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Conceptualising and Measuring Empathy

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DOI: 10.1093/bjsw/bcq048

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British Journal of Social Work (2010) 40, 2326–2343
doi:10.1093/bjsw/bcq048
Advance Access publication March 31, 2010

Conceptualising and Measuring

Empathy
Karen E. Gerdes *, Elizabeth A. Segal, and Cynthia A. Lietz

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Karen E. Gerdes is an Associate Professor in the School of Social Work at Arizona State
University. Elizabeth A. Segal is a Professor in the School of Social Work at Arizona State
University. Cynthia A. Lietz is an Assistant Professor in the School of Social Work at
Arizona State University.

*Correspondence to Dr Karen E. Gerdes, 411 North Central Avenue, Suite 800, Phoenix, AZ
85022, USA

Abstract
The purpose of this article is to briefly review the most influential existing literature on
conceptualizing and measuring empathy. In addition, we consider a second, highly
salient body of literature emerging from the relatively new field of social cognitive
neuroscience, which uses brain imaging to help identify the physiological components
of emotional and cognitive processes. We believe that social cognitive neuroscience
can assist social work in clarifying concrete, consistent ways of defining and measuring
empathy as a neurological phenomenon. Finally, we assess some of the most recent
social work-related empirical intervention-based research on empathy. Combining all
these research traditions leads to a compelling possibility: a unified, consistent, and
robust way to define and measure the empathic responses that help form the foun-
dation of just and beneficent social structures.

Keywords: Empathy, affect sharing, black and ethnic minority, perspective taking,
measurement

Accepted: February 2010

Introduction
The idea that empathy is essential for effective social work practice is
commonly accepted within the profession (Shulman, 2009; Hepworth et al.,
2009). Despite the significance of empathy to social work and related
fields, there is a long history of dissimilar and often vague definitions of
empathy in the literature. Some consider empathy a dispositional trait or
ability (Hoffman, 1982). Other researchers see empathy as a situation-

# The Author 2010. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.
 Conceptualising and Measuring Empathy 2327

specific cognitive – affective state (Duan and Hill, 1996). Still others define
empathy as a multi-stage interpersonal process (Reik, 1948; Rogers, 1975).
In addition to a multitude of definitions, different researchers have
employed a host of disparate ways to measure empathy (Pederson, 2009).
A review of the literature pertaining to empathy reveals that as a result of
these inconsistencies, conceptualisations and measurement techniques for
empathy vary so widely that it is difficult to engage in meaningful compari-
sons or make significant conclusions about how we define and measure
this key component of human behaviour—necessary steps if social work
practitioners are to cultivate empathy in ourselves and others (Pithers, 1999).

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The purpose of this article is to briefly review the most influential existing
literature on conceptualising and measuring empathy. In addition, we consider
a second, highly salient body of literature emerging from the relatively new
field of social cognitive neuroscience, which uses brain imaging to help identify
the physiological components of emotional and cognitive processes. We
believe that social cognitive neuroscience can assist social work in clarifying
concrete, consistent ways of defining and measuring empathy as a neurological
phenomenon. Finally, we assess some of the most recent social work-related
empirical intervention-based research on empathy. Combining all these
research traditions leads to a compelling possibility: a unified, consistent
and robust way to define and measure the empathic responses that help
form the foundation of just and beneficent social structures.

A historical review of the conceptualisations of empathy

Raines (1990) describes Mary Richmond’s (1917) Social Diagnosis as ‘a
masterpiece of empathic inquiry’ (p. 57). Richmond’s description of
social-work-in-action is pervaded with the assumption that social workers
behave empathically. The same could be said of Charlotte Towle’s
Common Human Needs (1945). However, empathy seems to have been
assumed as a constant in these models, rather than defined as an identifiable
phenomenon to be measured or enhanced. Furthermore, there is little evi-
dence in the empirical literature that Richmond’s or Towle’s emphasis on
empathy was explicitly articulated.
Through the 1940s and 1950s, the conceptualisation of empathy was
heavily influenced by Freudian-trained psychoanalysts, particularly the
Austrian-born Heinz Kohut (1959) and Theodor Reik (1948). Reik’s
(1948) comment that ‘the word empathy sometimes means one thing, some-
times means another, until now it does not mean anything’ (Reik, 1948,
p. 357) reflected the lack of a consensus about a precise and operational
definition of empathy. To Kohut (1959), empathy was:
. . . vicarious introspection [or] . . . the capacity to think and feel oneself into
the inner life of another person. It is our lifelong ability to experience what
2328 Karen E. Gerdes et al.

another person experiences, though, usually and appropriately, to an atte-

nuated degree (Kohut, 1959, p. 82).

Kohut’s description expanded on the first conceptualisation of empathy as a

strictly emotional response (Titchener, 1909) by adding an element of cog-
nition. However, Kohut’s definition nor any that preceded it did not help
researchers to precisely articulate, measure, enhance or in other ways oper-
ationalise the phenomenon of empathy.

The Carl Rogers effect

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During an extended period in the mid-twentieth century, the views of the
influential psychologist Carl Rogers dominated the conceptualisation of
empathy in social work. Corcoran (1982), citing Hackney (1978), pointed
out that between 1957 and 1967, there were twenty-one different definitions
of empathy offered in the social work literature. Most were derived from
Rogers’ (1957) definition of empathy as the therapist’s ability ‘to sense
the client’s private world as if it were your own, but without ever losing
the “as if” quality’ (Rogers, 1957, p. 99). (This definition is a foreshadowing
of the identification that self – other awareness plays a critical role in
empathy—a point to be discussed later in this article.)
Carkhuff (1969) diverged from Rogers’ model, arguing that empathy was
not an ambient interpersonal process, but a specific skill. Beginning in the
1970s, much of the social work empathy-related literature shows wide-
spread acceptance of Carkhuff’s (1969) perspective, in which empathy
was seen as a ‘facilitative communication skill’ (Corcoran, 1982, p. 63).
This definition sounded more proactive and measurable than Rogers’
concept of ‘sensing private worlds’ but, in practice, was also prone to vague-
ness and resistant to objective measurement. Carkhuff’s work is in many
ways the foundation for many of the dyad communication skills taught in
social work education today. Later in the paper, we briefly describe a sub-
jective observational rating scale that Carkhuff created.

The influence of social and developmental psychology

During the 1980s and 1990s, social and developmental psychologists, such as
C. Daniel Batson, Martin Hoffman and Nancy Eisenberg, strongly influenced
the empathy dialogue. The literature from this period reveals a broad assump-
tion that empathy is one individual feeling the inner experience of another.
This perspective suggested empathy has two major components: (i) the phys-
iological experience of feeling what another person is feeling (Batson, 1987),
often referred to as ‘motor mimicry’; and (ii) the cognitive processing of these
feelings (Hoffman, 2000). In addition, Batson et al. (1997) clarified the role of
the cognitive skill ‘self–other awareness’ in the empathic experience. By
 Conceptualising and Measuring Empathy 2329

contrast, Eisenberg et al. (1994) and Gross (1998) connected the importance
of the cognitive skill of emotion regulation to empathic accuracy.
Cognitive processing includes rational analysis of one’s own empathy,
and is necessary for intellectual practices such as perspective taking, role
taking, conditioning and social learning. Hoffman’s (1984) model of
empathy views empathy as progressing along a developmental continuum:
infants mimic emotion through physical mirroring, with virtually no cogni-
tive processing. Later, they gradually develop the ability to take on other
roles and imagine the feelings of others. If development is normal and suc-
cessful, the ‘cognitive processing’ facet of empathy eventually emerges.

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Levenson and Ruef (1992) identified three different qualities of empathy in
the literature: (i) knowing (cognitive) what a person is feeling (e.g. Ickes et al.,
1990); (ii) feeling (affective) what another person is feeling (e.g. Mehrabian
and Epstein, 1972); and (iii) responding compassionately to another
person’s distress (e.g. Coke et al., 1978). The first two are subjective qualities,
which are notoriously hard to measure, while the third—compassionate
action—can be objectively observed. All three, however, facilitate empathic
accuracy or ‘the ability to detect accurately the emotional information trans-
mitted by another person’ (Levenson and Ruef, 1992, p. 234). The Social Work
Dictionary incorporates these ideas, defining empathy as ‘the act of perceiv-
ing, understanding, experiencing, and responding to the emotional state and
ideas of another person’ (Barker, 2008, p. 141).

Self-awareness

Batson et al. (1997) highlighted the empathy debate between social psychol-
ogists and others over the relative importance of ‘self – other merging’ and
‘self – other distinctiveness’ or awareness. Hornstein (1978) and Lerner
(1980), among others, argued that self – other merging increases empathy
because of the confusion it creates between self and other, which yields
an empathically accurate ‘mutual identification’. On the other hand,
Hoffman (1975) and, more recently, de Waal (1996) argued that self –
other distinctiveness is critical to empathy, because it allows one to recog-
nise the particularity and uniqueness of the other. Wispe (1986) argued that
‘the attempt by one self-aware self to comprehend unjudgmentally the
positive and negative experiences of another self’ (Wispe, 1986, p. 318) is
essential to empathic accuracy. Batson et al. (1997) own research supported
the self – other awareness or distinctiveness hypothesis.

Emotion regulation

The independent research domain of emotion regulation was the last and
most recent psychological construct of the twentieth century to be
2330 Karen E. Gerdes et al.

connected to empathy and the concept of empathic accuracy. Gross (1998)

defined emotion regulation as the ‘process by which individuals influence
which emotions they have, when they have them, and how they experience
and express these emotions’ (Gross, 1998, p. 275). The underlying assump-
tion is that people who can control their emotions are less likely to be over-
whelmed by another person’s distress or by the emotional contagion aspect
of affective sharing. An overly emotional reaction can lead to one’s own
distress and away from an empathic response (Hoffman, 1977).

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Cross-cultural empathic accuracy

Recent research in the field of psychology provides strong support for the
cultural equivalency theory of emotion recognition or affective sharing
(Soto and Levenson, 2009). In short, this model suggests we evolved to
be equally accurate in recognising emotions in others, regardless of
culture, race or ethnicity. The underlying assumption of this model is that
the ability to accurately perceive, interpret and respond to the emotional
signals of others is necessary for our survival (Preston and de Waal, 2002).
Attachment theory informs us that nurture also plays a critical role in the
development of empathy (Masur, 2009). However, attachment theory and its
implications are also recognizably the same across cultures (van Ijzendoorn
and Sagi, 1999). The cultural equivalence model does little to help us under-
stand the cross-cultural context for the cognitive aspects of empathy—a very
important discussion that is beyond the scope of this article.
In sum, there seems to be a growing level of agreement in the social
science literature regarding the importance of empathic accuracy, and the
belief that empathy includes both an automatic physiological reaction
(affective sharing) and the cognitive process of perspective taking
(Spreng et al., 2009; Jolliffe and Farrington, 2006; Lawrence et al., 2004;
Duan and Hill, 1996; Ickes et al., 1990). Some authors have suggested
that other cognitive skills such as self-awareness (Corcoran, 1982; Wispe,
1986; Batson et al., 1997) and emotion regulation (Eisenberg et al., 1994;
Gross, 1998) are also critical to the experience of empathy.

The neurobiology of empathy

During the mid 1990s and 2000s, the investigation of empathy expanded to
include research on the neurobiology of empathy. A pivotal breakthrough
occurred one day in 1992, when three researchers in Parma, Italy, decided
to have lunch in the lab where they were studying the firing of motor
neurons in laboratory monkeys (Iacoboni, 2008). The researchers were
startled to observe that when the animals watched the humans eat, the
 Conceptualising and Measuring Empathy 2331

monkeys’ brains showed the same neural activity. From a neurological

perspective, it looked as though the monkeys, too, were eating.
This incident sparked a new era of research on how the human brain rep-
resents, recognises and reacts to the internal mental states of others. Break-
throughs have come in fields such as neuroscience (e.g. Gallese et al., 1996)
and social cognitive neuroscience (e.g. Decety and Moriguchi, 2007), as well
as within the inter-disciplinary world of ethology, biology and ecological
neuroscience (e.g. Preston and de Waal, 2002).
The Italian researchers had discovered ‘mirror neurons’—nerve cells that
allow humans (and other animals) to understand others’ experiences by under-

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going a kind of involuntary neurological ‘echo’ while observing one another’s
behaviour (Rizzolatti and Craighero, 2004; Iacoboni, 2008). The discipline
that focuses on such brain processes—social cognitive neuroscience—has
become a rich source of new questions and answers for a wide range social
science research, and is especially powerful in examining empathy.

A social cognitive neuroscience approach to empathy

Because of recent technological breakthroughs, scientists in the early years

of the new millennium have made huge strides toward understanding many
aspects of the brain, including its orchestration of emotions and human
interactions. In 2004, two social cognitive neuroscientists named Jean
Decety and Philip Jackson set out to combine the concept of empathy as
specific, observable brain activity with existing social science literature on
empathy. Decety and Jackson surveyed the numerous definitions and con-
ceptualisations of empathy found in the work of psychoanalysts (Freud,
1921; Reik, 1948; Kohut, 1959), humanistic therapists (Rogers, 1957), psy-
chologists (Davis, 1983) and social and developmental psychologists
(Batson, 1987; Ickes, 1997; Hoffman, 2000). They began comparing these
articulations of empathy with objectively observable brain phenomena.
As a result, they were able to identify the neural mechanisms that
mediate empathy in the brain (Rameson and Lieberman, 2009).
Combining cumulative, qualitative descriptions of empathy from the
social sciences with the new findings in social cognitive neuroscience,
Decety and Moriguchi (2007) ultimately defined empathy as the interaction
of four physically observable neural networks that include ‘both automatic
affective experience and controlled cognitive processing . . . [they are] dis-
tinct but interrelated processes that may be instantiated differently in the
brain’ (Rameson and Lieberman, 2009, p. 95). The four components of
empathy identified by Decety and Moriguchi (2007, p. 4) are as follows:
(1) Affective sharing: This refers to the subjective ‘reflection’ of another
person’s observable experience (e.g. feeling amused when someone
else laughs or sad upon seeing another person cry). This is based on
2332 Karen E. Gerdes et al.

automatic neural mirroring and the ‘shared representations’ such as facial

expressions or activities associated with feeling.
(2) Self-awareness: Mirroring alone can be so powerful that it effectively
erases the perceived boundary between self and other. Self-awareness
implies that the empathic person clearly differentiates between his/her
experience and that of the person being observed.
(3) Mental flexibility and perspective taking: This refers to the cognitive
ability to learn about the situations affecting others, and to effectively
imagine what it would be like to experience the world from the other’s

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position. It requires abstract thought, calculation and applied knowledge.
(4) Emotion regulation: This refers to the empathic person’s ability to ‘turn
down the volume’ of his/her own feelings as they arise from mirroring
another’s experience. Inability to regulate emotion can interfere with
compassionate action (e.g. by creating overwhelm and burnout for indi-
viduals in helping or caretaking social roles).
Current research in social cognitive neuroscience suggests all four of these
neural networks must be activated for a human to have a complete experi-
ence of empathy. If any of the components are missing or inhibited, subjects
may have a partial empathic reaction (e.g. wincing when someone else feels
pain) but not a truly empathic response (e.g. reacting to the ‘empathic
wince’ as a personally uncomfortable experience, but failing to logically
imagine what the other person is subjectively experiencing). The findings
of social cognitive neuroscientists and researchers from other related disci-
plines are reminiscent of Kohut’s description of ‘vicarious introspection’.
Social cognitive neuroscientists have given new meaning to Kohut’s
description by showing that our brains are hardwired to provide an inner
simulation of other people’s feelings, thoughts and experiences (Iacoboni,
2008). We have known for some time that empathy is a complex, multidi-
mensional construct, but we have not seen it explicated in this way before.

The human mirror neuron system and mental state attribution: a

foundation for empathic accuracy

Even for most academics, reading the brain studies from the social cognitive
neuroscience literature is a daunting task because of the technical medical
and neuro-anatomy language. However, the profession’s conceptualisation
of empathy and how we measure it could be more clear and consistent if we
are able to incorporate the new neuroscientific findings. Indeed, research-
ers approaching the concept of empathy from a neurological standpoint
have already made observations that could be easily incorporated into
every social science discipline. The existing views of empathy in social
work could utilise this research both to answer some basic questions and
to serve as a foundation for extensive future research.
 Conceptualising and Measuring Empathy 2333

For example, in a 2009 study, Zaki et al. used fMRI imaging to see what
was happening in the brains of individuals as they watched videos of other
people describing highly emotional events in their own lives. These
viewers were also asked to rate what they thought the interview subjects
were feeling as they told their stories. The researchers found heightened
activity in two specific areas of the brain—one that ‘mirrored’ the storytel-
lers being watched on videotape and another that appeared to be respon-
sible for cognitively processing and articulating a description of the
storytellers’ feelings. This brain activity was found to be correlated with
the subjective feelings of the video viewers. To determine whether they

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were truly experiencing empathy, rather than simple projection, the
viewers’ impressions of the storytellers’ emotions was compared to the
self-reports of the people who were interviewed (they were asked to
watch their own videotaped performances and report what emotions
they had felt as they told the stories).
This was one of the first studies that cross-checked and internally vali-
dated three different phenomena: the subjective experience of people
telling an emotional autobiographical story; the empathic response of
people watching the storytellers; and the brain activity of the story
viewers. By comparing all three, Zaki et al. were able to confirm a statisti-
cally significant correlation between phenomenological empathy, empathic
accuracy and brain activity in specific areas of the brain. This study suggests
that brain activity can be used as an empirical measure of affective sharing
and cognitive processing, and that ‘accurate’ empathy may be physically
differentiated from projection or other emotional reactions.
Though this is technical work, requiring the skills of neuroanatomists and
fMRI operators, as well as social scientists, such a valuable trove of evidence
is certainly worth bridging the gap between disciplines, allowing social work
theorists to form more valid, robust and empirical models of empathy.

The measurement of empathy

Numerous authors have commented on or critiqued the empathy measures

that have been developed over the past forty years (see Eisenberg and
Lennon, 1983; Wispe, 1986; Pederson, 2009). Over time, their conclusions
have remained remarkably similar; analysts have noted that the ambiguity
of the term ‘empathy’ has led to the use of indefinite and inconsistent
measures (Wispe, 1986). Disparate measures make meaningful compari-
sons difficult (Pithers, 1999). Most measures are narrow in scope and, as
a result, are limited in their ability to provide valid and reliable data
(Levenson and Ruef, 1992). These comments and conclusions beg the ques-
tion: How do we know if any operationalisation technique or measure is
really measuring empathy—and, if so, which does the job most effectively?
Several authors have argued that many empathy instruments are actually
2334 Karen E. Gerdes et al.

measuring sympathy (Wispe, 1986; Eisenberg and Strayer, 1987). The con-
clusion is virtually unanimous that construct validity requires an agreed
upon definition and consistent measurement procedures that have not yet
been achieved (Wispe, 1986).
The purpose of our review of the measurement literature is not to repeat,
summarise or dispute the findings of any of the above-named authors. It is
designed to (i) describe how the measurement literature has paralleled the
conceptualisation literature; (ii) review some of the most recent empirical
social work research on empathy that has not been included in past
reviews; and (iii) evaluate whether the measures that have been developed

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incorporate or include the four components of empathy identified by
Decety and Moriguchi (2007) (i.e. affect sharing, mental flexibility and
perspective taking, self-awareness and emotion regulation).

Parallels between the conceptualisation and operationalisation of

empathy

Just as we identified a wide variety of definitions of empathy in the litera-

ture, we likewise found a set of diverse measures. When reviewing the lit-
erature for measures of empathy, we located self-report measures that
address only the emotional component of empathy (Spreng et al., 2009),
as well as self-report measures that address only the cognitive component
(Hogan, 1969). The most widely used self-report measure in the literature
over the last twenty years (i.e. the Interpersonal Reactivity Index or IRI)
purportedly includes both affective and cognitive components (Davis,
1980, 1983).

Self-report measures of empathy

Likert-type, self-report measures are by far the most typical instrument

used in empathy research. Perhaps this is due to the fact that they are logis-
tically and economically expedient. However, because they are based on
self-assessment, they usually tell us very little about empathic accuracy.
Self-report findings are more useful when validated through triangulation
or comparison methods. For example, self-report data can be evaluated
in conjunction with the accuracy of responses to video assessments, vign-
ettes or actual behaviour that force an explicit judgement about a focal
person or situation (Tamburrino, 1993). Alternatively, the researcher can
use self-report measures to examine empathy agreement, as was the case
with Cliffordson (2001). She used the IRI and a global-item measure to
examine empathy agreement between parents’ judgements of self and stu-
dents’ judgements of their parents.
 Conceptualising and Measuring Empathy 2335

Using observation to measure empathy

Observation measures are based on reports of verbal and non-verbal beha-

viours of the target or focal person. The reports can be qualitative statements
(Long et al., 2006) or subjective ratings (Moran and Diamond, 2007). The
Carkhuff Empathy Scale (Carkhuff, 1969) and the Barrett-Lennard Relation-
ship Inventory/Empathy Understanding Subscale (EUS) (Barrett-Lennard,
1962) are both derived from the early work of Carl Rogers. The five-level Car-
khuff scale and the sixteen-item EUS have primarily been used by clients to
rate their therapists’ empathic understanding or accuracy during the thera-

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peutic process. The use of these measures has helped therapists to realise
they often overrate their empathic abilities (Kurtz and Grummon, 1972).
This may be due to the fact that both scales represent professional views
of empathy and were created without any input from clients’ perspectives
(Reynolds et al., 1999). (Clients almost certainly have valuable insights that
contribute to our understanding of empathic understanding and communi-
cation; omitting their perspective can itself be seen as a failure of empathy.)
The Carkhuff scale was frequently used in the social work literature during
the 1970s and 1980s (Goldstein and Michaels, 1985). It continues to be used
less frequently today (e.g. Nerdrum, 1997).

Physiological measures of empathy

Studies that utilise physiological measurement of empathy are less common

in the literature (Ickes et al., 1990). This is most likely due to the fact that
they require more resources and the logistics are more complicated than
self-report and observation methods. For example, participants in Leven-
son and Ruef’s (1992) physiological study of empathy were asked to com-
plete a modified version of the Questionnaire Measure of Emotional
Empathy (QMEE) (Mehrabian and Epstein, 1972) and the Empathy sub-
scale from the California Personality Inventory (Gough, 1978). In addition,
while watching a video interaction of a married couple, participants’ heart
rate, skin conductance, general somatic activity, pulse transmission time to
finger and finger pulse amplitude were monitored second by second using
various electrodes and other electromechanical equipment. The couples
in the video had also been physiologically monitored.
Finally, the participants watched the video a second time using a joystick
to record the level of negative and positive affect they were feeling while
watching. The findings support a physiological substrate for emotional
empathy. There was a high correlation between the physiological signs
and ratings of positive and negative affect between the observers and the
observed. However, there was no significant correlation between the phys-
iological indicators, the affect ratings and the self-report measures of
empathy.
2336 Karen E. Gerdes et al.

Table 1 Empathy-related intervention research measures

Clinical intervention Sample Empathy measure Authors

Psychoanalytic approach A three-year-old Therapist’s observation Hart, 2008

Short-term filial therapy Thirty-three German Parents ranked several items Grskovic and
mothers related to empathy using a Goetze,
five-point scale (1 ¼ no 2008
change; 5 ¼ great change)
Filial therapy One Jamaican mother Qualitative assessment Edwards
et al., 2007
Attachment-based family Thirteen parents and Therapist Behavior Rating Moran and
therapy their adolescent chil- Scale (TBRS-3), an Diamond,

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dren diagnosed with observer-based instrument 2007
depression (Diamond et al., 2007)
Education/training
Six-week empathy train- Sixteen volunteer, Qualitative assessment of Long et al.,
ing programme married couples videotaped interviews 2006
Conflict mediation Sixty-three pairs of Batson’s eight-item Empathy Welton et al.,
disputants Scale (Coke et al., 1978) 2008
and Long and Andrews
(1990) thirteen-item Self
Dyadic Perspective Taking
Scale
Family Nurturing Program 781 participants at risk The ten-item empathy sub- Palusci et al.,
(a parent education for abusing their scale of the Adult Adoles- 2008
programme) children cent Parenting Inventory,
AAPI-2 (Bavolek and
Keene, 2001)
School-based programme
Education and Commu- Forty sixth graders in Eighteen of the twenty-two Lakin and
nity Service Program treatment; twenty in items from the Index of Mahoney,
control Empathy for Children and 2006
Adolescents (IECA)
(Bryant, 1982)

In a more recent study, Marci et al. (2007) studied the correlation between
skin concordance in client – therapist dyads and client perception of thera-
pist’s empathy. Their results indicated there was a positive correlation
(r ¼ 0.47, p ¼ 0.03) between skin concordance and perceived therapist
empathy. During moments of high correlation in skin concordance, partici-
pants also reported more positive social– emotional interactions. Both of
these studies required lengthy and often tedious processes that are not prac-
tical in an everyday setting. However, these methods could be used to help
identify and validate the most accurate measures of self-report.

A review of recent empirical social work-related studies on

empathy
Using two databases, PsychInfo and Social Service Abstracts, we searched
for recent (2005 – 10) intervention-based studies on empathy. Intervention-
 Conceptualising and Measuring Empathy 2337

based research is designed to cultivate and increase empathy in client popu-

lations (see Table 1). For a recent review of therapists’ empathy studies, see
Gerdes and Segal (2010). The articles in our current review included
research from social work, mental health, counselling and the general psy-
chology literature.
Most of the authors we reviewed still relied on definitions of empathy
that were over a decade old—sometimes two decades (e.g. Davis, 1983;
Bryant, 1987; Long and Andrews, 1990; Batson et al., 1991; Perry and
Orchard, 1992; Marshall et al., 1995; Hoffman, 2000). Not surprisingly,
the conceptualisations of empathy and the measures used in the recent

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social work literature were as varied and inconsistent as in earlier
reviews. Unexpectedly, several of the intervention articles we reviewed
(e.g. Moran and Diamond, 2007; Sprinkle, 2008) did not include any defi-
nition or conceptualisation of empathy at all—evidence that some prac-
titioners assume all readers would know and agree about what empathy
actually is.
The intervention research includes discussions of clinical interventions
such as filial therapy (e.g. Edwards et al., 2007; Grskovic and Goetze,
2008) and attachment-based family therapy (Moran and Diamond, 2007).
The cultivation of client empathy is assumed to be a natural outcome of
the therapeutic process. There are also empathy training or education pro-
grammes (e.g. Palusci et al., 2008) that utilise specific curricula and activities
designed specifically to increase client empathy.
There was a passing reference to recent neuroscience in one of the
articles we reviewed. Hart (2008) made brief mention of mirror neurons
in her psychoanalytic intervention case study of a dissociated three-year-old
child. However, this isolated case study did not include a full conceptualis-
ation of empathy as a neurological function. The subset of social work lit-
erature that deals with empathy is perhaps most developed in research on
sex offenders.
Finally—and unsurprisingly—our recent literature review revealed that
there is still no consensus in the current social work research about how
to measure empathy. As illustrated in Table 1, researchers have used a
wide variety of measurement techniques, from qualitative assessments
based on interviews (Edwards et al., 2007) to observational methods
(Diamond et al., 2007) to standardised self-report instruments such as the
ten-item parental empathy subscale on the Adult Adolescent Parenting
Interview (AAPI-2) (Bavolek and Keene, 2001) and the Index of
Empathy for Children and Adolescents (IECA) (Bryant, 1982).
While the findings of some of the studies in Table 1 are important and
encouraging, there are serious limitations. Most are not generalisable due
to small sample sizes. The data were collected through procedures that
often did not establish the reliability or validity of the data. And, as we
stated previously, the studies do not utilise consistent definitions or concep-
tualisations of empathy. The use of disparate measurement techniques
2338 Karen E. Gerdes et al.

makes comparisons difficult. While we have made some progress—a

growing consensus that empathy is an automatic affective reaction and a
cluster of cognitive abilities—the current literature is as plagued with defi-
nitional and measurement problems as the literature from twenty years ago.

Measurement in a social cognitive neuroscience context

None of the studies we reviewed measured empathy with methods that

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combined inter-disciplinary social-science research and findings from
social cognitive neuroscience. In other words, we could not identify even
one measure that included all four components from Decety and col-
leagues’ review of the empathy literature (affect sharing, mental flexibility
or perspective taking, self-awareness and emotion regulation).
As an applied profession that seeks to understand psychological, cogni-
tive and physical aspects of human interaction, social work is uniquely posi-
tioned to blend social science perspectives of empathy with findings from
neuroscience. Of course, not every social worker needs training in neurol-
ogy, but theorists who establish the field’s prevailing view of empathy
should indeed team up with neuroscientists to marry the perspectives of
‘soft’ and ‘hard’ science on this subject. If social work as a discipline can
agree on a conceptualisation of empathy as uniform, consistent and testable
as that proposed by Decety and Moriguchi (2007), and develop a measure
based on rigorous analysis that combines the social and neurological
sciences, the benefits could be invaluable to social work as a discipline—
and thus, perhaps, to society itself.
The existing literature on empathy, from both social work and neuro-
science, has convinced the present authors that social workers need a reliable
and valid self-report measure of empathy that incorporates neurological find-
ings, but is more accessible to behavioural professionals at all levels. This
measure would include all four components of empathy that are known to
be neurologically disparate: affective sharing, mental flexibility, self-
awareness and emotion regulation. It would be created using neuroscience
to verify accuracy, but would be less expensive and labour-intensive than a
full neurological workup. Not every social worker has access to an fMRI
machine—but those of us who do can use the full spectrum of available
data to create a measure of empathy with more accuracy than existing
instruments, but less cost and logistical complexity than an fMRI.
We believe the best initial approach is a self-report instrument; each item
could be tested and validated by correlating phenomenological observation,
self-report responses and specific brain activity. The study by Zaki et al.
(2009) has shown this kind of triangulation to be possible and to yield stat-
istically significant findings. Utilising it to create an inexpensive but accu-
rate instrument for recording and measuring empathy would utilise
 Conceptualising and Measuring Empathy 2339

existing research parameters in a way that could enrich social work in both
theory and practice.
The self-report measure we have proposed could assess our clients’
strengths and target empathy interventions in areas that need development.
It could yield methods of evaluating, quantifying and increasing empathy
that would potentially benefit both social workers in the field and clients.
Social work would be well served by embracing a clarity and consistency
in both the conceptualisation and measurement of empathy. These tasks
should be at the forefront of social work research over the next decade.
As a final point, the ethical use of a self-report or standardised empathy

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measure is also of critical importance to us. We would not recommend the
practice of using an empathy score as an admission criterion to a school of
social work or as an isolated tool leading to decision making in practice.
Such decisions should be informed by a broad assessment of one’s function-
ing, not based on one instrument, even one that is standardised. Addition-
ally, conceptualisations of empathy discussed in this article suggest empathy
can be developed over time. Although we suggest measuring empathy at
one point in time, that should not be the only criterion to inform decision
making; a standardised tool can be used to measure empathy before and
after interventions or educational experiences. This would allow research-
ers and practitioners to evaluate the effects of strategies used to cultivate
affective and cognitive empathic abilities.

Conclusion
Definitions of empathy have been semantically vague or confusing. As a
result, conceptualisations and measurement techniques for empathy vary
greatly from study to study—so much so that it has been difficult to
engage in meaningful comparisons or make significant conclusions about
how we define and measure empathy. Now, social cognitive neuroscientists
have succeeded in observing the neural networks that comprise empathy.
Social work can and should be at the forefront of developing a consistent
definition of empathy and creating measures that capture all four com-
ponents and the element of empathic accuracy.

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