Empathy and the Impossible Balancing Act

It is hard and sometimes I paint the picture that things are simple – it is so far from the truth.

People often describe empathy as “putting yourself in someone else’s shoes”. It sounds sensible enough and is usually presented as something deeper than sympathy, which is simply feeling concern for another person.

I think there is a lot of truth in that description, but I have come to believe that there are two very different ways of trying to do it.

The first is imagining how you would feel in someone else’s situation. That is valuable because it encourages us to think beyond ourselves and to consider another person’s experience. Without it, we would struggle to show kindness, compassion or understanding.

But there is another form of perspective-taking, closely related to what psychologists call cognitive empathy. Instead of asking how I would feel in your position, it asks me to try to understand how you feel, given who you are, what you value and how you see the world.

The first asks: How would I feel if this happened to me?

The second asks: How does this person feel, given who they are?

The distinction may appear small, but it is actually profound. When I imagine myself in another person’s position, I am still viewing the situation through my own values, assumptions and experiences. Cognitive empathy requires something more difficult. It requires me to understand how the other person sees the world, what they value, what they fear, what they hope for and how their experiences shape their thinking.

There is even some evidence that this distinction matters for caregivers themselves. One study of 140 informal caregivers found that those with higher cognitive empathy tended to see caregiving as less stressful and threatening, experienced less depression and reported greater life satisfaction. Emotional empathy did not show the same pattern. In other words, understanding another person’s perspective may sometimes be healthier than simply absorbing their emotions.

As a 51-year-old man living with PSP, there is little value in me trying to work out how I would feel if I were my wife or one of my children. Whatever answer I arrive at will still be filtered through my own perspective. What I really need to understand is how they are experiencing this journey. What concerns them? What pressures are they carrying? What are they hoping for? What does the future look like through their eyes rather than mine?

I remember a Politics professor at Leeds University making a similar point more than thirty years ago when discussing relations between the United States and China. He argued that one of the mistakes often made was trying to understand China by asking what Americans would do in China’s position. A much better question was what China would do, given its own history, culture and perspective.

At the time it seemed like a lesson about international relations. Looking back, it feels just as relevant to family life.

One of the things PSP has taught me is that the people who love each other most are often trying to achieve different things at the same time, and sometimes those objectives appear to conflict.

I want my children to live their lives fully. I want them to pursue their careers, relationships and ambitions without PSP becoming the defining feature of their futures. I do not want them to feel that their lives have been placed on hold because of me.

At exactly the same time, I want the warmth, compassion and closeness that comes from being part of a loving family. I enjoy the phone calls, the visits and the conversations. I want to know they care and I want to feel connected to them.

On a purely logical level, those desires do not sit comfortably together. If I truly want them to focus on their own lives, perhaps I should expect less of their time and attention. Yet that is not how I feel.

I want both.

The more I think about it, the more I realise that this is not a contradiction so much as a reflection of the fact that human beings are not logical equations. We routinely hold competing hopes, fears and priorities at the same time.

My children may be experiencing something similar from the other side. They may want to support me whilst also building their own futures. They may sometimes feel torn between family responsibilities and personal ambitions. Neither objective is wrong.

The same is true for spouses and carers, who often find themselves trying to preserve a person’s independence whilst keeping them safe, or trying to provide support without taking away autonomy. Patients face their own tensions. We want help but not dependency, support but not pity, protection but not unnecessary restriction.

Nobody is wrong.

The challenge is that each person experiences these tensions from their own perspective, which is why cognitive empathy matters so much. We may never fully understand another person’s experience, but we can make a genuine effort to understand the hopes, fears, responsibilities and conflicting objectives they are carrying.

In many ways, that is why conversations about wishes, values and priorities become so important. Whether through ordinary family discussions, advance care planning or a Lasting Power of Attorney, we make life easier for those we love when we explain what matters to us. We cannot expect people to infer our priorities or guess our intentions.

Perhaps that is what the deepest form of empathy really means. It is not simply putting yourself in someone else’s shoes. It is recognising that they are walking a different path, carrying a different set of hopes and fears, and making a genuine effort to understand the world as they experience it.

For families living with PSP, that may be one of the hardest things we are ever asked to do. It may also be one of the most important.