The Meaning and Importance of Victim Empathy
CONSIDER IT FROM THE MEDICAL BOARD’S POINT OF VIEW:
Dr. Jones has admitted having sex with a patient, but insists she was a willing partner. According to him, the patient is bringing charges simply because she is upset that he ended the relationship. He understands he broke the rules. And he accepts the suspension of his license. In fact, he says, it has helped him realize just how serious his mistake was. He tells the board he has learned his lesson. He will never offend again. He’s ready to return to work.
SHOULD THE BOARD BELIEVE HIM?
In such cases, boards often turn to professional evaluators like Peter Graham, co-founder of Acumen Assessments and the Acumen Institute. Graham and his colleagues evaluate professionals’ fitness to practice and make recommendations to boards. There are times when Graham recommends that someone be allowed to return to work immediately. Other times, he urges boards to revoke a doctor’s license. More commonly, though, he recommends something in between. Often he suggests people complete a rehabilitation program before having their license reinstated (with or without conditions).
Graham says that victim empathy is an important factor in his evaluations. “One of the things we’re looking at is whether or not the person even considers the victim to be a victim,” he explains. Many boundary violators insist that no one has been hurt by their actions. Some even see themselves as the real victim. Rather than face up to the harm they’ve caused another person, the most they will take responsibility for is violating a rule. That’s a far cry from acknowledging that they have violated a vulnerable patient.
IT’S NOT ABOUT BREAKING A RULE.
Swearing not to break the rules again works about as well for a physician as it does for a 10-year old caught hitting a classmate. And for the same reason: good intentions are simply not enough. If everyone who intended to obey the rules of the road followed through, there would be no need for traffic tickets. If everyone who honestly believed they would remain law-abiding citizens kept their word, the courts would be far less crowded.
“Most of our clients are intellectually able to learn the rules of conduct and professional boundaries, and to understand their obligations to stay within them,” explains Graham, “but the issue is whether or not they are going to follow up that intellectual understanding with a change in attitude.”
Without a change in attitude, it takes constant effort to be obedient. And that effort is all too likely to flag as pressures mount. No matter how determined we are to obey the speed limit, we are likely to lose our resolve when we’re late for an appointment.
When our good behavior springs from our deepest feelings, however, we have much more control. You are far more likely to follow the rules of the road if you are genuinely afraid of injuring someone. Once you know what it’s like to hit a pedestrian, you are going to be a lot more careful at crosswalks.
The same holds true for physicians or nurses. That’s why rehabilitation programs do all they can to help violators recognize the real pain they have caused. “Violators need to develop the capacity to be thoughtful about the other person as a subjective human being, with their own needs and their own emotional experience,” says Graham. “Not just being able to tell a story about the narrow experience of how a patient was victimized, it’s being able to imagine someone else’s internal experience. It’s being interested in that and making it a part of the way they work.”
Imagination plays an important role. “If you’re not in touch with the patient after an incident, you often don’t know what specific harm you’ve done,” says Stephen Schenthal, founder and CEO of Professional Boundaries, Inc. “But it’s important to acknowledge that you have inflicted serious harm.”
The harm can take many forms. Some victims blame themselves and suffer terrible shame and guilt. Others neglect their own health rather than trust another provider. Those who have been abused before are re-traumatized. Some even commit suicide.
It doesn’t matter whether or not the violator knows the exact nature of the harm they have done. What does matter is that they understand how they would feel if they were the victim. Only someone who can imagine the pain they have caused can be trusted to avoid causing it again.
So Dr. Jones has some work to do before the board will agree to restore his license. It’s not enough for him to swear he has learned his lesson. He has to convince the board that he fully grasps the harm he has done, feels genuine remorse, and never wants to do such harm again.