A review of empathy in social work: A relational and situated practice with directions for further research

Abstract

Summary

Empathy is a core value and practice within the international social work profession, yet it is not coherently or consistently understood, which presents challenges for research and practice. This article aims to develop understanding of how empathy has been constructed, researched, and represented. It presents findings from a narrative scoping literature review that included 32 studies from nine countries published between 2000 and 2023.

Findings

The review identified five categories of studies, dominated by quantitative and theoretical approaches, with a relatively limited contribution from interpretive empirical studies. Underpinned by a diverse range of theoretical perspectives, empathy was predominantly represented as an individual construct with affective, cognitive, behavioral, and social dimensions. Areas of practice development focused on training, with additional focus on organizational and policy contexts, although empirical evidence was limited. Theoretical complexities and conceptual fuzziness present challenges for research and practice, and further research is needed.

Applications

The article offers a thorough overview of how the concept of empathy has been studied within the international contemporary social work literature. An outline of training to support practice development, focused on affective, cognitive, and behavioral dimensions, and a conceptual model, positioning empathy as a relational and situated social work practice, can be applied in research and practice. Opportunities to develop new understandings of empathy in social work focus on addressing conceptual and theoretical complexities and extending empirical exploration to focus on meanings and experiences of empathic practice from the perspectives of social workers and people who engage with social work services.

Keywords

Social work child protection children and families social work research social work values social work practice

Introduction

This article presents a review of the concept of empathy within the international social work academic literature since the year 2000. Widely recognized as an important value and practice across the global profession of social work, empathy is not coherently or consistently understood, which presents challenges for research and practice.

The review was conducted at the outset of a doctoral study in the context of the English child protection system. The study was inspired by evaluation research studies within the Department for Education Children's Social Care Innovation Programme in England (“Innovation Programme”; Sebba et al., 2017). The Innovation Programme, funded as a government response to an independent review (Munro, 2011), sought to improve the quality of services for children and families (Sebba et al., 2017). Innovations funded within the program included a focus on developing social work practice within local authority organizations (Bostock et al., 2020; Forrester et al., 2017). Evaluations assessed social work practice with a focus on care and engagement, including empathy, as a verbal communication skill (Bostock et al., 2020; Forrester et al., 2017). Overall findings from the Innovation Programme echoed key messages from the Munro Review and emphasized the importance of and need for an increased focus on relational social work practice, with individual studies demonstrating a relatively low overall level of empathy skill (Bostock et al., 2020; FitzSimons & McCracken, 2020; Forrester et al., 2017).

A subsequent review of policy and professional guidance for child protection social workers in England emphasized the core position of empathy in the code of ethics (British Association of Social Workers (“BASW”), 2021), as a key element of required professional practice skill (Department for Education, 2018; Social Work England, 2019) and of the first principle of statutory guidance relating to working collaboratively with parents (HM Government, 2023). However, inconsistencies and absences in its representation suggested there was a need to develop understanding of the meanings and practices of empathy. Inconsistencies included a positioning of empathy as part of a value system (BASW, 2021; HM Government, 2023), and in professional guidance as a “skill” (Department for Education, 2018, p. 3), a “position” (Department for Education, 2018, p. 5) and an “ability” (Social Work England, 2019, p. 5), but with no accompanying definitions or notes related to meanings or practices.

The review aims to contribute an accessible overview of the social work empathy literature without losing the complexities, to set out how empathy has been constructed, researched, and represented, and to outline the opportunities to develop new understandings.

Review method

The review was conducted in 2021 and updated in 2023. It was guided by the aims and principles of narrative and meta-narrative approaches: to develop a thorough awareness and understanding of current research and perspectives including “complexities and ambiguities” (Greenhalgh et al., 2005, p. 417). The principles of reflexivity, focusing, pluralism, and pragmatism were applied (Wong et al., 2014) within each phase of a scoping review process: defining search terms; selecting databases, confirming inclusion criteria and conducting the review (Arksey & O’Malley, 2005).

Initial search strategies governed by the guiding principles generated sources written in the English language from the year 2000 in social work journals within two databases (Scopus and Social Care Institute for Excellence), with a focus on the construct of empathy in the profession and discipline of social work. A two-phase review process included an early review of abstracts and a full review of complete sources.

The early review of abstracts including the location and year of each source informed selection of the set for full review. Selection for full review was guided by reflexive application of three core principles. “Focusing” prioritized the most relevant sources focused on empathy for the English child protection social work context. Key relevant constructs that were consciously excluded to prioritize “empathy” were relationship-based practice (e.g., Ruch et al., 2018), reflective practice (e.g., Ruch, 2009), elements of child protection practice, including the home visit and emotion (e.g., Ferguson, 2016; Gibson, 2016) and cognate concepts such as compassion (e.g., Tanner, 2020). Similarly, the review excluded a focus on empathy in disciplines of therapy, nursing, medicine, and teaching. Within empirical social work studies focused on empathy, practicing social workers were prioritized over students as a participant group. The application of “pluralism”-guided inclusion of diverse and contesting perspectives. Pluralism was applied both geographically, by seeking a broad range of international studies, and methodologically, to include quantitative and theoretical as well as qualitative empirical studies. Attention to “pragmatism” limited the number of sources to a manageable quantity to achieve depth of review within the relatively constrained resources of the study.

The full review of the final set of 32 sources involved a “mapping” of information to a summary template (“review table”) including date, location, aims, theoretical perspective, methodological position, constructs, design, key findings, discussion and implications, enablers and barriers, with reflection on quality, according to the relevant tradition (Wong et al., 2014). No sources were excluded following the quality appraisal process.

Analysis of year of publication indicated an increase in studies, with four published 2000–2009; 19 published 2010–2019 and nine already published in the 4 years since 2020. Analysis of geographical location identified 30 studies in seven countries in the Global North: United States of America (14); England (8); Sweden (3); Australia (2); Canada (1); Island of Ireland (1); and Spain (1), with two studies in the Global South; Kuwait (1) and India (1). This growing and international focus on empathy in social work reflects increasing attention to empathy since the beginning of the 20th century across disciplines (Coplan & Goldie, 2011).

The 32 review tables were categorized in relation to study type, theoretical perspective, methodological approach, and conceptualization of empathy, generating five broad categorizations. The review tables were synthesized within each category, with a focus on theoretical perspectives; constructs of empathy; significance and complexities of empathic practice; supporting empathic practice; and the need for further research.

Review findings

The review findings are presented in five sections focusing on: study categorization; theoretical perspectives; conceptualization and constructs; need to support practice development; and need for further research.

Study categorization

Five categories of studies were identified, with a dominance of quantitative and theoretical approaches, with a relatively limited contribution from review and interpretive empirical studies. The Supplemental File outlines the studies by category in a series of five tables.

Category 1: Conceptual review

Four review papers published between 2011 and 2022 in the United States, Sweden, and Australia (Gerdes, 2011; Gibbons, 2011; Nilsson, 2014; Watson et al., 2022) aimed to develop understanding of the conceptualization of empathy in social work, with an international focus. They focused on the evolution of disciplinary influences on empathy (Gibbons, 2011; Watson et al., 2022); relationships between empathy and the cognate concepts of sympathy, pity and compassion, and the contested position of empathy as an emotional construct in the social work context (Gerdes, 2011; Nilsson, 2014; Watson et al., 2022). Quality appraisal identified scope for increased transparency and articulation of review methods.

Category 2: Theoretical model

Seven theoretical models were represented by ten sources, developed between 2007 and 2021 in the United States, Australia, and England. The 10 sources included a book as the most recent publication relating to two of the models (Segal et al., 2017) identified through a wider search. Each model aimed to develop conceptual understanding and enhance social workers’ empathic practice.

The seven theoretical models of empathy identified were:

Interpersonal empathy and

Social model of empathy: Developed through an extensive research program in the United States between 2011 and 2017 drawing on neuroscience, psychology, and social work (Gerdes & Segal, 2011; Gerdes, Lietz, & Segal, 2011; Gerdes, Segal et al., 2011; Mullins, 2011; Segal et al., 2017);

Structure of empathy model (King, 2011): Developed in the United States drawing on clinical and social psychological theory and the therapeutic relationship in social work;

Integral empathy model (Clarke & Butler, 2020): Developed in the United States drawing on clinical psychological theory and the therapeutic relationship in social work;

Phenomenological embodied model (Van Rhyn et al., 2021): Developed in Australia drawing on existential phenomenological theory of embodiment (Merleau-Ponty, 2005/1945);

Relational-feminist model (Freedberg, 2007): developed in the United States, building on relational and feminist theory with case examples;

Working model of empathy (Grant, 2014), developed in England, through a small set of empirical quantitative studies with social work students (also included in Category 4).

Three models informed the development of two self-report scales and indices, applied to measure social workers’ empathy skill (outlined in Category 4), including the “Empathy Assessment Index” (Segal et al., 2017) and the Empathy Scale for Social Workers (King & Holosko, 2012). Quality appraisal identified robust development of the interpersonal empathy and social model of empathy models (Gerdes & Segal, 2011; Gerdes, Lietz, & Segal, 2011; Gerdes, Segal et al., 2011; Mullins, 2011; Segal et al., 2017) with scope for increased transparency relating to development processes and theoretical integration, more generally.

Category 3: Empirical study with observed verbal communication skill measures

Six empirical studies focused on social workers’ verbal empathic communication skill using simulated observational and observational approaches. The first study, in Sweden (Holm, 2002) assessed 110 social workers’ written responses following observing a video recording of a simulated client. Five studies, within the U.K. child protection context, built on the premise that empathy is “central to good social work communication in child protection” (Forrester et al., 2008, p. 41). Aiming to understand and improve social work communication skills, including empathy, the studies measured behaviors, including the impact of training and development (Forrester et al., 2008 , 2018; Lynch et al., 2019; Wilkins & Jones, 2018; Wilkins & Whittaker, 2018). Three studies adopted a quantitative or mixed-methods approach and focused on social worker skill (Forrester et al., 2008 , 2018; Lynch et al., 2019); one focused on the simulated skills of supervisors (Wilkins & Jones, 2018) and a reflective case study focused on coaching conversations (Wilkins & Whittaker, 2018). Quality appraisal focused on ecological and population validity identified variation between studies. While some studies included both robust sample sizes and direct observational approaches focused on practicing social workers in the child protection context in England (Forrester et al., 2018; Lynch et al., 2019), none of the studies included the perspectives of social workers or people who engage with social work services.

Category 4: Empirical quantitative study with multidimensional self-report measure

Eight studies between 2014 and 2023 assessed empathy skill using self-report questionnaires and surveys, with groups of practicing social workers, located in the United States, Kuwait, and India (Al-Maseb, 2017; Lawrence et al., 2022; Stanley et al., 2020; Stewart et al., 2022), and student social workers, located in England, the Island of Ireland, and the United States (Grant, 2014; Grant et al., 2014; Grant & Kinman, 2012; Lawrence et al., 2022; McFadden et al., 2023; Stewart et al., 2022). The studies aimed to investigate empathy skill in relation to gender, age, and experience and four studies additionally investigated spirituality, attitudes, emotional intelligence, reflective ability, psychological distress, feelings of competence in social situations and resilience (Grant, 2014; Grant & Kinman, 2012; Stanley et al., 2020; Stewart et al., 2022). Two studies measured the impact of focused and general training and development (Grant et al., 2014; McFadden et al., 2023) with a mixed-methods approach. Quality appraisal indicated that whilst most sample sizes were robust (up to 455; Lawrence et al., 2022), some were limited, with the smallest sample size being 28 (Grant et al., 2014). Despite the inclusion of qualitative methods in two mixed-methods studies, there was limited reporting of this data (Grant et al., 2014; McFadden et al., 2023). It was notable that studies in England had limited population validity, with a sole focus on social work students (Grant, 2014; Grant et al., 2014; Grant & Kinman, 2012).

Category 5: Empirical interpretive research study

Five empirical interpretivist studies aimed to develop understanding of the construct of empathy and how to enhance social workers’ practice experiences of empathy. The studies adopted phenomenological (Adamson et al., 2018; Eriksson & Englander, 2017; Ortega-Galán et al., 2021) and contemporary psychoanalytic (Tempel, 2007, Warner, 2016) theoretical perspectives. Four studies adopted interviewing and focus group approaches, in hospital, community, and clinical social work settings (Adamson et al., 2018, USA; Eriksson & Englander, 2017, Sweden; Ortega-Galán et al., 2021, Spain; Tempel, 2007, USA). One study presented a reflective account with the inclusion of dance as a parallel creative process (Warner, 2016, USA). Four studies focused on empathy in the relationships of social workers and people who use social work services both generally (Ortega-Galán et al., 2021; Warner, 2016) and in relation to specific groups (mothers and children with safeguarding concerns; Tempel, 2007 and forced migrants; Eriksson & Englander, 2017). One study focused on interprofessional teams (Adamson et al., 2018). Theoretically aligned analytical approaches generated themes illustrated by related data excerpts. Appraisal focused on trustworthiness (Tracy & Hinchins, 2017) highlighted studies that included case examples (Eriksson & Englander, 2017) and a sequence of interviews (Adamson et al., 2018; Tempel, 2007) as representing enhanced quality. Some issues were noted relating to a disconnect between the theoretical framing and design and some confusion in the reporting of the method (Ortega-Galan et al., 2021). This led to reflection on challenges for researchers for whom English is not their first language, in relation to the theoretical complexity of empathy.

Theoretical perspectives

Seven theoretical perspectives were identified:

A “new science” perspective integrated cognitive psychology and neuroscience to define empathy as the affective response to another's emotions and actions and the cognitive processing of one's affective responses. New science informed the development of two models, the interpersonal empathy and social empathy models (Decety & Meyer, 2008; Lamm et al., 2007 in Gerdes & Segal, 2011; Gerdes, Lietz, & Segal, 2011; Gerdes, Segal et al., 2011; Mullins, 2011; Segal et al., 2017).

A social psychological perspective defined empathy in relation to the reactions of one individual to the observed experiences of another. Social psychology informed three models; the interpersonal empathy and social empathy models (Gerdes & Segal, 2011; Gerdes, Lietz, & Segal, 2011; Gerdes, Segal et al., 2011; Mullins, 2011; Segal et al., 2017) and the working model of empathy (Davis, 1980; Davis, 1983in Grant, 2014; Grant et al., 2014; Grant & Kinman, 2012; McFadden et al., 2023; Segal et al., 2017; Stewart et al., 2022).

A social work perspective contributed concepts to five theoretical models. “Social justice” featured in the interpersonal empathy and social empathy models (Gerdes & Segal, 2011; Gerdes, Lietz, & Segal, 2011; Gerdes, Segal et al., 2011; Mullins, 2011; Segal et al., 2017). “Reflective practice” (Ruch, 2009) informed the working model (Grant, 2014). Compassion, care, and concern informed the structure of empathy model (King, 2011). A relationship-based approach to social work practice (Trevithick, 2003) informed the integral empathy model (Clark & Butler, 2020).

A contemporary psychotherapeutic psychoanalytic perspective defined empathy as “the capacity to think and feel oneself into the inner life of another person” (Kohut, 1984, p. 82; in Gibbons, 2011; Watson et al., 2022). This perspective informed the integral empathy model (Clarke & Butler, 2020) and underpinned two empirical interpretive studies (Tempel, 2007; Warner, 2016).

A psychotherapeutic Rogerian experiential psychology perspective defined empathy as the ability to perceive the internal emotional state of another “as if” they were that person, with a nonjudgmental, accepting reflection of the client's emotional state (Rogers, 1959 in Watson et al., 2022). The Rogerian perspective informed the working empathy model (Grant, 2014) and the structure of empathy model (King, 2011), the integral empathy model (Clarke & Butler, 2020) and the empirical, mostly quantitative studies that focused on empathy as a verbal communication skill (Forrester et al., 2008 , 2018; Holm, 2002; Lynch et al., 2019; Wilkins & Jones, 2018; Wilkins & Whittaker, 2018).

A phenomenological philosophical perspective, following Husserl and Stein (Depraz, 2017 and Stein, 1917/1989 in Watson et al., 2022) and Merleau-Ponty (2005/1945) underpinned the phenomenological model of empathy (Van Rhyn et al., 2021) and three empirical interpretive studies (Adamson et al., 2018; Eriksson & Englander, 2017; Ortega-Galán et al., 2021). The phenomenological perspective positioned empathy as an embodied experiencing and emotion-driven construct (Van Rhyn et al., 2021).

A relational feminist perspective informed a theoretical model that moved “beyond the traditional definitions of empathy” as “a static skill” (Freedberg, 2007, p. 258) to conceptualize empathy between the client and the social worker “in an increasingly mutual, interactive, and humanist way” (Freedberg, 2007, p. 251).

The theoretical diversity reflects the multiple conceptual origins of empathy across the disciplines of art and nature, psychology, and phenomenology at the beginning of the 20th century (Watson et al., 2022). The inclusion of therapeutic perspectives reflects the introduction of the concept of empathy to social work by psychoanalytic-informed social workers in the United States in early 1900s, and the enduring influence of Carl Rogers in the second half of the 20th century (Gibbons, 2011; Watson et al., 2022). More contemporary and dominant perspectives center on contested new science approaches, with a relational feminist perspective introduced at the beginning of the 21st century (Freedberg, 2007). While some studies were characterized by clarity and transparency, there were some challenges in deciphering and unraveling apparently complex and melded theoretical perspectives. This reflects Gibbons’ (2011) conclusion, identifying concerns relating to the “epistemological confusion” and “theoretical conflicts” within the field (Gibbons, 2011, pp. 243–244).

Conceptualization and constructs

The “semantic fuzziness” of empathy (Gerdes & Segal, 2009, p. 115 in King, 2011) was recognized in relation to the cognate concepts of “attachment” (Bowlby, 1969; Decety & Meyer, 2008 in Segal et al., 2017); “emotional intelligence” (Goleman, 1995 in Segal et al., 2017); “sympathy” (Gerdes, 2011; Watson et al., 2022); “pity” (Gerdes, 2011), and “compassion” (Nilsson, 2014). The conceptual overlap with “sympathy” reflected the initial use of the term “priceless sympathy” alongside the German term of einfühlung (later translated as empathy; Lanzoni, 2018 in Watson et al., 2022). Gerdes (2011) emphasized a distinction between empathy in contrast to sympathy and pity, in relation to two elements. First, the collaborative position between a social worker and a client as the social worker “feeling with” the client (empathy) rather than a hierarchical position of “feeling for” (sympathy and pity), and the inclusion of the constructs of perspective taking and emotional regulation within empathy that are missing from sympathy and pity (Gerdes, 2011). The importance of focusing on empathy as a separate concept was emphasized, so that empathy did not “dissolve” into the other constructs (Segal et al., 2017, p. 67).

Across study categories and theoretical perspectives, an array of constructs was framed in relation to four dimensions of empathy: affective, cognitive, behavioral, and social. From neuroscientific, psychological, and quantitative perspectives the domains were presented as separate, if interacting elements, at the level of the individual. From therapeutic, phenomenological, relational, and interpretive perspectives, the domains were positioned as more integrated, and the social element of empathy was recognized. The constructs were predominantly presented in respect of social workers and in relation to people who engage with social work services.

Affective empathy

Constructs in the affective domain were positioned as part of the empathic process and as postive and negative outcomes. The neuroscientific perspective positioned the affective empathic process as mirroring; an involuntary physiological reaction and feeling when observing or listening (Gerdes, 2011; Segal et al., 2017). From a phenomenological perspective, the affective process related to directly perceiving emotion (Van Rhyn et al., 2021). From a contemporary psychoanalytic perspective, it was described as feeling into the client's experiences (Kohut, 1984 in Gibbons, 2011; Tempel, 2007; Warner, 2016). Positive affective outcomes included emotional attunement and resonance (Freedberg, 2007; Tempel, 2007) and caring and congruent “emotional connection” (King, 2011, p. 688) between the social worker and person who they are supporting. Negative affective outcomes where the social worker experiences the difficult emotions experienced by the person who they are supporting, sometimes unconsciously, were described as social workers’ experiences of empathic distress, vicarious emotion and emotional contagion (Grant, 2014; Nilsson, 2014; Ortega-Galan et al., 2021; Tempel, 2007; Watson et al., 2022; Warner, 2016).

Cognitive empathy

Cognitive processes were articulated according to theoretical perspective to include the concepts of vicarious introspection, emotional regulation, self-other boundaries, perspective-taking, power, and reflective ability.

From a psychoanalytic perspective, cognitive processes were framed as vicarious introspection ( Kohut, 1984 in Gibbons, 2011; Tempel, 2007; Warner, 2016). Within the psychological and quantitative perspectives (Grant, 2014; Segal et al., 2017), emotion regulation was defined as an ability to change or control one's own emotional experience of mirrored feelings and affective response. Here, self-other awareness was also included as an ability to temporarily identify with someone else without confusion between self and other. This was also construed as an ability to maintain appropriate boundaries between one's own emotions and thoughts and another person's emotions and thoughts. A further cognitive construct of “reflective ability” was conceptualized as the ability to consider the situation of others, be open to different ways of thinking and appraisal, and clarify and create meaning with others (Aukes et al., 2007 in Grant, 2014). Reflective ability was represented as enhancing empathy by countering the impact of distress, by supporting a focus on emotion regulation and the self-other boundary (Grant, 2014). Two further cognate concepts relating to the self-other boundary were included. In the relational model, empathy was represented as being “cognitively aware” that the source of affect “emanates from the other person” (Freedberg, 2007, p. 255). The importance of a “barrier” was identified in a phenomenological interpretive study in Spain, from the perspectives of social workers; “otherwise you die of a broken heart” (Ortega-Galán et al., 2021, p. 1354).

Perspective-taking was conceptualized within the psychological and quantitative approaches as the ability to be mentally flexible and imagine another's situation from the inside, to step into another's shoes and to be open to different points of view (Grant, 2014; Grant et al., 2014; Grant & Kinman, 2012; Lawrence et al., 2022; McFadden et al., 2023; Segal et al., 2017; Stanley et al., 2020; Stewart et al., 2022). Within therapeutic interactional approaches, perspective-taking was similarly conceptualized, including as an “openness to understanding the experiences and taking the perspective of others” by stepping back to create distance from the client's emotional content, with an “interpersonal sensitivity” and “intellectual flexibility” (Clarke & Butler, 2020; King, 2011, p. 689).

Perspective-taking also incorporated a broader focus. This was conceptualized as macro self-other awareness; an ability to understand the position of others with different characteristics of group identity, recognizing the inherent power differential (Segal et al., 2017) and contextual understanding of barriers; and an ability to consider how membership of social groups has led to clients’ experiences of structural inequalities and oppression (Segal et al., 2017). It involved intentionally accessing and integrating broader theoretical and observational information to develop a richer understanding of the client's experiences (Clarke & Butler, 2020) and recognizing the influence of differential social and cultural positions of power (Freedberg, 2007, p. 255).

Behavioral empathy

Two types of behavioral construct were identified. Firstly, attitudes and beliefs, including care and responsibility (Segal et al., 2017), prosocial attitude and motivation (King, 2011) and non-judgment (Warner, 2016) and a compassionate stance (Van Rhyn et al., 2021), with achievement of social justice identified as an empathic outcome (Segal et al., 2017). Secondly, behaviors including active listening (Warner, 2016) and observable empathic expressions and responses including helping, emotional support including accepting and attentive collaborative inquiry (King, 2011); sensitively attending and responding to emotion (Van Rhyn et al., 2021), including beneath the surface feelings, with open questions and tentative attempts to convey understanding (Forrester et al., 2008; Holm, 2002; Lawrence et al., 2022; Lynch et al., 2019; Warner, 2016).

Social empathy

Three perspectives included additional constructs that introduced a social element, related to mutuality. From a self-reflective psychoanalytic perspective, Warner (2016) conceptualized empathy as a dance, emphasizing the social worker's invitation to the client and the client response. From a theoretical relational feminist perspective, Freedberg (2007) conceptualized empathy as an element of a “complementary helping relationship” (Freedberg, 2007, p. 257), where a social worker is “willing to take risks, admit mistakes and allow the client to guide” (Freedberg, 2007, p. 255). Freedberg (2007) additionally focused on empathy from the perspective of the person engaging with social work services, in relation to an affective resonance and authenticity, and from a broader perspective, as part of the “client-worker relationship … and a wider relational context” (Freedberg, 2007, p. 258). With a focus on this larger relational context, from a phenomenological empirical perspective, Adamson et al.’s (2018) focus on interprofessional empathy identified characteristics of the interactional empathic process as being willing and able to listen to, understand and bond with one another.

Need to support practice development

The need to support social workers’ empathic practice development was associated with the significance and complexities of empathy for social work practice.

Significance was indicated by the growth in the number of studies and emphasized within them. Two studies demonstrated the importance of empathy from social workers’ perspectives. In Sweden, empathy was “imperative” and “vital” (Eriksson & Englander, 2017, p. 617). In Spain, empathy was recognized as a “moral and ethical obligation … and a given in our code of ethics” (Ortega-Galán et al., 2021, p. 1353).

Complexities were identified in relation to elements of empathy and inconsistencies in levels of practice skill. Challenges related to affective elements of empathy concerned the emotional impact of empathy on social workers, including empathic distress and emotional distancing, which required some form of emotional regulation (Eriksson & Englander, 2017; Grant, 2014; Nilsson, 2014; Ortega-Galán et al., 2021; Tempel, 2007; Warner, 2016). Challenges related to cognitive elements of empathy concerned the impact of the social positionings of people who engage with social work services on social workers’ capacities for perspective-taking (Holm, 2002; Segal et al., 2017). Inconsistencies in the overall reported level of practice skill were identified between studies that measured observed behavioral empathy (Category 3—overall lower; Forrester et al., 2008 , 2018; Holm, 2002; Lynch et al., 2019) and those that measured empathy as a multidimensional individual trait or skill with self-report methods (Category 4—overall higher; Al-Maseb, 2017; Grant, 2014; Lawrence et al., 2022; McFadden et al., 2023; Stanley et al., 2020). No overall variability in skill was identified in relation to social workers’ social identities, including gender.

The focus on practice development centered on training and development for social workers, including a call for a “pedagogy of empathy” (Watson et al., 2022, p. 725), with a focus on affective, cognitive, and behavioral dimensions. Suggestions for delivery of training for social workers to support the development of empathic practice relating to these three dimensions from across all review articles are summarized in Table 1.

Table 1.

Training for social workers to support the development of empathic practice.

Empathic practice dimension	Training aim	Training focus	References
Affective	Support social workers’ well-being and to tune into emotions and feelings, including experiences of emotional conflict	Delivery of workshops and engagement in creative arts activities including reflective and emotional writing practices and dance	Grant (2014); Grant et al. (2014); Grant and Kinman (2012); Holm (2002); Stanley et al. (2020); Warner (2016)
Cognitive	Support social workers to process emotion and develop understanding of service users’ experiences and situations	Appraisal techniques to identify sources of emotional stress and distress and identity how these can be overcome Understanding and application of psychoanalytic theory to frame service user and social worker responses in relation to fear and defenses Understanding of service users’ social positions and experiences, such as relating to substance use, through role play, reading fiction, and use of vignettes Increasing emphasis on values and recognizing a shared humanity with service users	Eriksson and Englander, 2017; Gibbons (2011); Grant (2014); Grant and Kinman (2012); Lawrence et al. (2022); Segal et al. (2017); Stanley et al. (2022); Stewart et al. (2022); Tempel (2007)
Behavioral	Support social workers to develop empathic communication with service users	Understanding and application of motivational interviewing Tuning into and responding to the emotional content of service users’ expressions, with a sense of curiosity, focus on reflecting said and unsaid meanings, and offering tentative understandings	Holm (2002); Forrester, Westlake et al. (2018); Grant (2014); Lynch et al. (2019); Wilkins and Whittaker (2018)

A further focus on the social domain indicated three features of wider organizational and policy contexts that required development to support social workers’ empathic practice. Firstly, attention to and promotion of the values and principles underlying social work and the experiences of social workers and families (Lynch et al., 2019; Wilkins & Whittaker, 2018). Secondly, empathic and emotionally receptive organizational cultures. This included a focus on empathic motivations, actions and behaviors (Holm, 2002), emotional-receptivity (Adamson et al., 2018), the emotional impact of empathy on social workers (Nilsson, 2014) and the provision of “organizational resources to ameliorate empathic distress” (Watson et al., 2022, p. 725). Resources included emotionally attuned supervision focused on social workers’ experiences with offers of emotional support (Grant & Kinman, 2012; Tempel, 2007; Wilkins & Jones, 2018). Thirdly, in relation to the U.K. statutory child protection system, the risk narrative and focus on managerialism were recognized as presenting a conflict for a relationship-based approach to practice (e.g., Ruch et al., 2018), encompassing empathy (Forrester et al., 2008; Wilkins & Whittaker, 2018). Although examples relating to training and development and wider contexts were included as pathways to support the development of empathic practice as part of discussions in the studies, supporting empirical evidence was generally limited.

Need for further research

Across the studies, there was a call for future research to focus on the conceptualization and contested position of empathy in social work to address gaps in practice understanding. Gibbons (2011) concluded with the need to develop understanding of the “complex construct” of empathy with a “transtheoretical” and “contested” position in the context of social work, emphasizing the “epistemological confusion” and “theoretical conflicts” (Gibbons, 2011, pp. 243–244). A decade later, this need had not been met. Watson et al. (2022) identified a “lack of a cohesive theoretical foundation for empathy” and “definitional debates” that “remain unresolved” which threaten research activity and research quality (Watson et al., 2022, p. 726). With a specific focus on the context of social work, studies emphasized how therapeutic and “new science” conceptualizations of empathy were “contested” (Nilsson, 2014; Watson et al., 2022, p. 714).

There is a need to address this confusion and conflict that presents barriers for social workers to apply research findings and threatens their development of a “cohesive and theoretically sound approach” to empathy in practice (Watson et al., 2022, p. 726). Study recommendations for future research focused on social workers’ practice experiences. Eriksson and Englander (2017) called for further investigation and explication of the phenomenon of empathy to address the complexities, contradictions, ambiguities, and uncertainties in how social workers define and delimit empathy. They emphasized the need for a shift in the contemporary focus on measurement and multiple neuroscientific and psychological constructs, such as “mirror neurons,” “simulation,” and “perspective-taking,” toward increasing social workers’ focus on “what is expressed and what is unfolding right in front of us” (Eriksson & Englander, 2017, p. 619). Similarly, Van Rhyn et al. (2021) indicated that new understandings of empathy should reprioritize social workers’ lived experiences and the “body's potential as a powerful instrument of empathy” (Van Rhyn et al., 2021, p. 146). Warner (2016) identified the specific need for increased attention to the “process of listening, understanding, and working through” (Warner, 2016, p. 32). The conclusion in the most recent review called for further research that focused on the “meanings and practices” of empathy as a “concept-in-use” within our social work communities (Watson et al., 2022, p. 726).

Discussion

The narrative scoping review process, incorporated careful balancing of the guiding principles, enabled a thorough “sensemaking of the literature” and created “a rich picture” of the “multiple perspectives” that have framed understanding of empathy in social work internationally (Wong et al., 2014, p. 40), and identified areas for further research.

The categorization of studies illustrated how research on empathy in social work has been approached since the beginning of the 21st century. It highlighted the prominence of theoretical and quantitative approaches, and a relatively limited representation of empirical interpretive studies. The relative absence of perspectives of social workers and the complete absence of representation of people who engage with social work services is recognized as an issue of epistemic injustice (Fricker, 2007). Articulation of underpinning theoretical perspectives demonstrated the diversity and historicity of influences, and reflected the challenges identified in previous reviews relating to epistemological and theoretical complexity and confusion that threaten research activity and quality (Gibbons, 2011; Watson et al., 2022). There was an absence of framing of empirical studies by relational and social work theoretical approaches. Recognition of a persisting issue of conceptual fuzziness (King, 2011), and the close relationship of empathy with cognate concepts including non-judgment, care, sympathy, pity, and compassion (Gibbons, 2011; Nilsson, 2014) indicates the importance of further exploration to articulate meanings of empathy for practice contexts. Identification of an array of constructs within core affective, cognitive, and behavioral dimensions and the lesser-represented social dimension emphasized the complexities and barriers relating to researching hidden and relational elements of empathy, especially within the context of the “invisible trade” of social work practice (Pithouse, 1998), limiting application of research knowledge for practice. The shared emphasis across studies on the need to support social workers’ practice reflected the significance and complexities of empathy in social work. Potential pathways to support empathic practice development require further investigation, both focused on training (as outlined in Table 1) and in relation to wider organizational and policy contexts.

Conceptual model

The development of a conceptual model; “Relational and situated practice of empathy in social work” (Figure 1) represents a visual representation of current understanding of empathy in social work gleaned from the review. With a relational framing (Freedberg, 2007) and focus on empathic practice from the perspective of the social worker, the model depicts empathy as a core embodied practice between social workers and people who engage with social work services, with affective, cognitive, and behavioral dimensions. By including the broader organizational and policy contexts, and identified restricting and supporting elements, the model emphasizes the situated and social dimensions of empathic practice.

Figure 1.

Relational and situated practice of empathy in social work.

It is hoped that the model will be of value to members of research, policy, and practice communities who aim to develop relational empathic practice with people who engage with social work services.

Future research

The review identified areas of focus for future research. Firstly, research that extends review processes to explore the conceptual fuzziness of empathy, to include cognate concepts with an interdisciplinary perspective and deeper exploration of theoretical models and quantitative measures. Secondly, research that attends to underpinning theoretical perspectives, and enhances clarity and transparency, mindful of challenges that might exist for members of the international community for whom English is not a first language. Thirdly, with a focus on empirical studies, there is a need for research that broadens the dominant theoretical and quantitative positionings of empathy as an individual trait or skill, and includes a focus on broader organizational and policy contexts. There is a need to develop understandings of meanings and practices of empathy from the perspectives of social workers and people who engage with social work services; extend the focus on behavioral elements beyond verbal communication, and discover more about how to develop social workers’ empathic practice, including investigating its impact. The review provided support for a study that develops understandings of empathy within the context of child protection social work in England; characterized by an enduring need to support the development of social work practice including attending to emotional elements (Ferguson, 2016; FitzSimons & McCracken, 2020; Gibson, 2016; Munro, 2011; Ruch et al., 2018; Sebba et al., 2017).

Limitations of the review

Limitations related to pragmatic constraints. The specific focus on the construct of empathy in the discipline and profession of social work led to the exclusion of relevant sources, a broader set of constructs and focus on empathy in closely aligned professions and disciplines. A focus on plurality prevented a deeper review and synthesis, specifically in relation to theoretical models and quantitative measures. Future reviews might seek to achieve such a broader or deeper focus.

Conclusion

The review highlighted the complexities of the construct of empathy and the opportunities to develop new understandings. An outline of training to support practice development (Table 1) and a conceptual model (Figure 1), positioning empathy as a relational and situated practice, will be of value for application in research and practice. Further research is needed to develop understandings of meanings and practices of empathy by including the perspectives of social workers and people who engage with services.

Supplemental Material

sj-docx-1-jsw-10.1177_14680173251353087 - Supplemental material for A review of empathy in social work: A relational and situated practice with directions for further research

Supplemental material, sj-docx-1-jsw-10.1177_14680173251353087 for A review of empathy in social work: A relational and situated practice with directions for further research by Amy Lynch in Journal of Social Work

Footnotes

Acknowledgements

The author gratefully acknowledges support from Prof. Gillian Ruch and Prof. Michelle Lefevre during the study and Prof. Graeme Currie during the development of the article.

Ethical approval

Ethical approval for the study was granted by University of Sussex (AL643/01/02/03).

Funding

The author disclosed receipt of the following funding for the research, authorship, and publication of this article: Economic and Social Research Council (ESRC) South East Network for Social Sciences (SeNSS) Doctoral Training Partnership (Grant No. ES/P00072X/1) and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands (Grant No. NIHR200165). The views expressed are those of the author and not necessarily those of the ESRC, SeNSS, NIHR, or ARC.

Declaration of conflicts of interest

The author declares that there is no conflict of interest with respect to the research, authorship, and/or publication of this article.

Author’s Note

The literature review was conducted while the author was affiliated to the University of Sussex and the article was written while the author was affiliated to Warwick Business School, University of Warwick.

ORCID iD

Amy Lynch

Supplemental material

Supplemental material for this article is available online.

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