice. I realized that this same thing was showing up in the media, in major newspapers, about doctors. Patients wanting their doctors to have more empathy. I realized that what I was seeing was actually a national trend. When I realized that we had tools for teaching this skill, which, really in medical schools, this has not been a focus, teaching.

Alan:                            08:40               Is it more so now? Or is there more attention to training and empathy?

Helen:                          08:40               There’s more attention now because the epidemic of burnout is on everyone’s mind.

Alan:                            08:47               I don’t think people realize how severe a problem burnout is. I didn’t. When I first heard the figures, I was astonished. I just heard the other day, for instance, that two-thirds of physicians would not recommend this as a life to their children.

Helen:                          09:04               That’s true.

Alan:                            09:05               That’s astonishing.

Helen:                          09:06               It’s really sad because it used to be a profession everyone would want to pass on.

Alan:                            09:12               Yeah.

Helen:                          09:12               Yep.

Alan:                            09:14               It has an effect not only on the physician who feels often depressed, not feeling that they’re accomplishing anything meaningful. But it can lead to mistakes with regard to the patient’s wellbeing. The disengagement just to try to survive and keep your head above water I guess.

Helen:                          09:35               Exactly. I think that one of the things that’s lost in some of the trends of using so much technology in the room, like typing into the computer. Many times when I have observed patient-physician visits, the first thing the physician does is go to the computer before even saying hello, and these-

Alan:                            09:59               Before saying hello. Hello is such a simple thing to say.

Helen:                          10:02               You would think, but it seems like saying hello to the computer is more important.

Alan:                            10:06               Is more important.

Helen:                          10:08               But a lot of this is just, I think, a lack of awareness, because people didn’t use to be like this.

Alan:                            10:15               But if the computer is in the room and there’s an obligation, and really a strict obligation, to enter information into the computer. As I understand it, it’s not uncommon for the computer to be against the wall and make the doctor sit with his or her back to the patient.

Helen:                          10:33               Well, that’s actually very true. I would say that anyone designing a hospital or a clinic or anyone renovating one to be sure to make the face-to-face interaction with the patient a top priority. Otherwise, the patient’s sitting there feeling like they’re sort of like a sideline instead of the main event.

Alan:                            10:54               Right. Even with empathy training, they don’t get a chance … if their back is to the patient … to do what you learned to do in that encounter with your patient where you realized that you could pick up on clues.

Helen:                          11:07               Right.

Alan:                            11:08               If a patient tells a doctor about symptoms and has an expression on her face that really means there’s more to tell you than what I just told you and you missed that, you don’t get the full story.

Helen:                          11:24               That’s true. If a physician is recommending a medication and misses a facial expression of disgust, which probably means there’s no way in the world I’m gonna take this, because the last time I did I was vomiting for three weeks.

Alan:                            11:38               Oh, wow.

Helen:                          11:40               If you don’t see that look and the patient doesn’t speak up, you might hand a prescription and think you’re all set when you’ve actually just broken a partnership.

Alan:                            11:51               The underlying sense of trust seems to me to be really important. If the doctor is actually paying attention to the patient, the patient is, I think, my guess is, more likely to trust the recommendations of the doctor.

Helen:                          12:06               Well, Alan, you’re really getting to some of the really important consequences of a lack of partnership and trust and that is the poor medical outcomes. Our team at MGH did a systematic-

Alan:                            12:21               MGH is what?

Helen:                          12:22               It’s Massachusetts General Hospital. We did a systematic review and a meta-analysis of all randomized control trials that claimed that relationship factors helped hard health outcomes such as obesity, diabetes, hypertension, asthma, lung infections, et cetera. We found 13 very excellent, rigorously done studies that showed that just by changing the level of trust and cooperation between the doctor and the patient, they could get significant improvement in some of our most vexing health problems in our country.

Alan:                            13:02               This has been a curious issue for me. What effect does that have? It’s clear it has a good effect on patient. Does it have an effect on the doctor as well? Does the doctor feel better if he or she is able to show empathy?

Helen:                          13:18               You know? That’s a really great question. Most people choose medical professions because they want to help people. They’re people-oriented individuals. There is an innate reward when we help people. It’s like a reciprocal experience of feeling good. It’s been described as exquisite empathy, like that moment where what you say to a patient and where they recognize that they are really understood and being helped, that the benefit is both to the patient and to the physician. This is true in any two-person interaction. People love to help. When you feel helpful, you want to help more.

Alan:                            14:02               You’re getting signals back from the other person. It’s not just a one-way communication. It’s a real partnership that starts to be established I imagine.

Helen:                          14:11               Exactly because our emotions are contagious and most feelings are mutual. If you make another person feel understood and good and that you’re an ally in their journey, that gratitude is just gonna come back and fill you up. That’s the loop that I think has gotten broken by not paying attention to patient emotions.

Alan:                            14:34               How do you get doctors to do that? What kind of training do you give them?

Helen:                          14:39               Well, I developed an empathy training program that I knew it had to be brief and it had to reinforce the training. It was based on a neuroscience fellowship I did at Harvard where I got to take a deep dive into the neuroscience of empathy. I realized that so many of the ways that we naturally connect are teachable. They start with basic things like acknowledging one another’s presence. That’s done by making some eye contact.

Alan:                            15:20               Right.

Helen:                          15:20               Instead of running to the corner in the room.

Alan:                            15:22               Right. Sorry. So often when we say something that we feel is important, we look away from the person we’re talking to to make sure we get it right. We are in our own world. We’re communicating with our own brain rather than with the other person. It’s probably to say it sloppily to the person than perfectly not to the person.

Helen:                          15:48               That’s a really important point you’re making. I think most people don’t realize that they’re doing it. It’s almost like they’re reading their thoughts from the back of their brain instead of communicating directly.

Alan:                            15:57               Right. They’re processing the words rather than really making an interchange with you. Because if the other person is uncertain about what you mean by it, if you notice that, you can alter what you’re saying on the go. But you can’t if you’re looking away.

Helen:                          16:16               Exactly, which is the title of your book, If I Understood You, Would I Have This Look on my Face?

Alan:                            16:21               That’s right.

Helen:                          16:25               The empathy training that I developed, I knew no one would pay attention to it unless we tested it in the most rigorous way. I got some grants to test this training in six different specialties at Mass General Hospital. With this brief spaced education intervention, we had patients rating the doctors before and after the training.

Alan:                            16:52               Oh, so you really got the data on this?

Helen:                          16:54               It wasn’t self-report. It was: What do the patients say? The doctors were randomized by a computer to either receive the training or not. Then about a month after the training, we asked the patients again. Their ratings of their physician’s empathy and compassion and listening and showing concern for the whole person not just a body part significantly improved.

Alan:                            17:21               How did you do it? The doctor comes into his room. How much time do you have with the doctor to try to up his empathy or her empathy?

Helen:                          17:28               Well, our training eventually got translated into an online learning so that doctors can take the courses in a self-paced way. I ended up founding an organization called Empathetics that delivers this training online. We also provide classroom training to reinforce what they’ve learned. It’s three hours of self-paced learning that’s supplemented by other interactive training.

Alan:                            18:03               You get them both, in both modes. Right? Both online and in-person?

Helen:                          18:09               Right. It’s called blended learning. Our training is very amenable to other supplemental types of training like the kind of training that you do with improv. Anything that deepens the connection between people that can be paired with the scientific training that came out of the neuroscience research can bolster the training.






Alan:                            20:21               One of the things that I think you found that’s really interesting to me is that the doctor is in danger of something by having more empathy, which is getting swamped by the feelings of the patient, which I suppose can lead to burnout.

Helen:                          20:44               You know, Alan, that’s a very important point. I think it’s important for everyone to understand that empathy has both cognitive thinking components and feeling or affect emotional components. Some people are out there saying, “Let’s get rid of emotional empathy and just use cognitive, because people will get too burdened by other people’s emotions.” I think that’s a real mistake. I think that what we really need is self-regulation skills so that we can manage our own emotions. But if we try to wipe emotions out of a patient-doctor relationship, you might as well be talking to a robot. Some degree of emotional connection, I think, is absolutely necessary.

Alan:                            21:33               How can we go about regulating what we’re getting from somebody in distress?

Helen:                          21:45               Mm-hmm (affirmative). The key to self-regulation is first awareness that you’re in a dis-regulated state. We train to be aware of when you’re most likely to go into fight or flight mode, and that is when patients criticize us, refuse our recommendations, don’t come. What’s never really been made clear to physicians or physicians-in-training is how threatening these things are. They’re as threatening as somebody coming at you with a fist in your face when a patient says, “I don’t like your lousy medication. It made me feel so sick.” People think that’s having no impact on the physician, but it’s basically saying, “You’re not helping me, and your medicine is lousy.” We have to train them to be aware of when they’re actually getting emotionally worked up.

Alan:                            22:40               You know, I’m seeing a moment in my life in a new light as you talk. A doctor said to me once, “You’re on the borderline with this thing, so take this pill.” I said, “For the rest of my life?” He stopped, shocked that I was objecting, that I had the idea that-

Helen:                          23:02               Maybe not.

Alan:                            23:03               Yeah. For a minute, I was surprised at his reaction because he said, “Well, yeah.” I’m realizing now as you speak that I must have put him in an uncomfortable state in that moment.

Helen:                          23:18               Well, I think this is so important. Because of the knowledge they have, doctors are in a more powerful position, and they’re comfortable with that. They’re not so comfortable when they’re in a helpless position. When patients put doctors in a helpless position like, “What do you mean? I don’t want to take this,” that’s startling. That’s what we need to-

Alan:                            23:43               That puts them in fight or flight.

Helen:                          23:44               Yes, without even maybe realizing it. But if they were hooked up to skin conductance, they would start spiking. What we like to do in our training is have people reflect on what type of interaction really is very uncomfortable for me. Some doctors don’t mind patients crying. Other doctors just freak out. Some of them can deal with anger. It’s like, “Yeah, I had an angry mother. I know how to deal with that.” Other are like, “I hate it when patients get angry with me.”

Alan:                            24:12               I’m not getting the connection a little bit that I can understand if the patient is crying and you get drawn into that in an uncomfortable way, and you need to regulate your own emotions. Are you saying it also applies to when the patient says, “I don’t want to take that pill,” and you have an emotional response to that that you have to regulate as well?

Helen:                          24:39               Well, see, not everybody when a patient is crying will get drawn into the sorrow. Some people will get drawn into helplessness or even anger. Like, “What are you doing crying now? I’m trying to help you.” The emotion of crying can elicit very different reactions. If it’s empathy and I want to help you, that might be more comfortable than, “Oh, my gosh. I don’t know what to do with this person who is now crying. How did I get them to stop?” You know?

Alan:                            25:06               Yeah.

Helen:                          25:07               Learning what your own triggers are is really key to self-management.

Alan:                            25:11               I hadn’t thought of it that way. That’s very interesting. Even if your response is anger or withdrawal, that’s as dangerous and something that needs to be regulated just the same as if you get drawn into the quicksand of-

Helen:                          25:26               Of emotion.

Alan:                            25:27               … feeling what the patient is feeling to an extent that it inhibits your own functioning.

Helen:                          25:33               Exactly. Most people are not at the level of awareness of what triggers them. They’re going through their day. They might say, “Oh, that person just drove me up a wall.” They’re venting but they’re not realizing like, “I got really dis-regulated.” We do teach techniques through breathing, through taking a moment, through knowing when you need to talk to a colleague and talk something through that this emotional burden and load has to be relieved. Otherwise, it can just mount up.

Alan:                            26:07               I’ve found, I think I’ve found … I want to test this out on what you’ve found … is that when I’m more empathic, I think I’m more aware of my own feelings as well as those of others. Do you find that? Or am I kidding myself?

Helen:                          26:27               Well, I think you have thought a lot about this. It’s clear that this is a topic that you give great consideration to. I think it can go both ways. The more empathic you are, maybe the more you sink into the helplessness or hopelessness. But if you’re aware through cognitive empathy, it’s almost like you’re watching yourself at the same time that you’re with the person. You have like two modes of awareness going on. What helps me is to remember what my role is.

Alan:                            26:59               Oh, that’s good. Yeah.

Helen:                          27:02               In my psychiatric practice, I hear a lot of pain and suffering. I am very attuned to that. I know that I resonate with that. But I also have to say to myself, “I’m not here to just be crying with you. I’m here to understand this and to show my curiosity and learn more.” If we get triggered, we might not want to learn more.

Alan:                            27:30               Exactly. We would disengage.

Helen:                          27:32               Exactly. It’s a pretty sophisticated dance.


Alan:                            34:10               Do you find, what I think I’ve found, that empathy doesn’t necessarily produce compassion, but it is the basis for compassion if you want to be compassionate?

Helen:                          34:25               Thank you for asking that, because I think there’s so much confusion about empathy and compassion. Empathy is necessary in order to show compassion. Empathy is the perceptive arm, seeing a face, hearing the tone of voice, being moved by a person’s predicament. That elicits empathic concern, which is a state of mind of like, “Oh, I care about this.” Compassion is the response that is visible to the world. That’s what comes out of us, so it’s like a loop.

Alan:                            34:59               Doctors probably already have the impulse to be compassionate because they want to help. It seems to me, I think I hear you saying, that without the groundwork of empathy, it makes it harder for them to show the compassion they would like to show in order to be of help.

Helen:                          35:22               It’s like trying to get output from a speaker without inputting anything. Like if your gaze is at a computer screen and you’re not actually experiencing the person, it’s very hard for a compassion to come out of you because you’ve kind of missed the input.

Alan:                            35:42               This thing of actually paying attention to the person you’re trying to communicate with sounds so dumb. It’s so simple that it almost seems absurd. Somebody says, “Well, what’s the best way to communicate?” My impulse is to say, “Pay attention to the person you’re trying to communicate it.” It’s sort of basic.

You and I think independently discovered something that helps us be empathic. Maybe it’s been known by and studied by other people. I don’t know. But in order to enhance my own empathy, which drains away if I don’t work at it … We can talk for a second about why that happens. But in order to increase my empathy, I found actually looking people in the eye and trying to figure out what they’re going through, trying to name their emotional state really helps me focus on them and seems to generally increase my empathy altogether. You do that yourself, too, and you recommend that to people, don’t you?

Helen:                          36:59               Well, looking people in the eye or meeting someone’s gaze and I don’t mean glaring or staring at people, but really meeting someone’s gaze, it goes back to mother-infant bonding. The gaze between a mother and a baby is what releases oxytocin, which is the bonding hormone. If you’re talking to  someone and not meeting their gaze, something is not happening that is naturally supposed to unfold when we’re with people. The idea of naming emotion, that is very emphasized in psychiatric training.

Alan:                            36:59               Oh, I didn’t know that.

Helen:                          37:41               We actually have to write that down.

Alan:                            37:43               Really? You have to name it and write it down?

Helen:                          37:47               It’s part of what’s called the mental status exam. There’s an A for affect and you have to write down, “Was the affect sad? Confused, angry, intense?” Whatever adjective you want, but that orients you to the emotion of the person. In typical, non-psychiatric visits, affect, I’ve never seen that as like one of the questions in the review of systems. I think that’s really missing something important.

Alan:                            38:18               It’s common, I think, when you first start to ask yourself, “What’s the emotion the other person is going through, what their affect is?” It’s common to have a very limited vocabulary. I know when I tried to do it in the beginning, I think, “Well, is the person happy or sad?” I kind of had two choices, but there’s a very wide range of emotions that people can go through.

Helen:                          38:48               We talk a lot about perspective taking, like trying to understand where they’re coming from and try to guess or imagine the emotion. But there’s also perspective getting, which is just asking.

Alan:                            39:03               That’s good. Yeah. That’s very good. There was something that came up. Oh, why does it happen that we, no matter how empathic we are, it seems that in the course of a day or two that empathy can go down? We can lose it. Why do we lose it?

Helen:                          39:33               Well, you’re bringing up the point that it’s a very mutable trait. People have the greatest empathy when … I call it … their tank is full. Think about your car. It’ll go the farthest when your tank is full. It’s not go too far when it’s nearly on empty. That’s how empathy works. When we take good care of ourselves … I call this self-empathy … then we have a full reservoir to be more perceptive and to be more attuned to the needs of other people. But if we’re not taking good care of ourselves and medical training does beat it out of you to a certain degree because you’re exhausted, you have more work to do than you ever feel you can accomplish, that’s the risk of your tank being pretty low. That is why there’s so much emphasis on wellness and self-care coming into medical curricula now, because it’s been a process of training that really has beaten some of the humanity right out of it.

Alan:                            40:35               It sounds like you’re saying that stress, certainly the stress that doctors undergo in their training and in the practice of their profession, the stress probably puts you in a fight or flight mode. You have different hormones coursing through you that are not conducive to empathy I would imagine.

Helen:                          40:57               Exactly right. Cortisol is the stress hormone, and cortisol is like an antidote to empathy. Because when you’re stressed, who are you focused on? You’re focused on your own tiredness, your exhaustion. You become very centered on your uncomfortable feelings, and that doesn’t open up a big window into the feelings of others.

Alan:                            43:14               When you’re looking at somebody trying to figure out what they’re feeling, what they’re going through, is there something in just the effort to do that, do you think, that makes for a better connection? In other words, as I look at you now and I try to identify what it is you’re going through, I’m probably paying more attention to your face, and you pick up that attention that I’m spending on you. It must do something to you. For instance, when I was saying that, and right this second, I’m seeing more connection. You’re very connected, but there’s a little more connection than I saw a few minutes ago.

Helen:                          44:02               Well, I think when we focus our attention in a very acute way, even more connection opens up. But it’s almost like we have to remind ourselves to do it, because a lot of us are living in our own heads. I think we all know that when we’re talking with people we’re often thinking about what am I gonna say next instead of like, “How am I gonna just stay with this right here in the moment?” See, this is why when you said early, these things are so simple. They’re so obvious. These things may be simple, but they’re really difficult, because paying attention and focusing on any one thing for longer than about 10 seconds is a real challenge, and it’s just getting more challenge today.

Alan:                            44:51               Yeah. It reminds me of the evaluation of some brain scientist that the present moment only lasts for about five to seven seconds. If you can’t stay in that constantly, you’re drifting into the future. What’ll I say next? Or the past, what did I do wrong or how can I challenge this person’s idea? In really listening to the other person, you’ll not only get a good diagnosis probably, but you also get a chance for you to be partners in this exchange. Do you find that happening to you in real life, not just in your professional life?

Helen:                          45:33               You mean really listening?

Alan:                            45:34               Yeah.

Helen:                          45:35               Then develop-

Alan:                            45:35               Having more of a partnership with the person you’re listening to?

Helen:                          45:40               Absolutely. I think what I’m realizing is like tapping into what that other person cares about can bring about extremely rich conversations.

Alan:                            45:52               What would be an example of that?

Helen:                          45:54               Well, like I was talking to someone at a conference just on Saturday who was saying, “Oh, I’m gonna be leading some mindfulness workshops. Could you let the residents at your hospital know about it?” I could have just said, “Oh, yeah. Give me your card. I’ll pass it on.” Instead, I said, “That’s really fascinating. What got you interested in doing this work?” I learn how much training this person has been doing, how excited she is about the work she’s doing, and how it’s transformed her life. It made me way more motivated to share her workshop idea, because though curiosity and understanding.

Alan:                            46:46               That’s the word I was going to say, that it’s interesting, we often shrink from contact with another person and settle for small talk. Some of us don’t even like small talk, but small talk at least can start the ball rolling. But the ball really gets momentum when we have some curiosity about the other person. Who is this person? What’s going on in there?

Helen:                          47:13               Curiosity is the biggest gift, because most people do want to be known. Most people want to be seen.

Alan:                            47:24               Everybody has something worth contributing.

Helen:                          47:27               Exactly.

Alan:                            47:28               When they talk about the wisdom of crowds, the idea that if you have many different perspectives converging on a question, you get really, often, very good answers because you have all these different perspectives. That means that this person you’re talking to is maybe a perspective you haven’t heard before, and it could really be a contribution, a gift. But you don’t get the gift unless you pay a little curiosity and attention to the person.

Helen:                          47:57               I couldn’t agree more.

Alan:                            47:59               Well, I sure got a lot of gift out of you today. I think our time is coming to a close. But do you mind doing what we do with our guests? You probably have heard the podcast and you know there are seven questions we’d like to ask? Do you mind?

Helen:                          48:15               I don’t remember all of them, but-

Alan:                            48:16               Oh, you don’t? I’m gonna ask them to you one at a time as long as you’re okay with it.

Helen:                          48:21               All right. I’ll do my best.

Alan:                            48:22               They’re basically about the question of communication. They’re based loosely on the idea of communication. For instance, what do you wish you really understood?

Helen:                          48:37               Oh, I wish I really understood how to excite people about the life of the mind instead of the life of tasks?

Alan:                            48:56               Well, you got me excited.

Helen:                          48:59               Well, that’s good.

Alan:                            49:02               So, you’re on the right track. What do you wish other people understood about you?

Helen:                          49:07               I think one of the things I wish they understood is that the way I’ve lived my life is what Eleanor Roosevelt recommended, which is, “Every day do something that scares you.”

Alan:                            49:21               Oh, wow, so you’re in a constant state of fight or flight?

Helen:                          49:26               Well, it’s more like a constant state of stepping up to opportunity and stepping up to invitations. I guess I really recommend that even if the invitation seems a little bit daunting or like stretching you out of your comfort zone, it is so worth it.

Alan:                            49:43               Oh, that’s great. What’s the strangest question anyone has ever asked you?

Helen:                          49:52               I guess the most startling question was when one of my psychiatry teachers I was meeting with asked me, “What are you doing here?”

Alan:                            50:07               You really have to go down to your roots with that one.

Helen:                          50:10               That’s exactly right. Whenever I’d say, “I’m going to medical school,” or “Gonna be a …” People are like, “Oh, that’s so great. It’s such a wonderful profession.” It was always like such a foregone, but when she said, “What are you doing here?” I think every person should ask themselves in no matter what they’re doing in their lives, “What am I doing here? Why am I doing this thing? How is my participation in this maybe gonna make a difference?”

Alan:                            50:40               Okay, here’s the next question. How do you stop a compulsive talker?

Helen:                          50:45               Well, two weekends ago I was in a convenience store. The person behind the clerk noticed a BMW pulling out and he said, “I have a BMW.” He started to tell me about this litany of things that were wrong with it. He was going on for like five minutes. I was like clutching my bag trying to give it.

Alan:                            51:07               Trying to give him signals.

Helen:                          51:07               Yeah. I said, “Oh, gosh. You sound really disappointed. Have you thought about getting rid of it?” Thinking that my end the … Then he just said, “No, but you know, it drives like nothing else. It’s such an amazing car.” I said, “It sounds like you’re pretty ambivalent.” Then he had this big smile on his face and he goes, “That’s exactly it.” I think trying to get to the emotion that they’re trying to express kind of helps to stop the train going out of the station.

Alan:                            51:39               That’s so interesting that, in a way, the way to stop a compulsive talker is to listen a little more deeply.

Helen:                          51:45               Exactly. It’s sort of like one of those paradoxes.

Alan:                            51:48               Yeah. Is there anyone for whom you just can’t feel empathy?

Helen:                          51:57               Even people that we all know about in our world who seem to lack it totally and don’t elicit much empathy, I feel really sad to not know the experience of the richness of empathy. I would say I really can’t think of anybody. I am very challenged with people that have destroyed others and committed horrible acts of cruelty. I can only imagine that living in that brain cannot be a good experience.

Alan:                            52:38               Certainly not good for others, and it’s hard to feel empathy, I guess, but.

Helen:                          52:42               Very hard.

Alan:                            52:44               How do you like to deliver bad news? In person? On the Phone? Or my carrier pigeon?

Helen:                          52:54               In person.

Alan:                            52:55               You really like it?

Helen:                          52:57               I just feel like if you don’t see the whole reaction, you can get so off base and really end up botching it.

Alan:                            53:07               What, if anything, would make you end a friendship?

Helen:                          53:16               I think friendship is based on love and reciprocity. The boundaries of that can be quite stretched. But when they get stretched to the point of being broken where you realize someone really does not have your best interest at heart and it’s not in any way a reciprocal relationship, I think that really can break a friendship.

Alan:                            53:44               This has been so much fun for me. I really, really love talking to you.

Helen:                          53:44               It’s been great for me, too. Thank you.

This has been Clear + Vivid, at least I hope so.


My thanks the sponsors of this episode. All the income from the ads you hear go to the Center for Communicating Science at Stony Brook University. Just by listening to this podcast, you’re contributing to the better communication of science. So, thank you.



Dr. Helen Riess DOESN’T JUST TRAIN DOCTORS TO HAVE MORE EMPATHY. SHE’S INTERESTED IN HELPING THE REST OF US, TOO. HELEN is the author of a new book called “The Empathy Effect: 7 Neuroscience Based Keys for Transforming the Way We Live, Love Work and Connect Across Differences.” I think it’s a really useful book – and I was happy to join in when Helen asked me to write the foreword.


The Empathy Effect was largely inspired by Helen’s work as the Chief Scientist for Empathetics, which is a highly innovative training program in empathy and other interpersonal skills. She helped develop the program as a researcher at Mass General Hospital. You can learn all about Empathetics and Helen’s new book at: Empathetics.com


This episode was produced by Graham Chedd with help from our associate producer, Sarah Chase. Our sound engineer is Dan Dzula, our Tech Guru is Allison Coston, our publicist is Sarah Hill.


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Thanks for listening. Bye bye!