Episode 20: Partners in Pain (Part II) - Empathy as a Skill Set

Mastering Empathy to Support Partners in Chronic Pain

In this episode of Mind Your Body, Dr. Zev Nevo delves into the practice of empathy as a learnable skill, not just an inherent trait, particularly in the context of supporting partners suffering from chronic pain. Dr. Nevo outlines Brene Brown’s four attributes of empathy: perspective taking, staying out of judgment, recognizing emotion, and communicating understanding. He contrasts cognitive empathy, which promotes sustainable compassion and genuine connection, with affective empathy that may lead to burnout and enmeshment. He also discusses practical strategies for caregivers, emphasizing the importance of regulating one's own nervous system to effectively co-regulate their partner's. The episode provides actionable advice on maintaining balanced compassion without drowning in empathy fatigue, setting the stage for the upcoming part three on Compassion Plus Boundaries.

00:00 Introduction: Empathy as a Learnable Skill

00:40 Recap of Part One: The Invisible Burden

01:24 Understanding Empathy: Brene Brown's Framework

03:36 Attribute 1: Perspective Taking

04:32 Attribute 2: Staying Out of Judgment

05:35 Attribute 3: Recognizing Emotion

06:57 Attribute 4: Communicating Understanding

09:40 The Critical Distinction: Cognitive Empathy vs. Enmeshment

12:48 Polyvagal Theory: Co-Regulation and Emotional Intuition

15:31 Practical Strategies for Partners

21:33 Conclusion: Sustaining Empathy Long-Term

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 20 | Partners in Pain (Part II) - Empathy as a Skill Set

[00:00:00] What if I told you that empathy isn't something you either have or don't have, that it's not a personality trait you're born with, but a skill you can learn and practice. What if the key to supporting someone through chronic pain isn't about saying the perfect thing or fixing their symptoms, but about mastering four specific attributes that create genuine connection. Welcome back to Mind Your Body. I'm Dr. Zev Nevo, and this is part two of our Partners in Pain series.

[00:00:40] In part one, we explored the invisible burden that both people carry in a chronic pain relationship. We learned about the seven layers of suffering, how the person in pain isn't just dealing with physical symptoms, but also shame, guilt, fear, exhaustion, [00:01:00] isolation and resentment. We discovered that partners often appear indifferent when they're actually drowning in helplessness and fear. And we learned the critical distinction. Sympathy drives disconnection by creating distance and hierarchy, while empathy fuels connection by climbing down into the hole and saying, you're not alone.

[00:01:24] Today, we're going to learn exactly how to practice empathy. We're going to explore Brene Brown's four attribute framework that transforms empathy from an abstract concept into a concrete skill set. We'll hear the golden questions that Sarah, our patient living with chronic pain says she actually needs from her partner.

[00:01:47] And we'll explore the critical distinction between cognitive empathy, which is sustainable, and enmeshment, which leads to burnout. Because here's what's at stake. If you don't [00:02:00] learn this distinction, you'll either withdraw to protect yourself or you'll drown trying to absorb your partner's pain. Neither path leads to healing.

[00:02:11] Let's dive in. Here's where we need to completely reframe how we think about empathy. Most people think empathy is something you either have or you don't, like it's an innate personality trait. But Brown's research shows that empathy is an emotional skill set that allows us to understand what someone is experiencing and to reflect back that understanding.

[00:02:35] Let that sink in. Empathy is not a feeling, it's a skill. And like any skill, it can be learned, it can be practiced, it can be strengthened, it can be mastered. Brown emphasizes, quote, "empathy has no script. There's no right way or wrong way to do it. It's simply listening, holding space, withholding judgment, [00:03:00] emotionally connecting and communicating that incredibly healing message of you are not alone."

[00:03:07] This is immediately empowering for caregivers because it shifts the goal from saying the perfect thing or fixing the pain to the learnable practice of being present and nonjudgmental. Brown's framework is built on nursing scholar Theresa Wiseman's research, which identified four key attributes essential to the practice of empathy.

[00:03:30] Let me walk you through each one and show you how it applies to supporting someone with chronic pain. The first attribute is called perspective taking. This is the cognitive ability to see the world as others see it. To see the situation through someone else's eyes, through someone else's vantage point.

[00:03:52] It's not about agreeing with their perspective, it's about understanding it, In practice, this [00:04:00] means asking open-ended questions like, what is that experience like for you? Or, help me understand what you're going through, 

[00:04:10] or can you tell me more about what that was like? Sarah told me what she needs most is for her partner to ask, what does your body need today? Not what can I do, but what does your body need? That's perspective taking. It honors her as the expert on her own experience. The second attribute is staying out of judgment.

[00:04:36] This is the ability to just listen and resist the urge to critique or solve the problem. It requires suspending your own assumptions and biases. This is one of the hardest attributes in a caregiving relationship because the partner's primary instinct is often to offer solutions, but judgment shows up in subtle ways like, well, have you tried working out?

[00:04:59] Which [00:05:00] implies you're not trying hard enough or, that you're always stimulated comment, which implies you're being dramatic or, but you look fine, which implies it can't be that bad. Sarah described how her partner's expectations created judgment. "I feel like he forgets that I'm younger and sometimes expects me to be healthier and less in pain because I'm younger."

[00:05:26] Staying out of judgment means accepting the person's experience as valid without needing to understand it, explain it or fix it.

[00:05:35] The third attribute is recognizing emotion. This involves the ability to understand what the other person is feeling. This attribute is often facilitated by connecting with your own feelings, which helps you identify and connect with what the other person might be experiencing. For partners of people with chronic pain, this means developing what I call emotional intuition, the ability [00:06:00] to pick up on nonverbal cues and changes in patterns.

[00:06:04] Sarah gave me a masterclass in this. She told me the signs her partner should look for - body postural changes. "Like I tend to move a lot when I'm in pain or in a flare." Going quiet or withdrawing. "I tend to isolate. I'll just be like, oh, it's okay." Overstimulation. "I'll vocalize a lot.

[00:06:26] Like I'm very overstimulated right now." And fatigue. "It's 5:00 PM and you're passing out on the couch. Were you fighting a lot of pain today?" Her 4-year-old son has mastered this attribute. She told me he'll come in and he's like, you okay mom? And I'm like, yeah, buddy. He's like, oh, I'll just be right here with you.

[00:06:50] That's recognizing emotion. That child is more empathically attuned than most adults. The fourth attribute is [00:07:00] communicating that understanding. This is the final crucial step. Expressing that you're truly listening and communicating that recognition. This is the reflect back portion of Brown's definition, and here's what's beautiful about this.

[00:07:16] It's okay if you're a little off. The person can correct you. The attempt to understand and the willingness to be corrected is the mechanism of connection itself. Sarah told me the ideal response when she mentions pain would be maybe physical touch, whether it be just a hold or asking, do you need me to run a bath?

[00:07:39] By the way, there's neuroscience behind this. Hands on the forearm trigger a huge release of oxytocin. It's deeply therapeutic. There was even a study showing that when you touch someone's forearm during a conversation, they're more likely to have a positive memory of that interaction. So it's not just about verbal communication, it's about showing compassion through [00:08:00] non-verbal action.

[00:08:02] Let me show you what this looks like in practice. I asked Sarah, what would be the ideal reaction or response when you mention you're in pain. Would it be nothing? Would it be a certain phrase? Here's what she said. "I think for me it would be more like maybe physical touch, or like, okay, well do you need me to run a bath?

[00:08:23] Or showing compassion or even just sympathy, okay, yeah, I can tell she's not feeling well. Let me just take over one of her things that she does with the kids or the house." Notice what she's describing. Physical touch, which is communicating understanding. Specific concrete offers, which is compassionate action. And taking over tasks without being asked, which is perspective taking plus action.

[00:08:50] And then I asked her the following question: what would be the best question to ask when you see that someone suddenly has a change and is going through more pain? Her answer. [00:09:00] "I would say maybe more like, Hey, what does your body need today? What can we do? Not what can I do? It's more like, what can we do?"

[00:09:10] What can we do? That's the language of partnership. That's the language that says, you're not alone. I'm in this with you. We're going to figure this out together. It's not that, what do you want me to do? Question, which puts the burden back on them. It's not, let me know if you need anything, which is too vague and overwhelming.

[00:09:33] It's what can we do? That is empathy in action. Now, here's where Brown's research provides a critical warning that's absolutely essential for long-term caregivers. Don't conflate true empathy, which involves connecting with another's experience without losing yourself with emotional contagion or enmeshment.

[00:09:57] Brown distinguishes between two separate [00:10:00] neurological systems for empathy. First, there's cognitive empathy or perspective taking, which is the ability to understand another's perspective. This is the skill set brown advocates for. The second one is affective empathy or emotional contagion. The ability to feel the emotion of someone else.

[00:10:25] Brown explicitly relabels this as enmeshment, not knowing where you end and someone else begins. This distinction is a central thesis for supporting partners in chronic pain. Brown argues that affective empathy, enmeshment, is not a good idea. It's not helpful, and leads directly to burnout, overwhelm, secondary trauma and numbing.

[00:10:50] The goal for the partner is not to absorb the chronic pain of their loved one, which is an unsustainable path to what Brown calls drowning in [00:11:00] empathy. But rather, the goal is to practice cognitive empathy, the skill of understanding, perspective taking and validating the other's experience without becoming consumed by it.

[00:11:14] Think about it this way. If you're drowning alongside the person you're trying to help, you can't be their anchor. You just become two people drowning together. Here's what's fascinating from the neuroscience research Brown cites. Empathy, the affective or enmeshed kind, triggers the pain centers of the brain.

[00:11:37] Compassion, the action oriented kind, triggers the reward centers of the brain. Let that sink in. When you practice enmeshed affective empathy, when you try to absorb and feel your loved one's pain, you're literally activating your own pain centers. You're creating suffering in your own nervous system. [00:12:00] But when you practice compassion, which we'll explore in depth in part three, you activate reward centers.

[00:12:08] Your brain releases dopamine. You feel energized, not depleted. This is a transformative revelation for caregivers. Caregiver burnout is not a moral failure of compassion. It's a biological consequence of enmeshment. The partner is drowning by activating their own pain centers in a futile attempt to absorb their loved ones suffering.

[00:12:34] The prescription is not to care less. The prescription is to stop absorbing, to practice boundaried cognitive empathy, which fuels sustainable compassion. For partners of people who mask their pain like Sarah, you need to develop what I call emotional intuition, the ability to pick up on subtle cues.

[00:12:58] Sarah taught me the signs to [00:13:00] look for. Physical signs include postural changes, like being more fidgety or shifting positions frequently. Facial tension, like a clenched jaw or a furrowed brow. Fatigue, like passing out on the couch earlier than usual. And moving differently, slower, With more careful, cautious, and deliberate movements. Behavioral signs include going quiet or withdrawing from conversation. Isolation, like retreating to another room. Overstimulation, expressing feeling overwhelmed by noise, light, or activity. And irritability having a shorter fuse or less patience.

[00:13:42] From a polyvagal perspective, you're watching for signs of sympathetic activation, that's fight or flight. Or dorsal vagal shutdown, that's freeze or collapse. Sympathetic looks like agitation, restlessness, anxiety, and irritability. [00:14:00] Dorsal vagal looks like withdrawal, numbness, dissociation, and extreme fatigue.

[00:14:08] Sarah's son demonstrates this beautifully. His nervous system is detecting the shift in her nervous system, even when she's masking verbally. That is neuroception in action. Here's what's critical to understand from a polyvagal perspective. Your nervous system affects your partner's nervous system and vice versa.

[00:14:32] This is called co-regulation, the process by which one person's regulated nervous system helps to regulate another person's dysregulated nervous system. But here's the catch, you can't co-regulate someone else if your own nervous system is dysregulated. If you're in a state of sympathetic threat, anxiety, frustration, helplessness, your nervous system is broadcasting danger, threat, not safe. [00:15:00] Your partner's nervous system picks up on that even if you're not saying anything.

[00:15:05] Their neuroception, the non-conscious detection of safety and threat cues reads your dysregulation and responds with more dysregulation. This is why Sarah's partner's discomfort with her pain made everything worse. His nervous system was in threat, which made her nervous system feel more threatened, which increased her pain, which increased his discomfort, A vicious cycle.

[00:15:31] Breaking the cycle requires the partner to regulate their own nervous system first. First, regulate yourself. Before you engage with your partner in pain, check in with your own nervous system. Am I in ventral vagal? Safe, connected, calm? Am I am sympathetic? Anxious, frustrated, or activated?

[00:15:55] Or am I in dorsal? Shut down, numb, checked out? If [00:16:00] you're not in ventral, vagal and connected, you need to regulate yourself first. This might mean taking a few deep breaths, going for a short walk, doing a brief grounding exercise, or acknowledging your own feelings. I'm feeling helpless right now, and that's okay.

[00:16:18] Second, offer your regulated presence. Once you are regulated, your calm nervous system becomes a resource for your partner. You don't have to do anything. Your regulated state is the intervention. This is what Sarah's son was doing instinctively his calm, curious presence, you all right right, Mom? offered her nervous system a cue of safety.

[00:16:44] Third, use ventral vagal cues. These are the nonverbal signals that communicate safety. Soft eye contact, not staring, not avoiding. Relaxed facial expression, open body posture, [00:17:00] calm, modulated voice tone, and gentle touch when appropriate. Fourth, honor the window of tolerance. Both of you have a window of tolerance.

[00:17:11] That's the zone where you can process information, regulate emotions, and connect with others. When pain flares, the person's window of tolerance shrinks. They have less capacity for stimulation, decision making, or emotional processing. As a partner, your job is to help protect that window, reduce external stressors, simplify decisions, lower demands, create a calm environment.

[00:17:39] Sarah described this, quote. "Being around a lot of people sometimes fatigues me even more, so I'll be like, oh, I'm very overstimulated." End quote. Her partner's response, that always overstimulated comment. That response invalidates her experience and adds to her dysregulation. A better response might be, I hear [00:18:00] you.

[00:18:00] Let's find a quieter space, or what would help, right now? One of the most challenging aspects of chronic pain for partners is the unpredictability. Sarah described this beautifully. "There's constant change happening. There's going to be days where you feel better and there's going to be days where you don't feel the best, and I think that feeds into the relationship, whether it's a positive or a negative, but I feel like people don't know how to ride that wave."

[00:18:29] The frustration comes in when partners say, well, I can't help you. I don't know how to help you. Here's the reframe. You're not supposed to control the wave. You're supposed to ride it together. This means on good days, celebrate them. Don't wait for the shoe to drop. Don't say, are you sure you can do this?

[00:18:49] Just enjoy the moment. And on bad days, show up. Don't withdraw. Don't get frustrated that they're back in pain again. Just be [00:19:00] present. Sarah described how her partner's anxiety on good days actually made things worse. She says, "if we take the kids to Disneyland, and I'm feeling okay, it's the constant, are you flared?

[00:19:12] Are you going to be able to walk up this hill? Then I feel challenged, like, okay, well now I'm gonna push myself even more because this person's thinking that I can't do it." That anxiety reinforces the pain. It keeps her hypervigilant about her body. It turns a good day into a test. A better approach might be, I'm so glad you're feeling good today.

[00:19:35] Let's enjoy this. Trust that if she needs to rest, she'll tell you. And if she doesn't tell you, use your emotional intuition to check in with those body centered questions we discussed. So let's bring together what we've learned today. Empathy is not a feeling, it's a skill. And that skill has four specific attributes you can practice. First, perspective taking, [00:20:00] ask open-ended questions, honor them as the expert on their own experience.

[00:20:06] Use those golden questions. What does your body need today and what can we do? Second, staying out of judgment. Resist the urge to fix, minimize or offer unsolicited advice. Accept their experience as valid without needing to understand or explain it. Third, recognizing emotion. Develop emotional intuition.

[00:20:31] Learn to read the nonverbal cues, the postural changes, the withdrawal, the overstimulation, the fatigue. Fourth, communicating that understanding. Reflect back what you're hearing. Offer physical touch, take action without being asked. Show them they're not alone. But here's the critical distinction. Practice cognitive empathy, not enmeshment.

[00:20:57] Understand their experience without [00:21:00] absorbing their pain, because enmeshment activates your pain centers and leads to your burnout. Cognitive empathy allows you to be their anchor, stable, grounded, and present. Your nervous system affects their nervous system. So regulate yourself first. Offer your calm presence.

[00:21:21] Use ventral vagal cues and honor both of your windows of tolerance. And remember, you're not supposed to control the wave. You're supposed to ride it together. But here's the question we haven't answered yet. How do you sustain this long term? How do you practice empathy without burning out? How do you be an anchor without drowning yourself?

[00:21:44] And that's exactly what we're going to explore in part three of this series, Compassion Plus Boundaries. We're going to learn why the most compassionate people are also the most boundaried. We're going to discover that what's commonly called compassion [00:22:00] fatigue is actually a misnomer. It's empathy fatigue from unboundaried enmeshment. And we're going to explore the practical toolkit for both the person in pain and the partner, the specific language to use, the language to avoid, and the concrete strategies that create sustainable support. We'll also address the power dynamics that can shift in chronic pain relationships, how to preserve dignity and equality,

[00:22:27] and what to do when children are watching and learning from your example. Because here's the truth, compassion without boundaries leads to burnout, but compassion with boundaries, that's sustainable, that's transformative, that's healing. Until next time, practice those four attributes. Ask yourself, am I taking their perspective or am I imposing my own?

[00:22:54] Am I staying out of judgment or am I offering unsolicited advice? Am I [00:23:00] recognizing their emotion or am I missing the cues. And am I communicating my understanding or am I staying silent? And most importantly, am I practicing cognitive empathy or am I drowning in enmeshment? Protect the sacred mind body connection. And remember, the body embodies the mind. The mind embodies the body. It's the only one we've got. Nurture the mind and heal the body. This is Dr. Zev Nevo, and you've been listening to part two of Partners in Pain. See you next time for the final episode.