Menka: Can you say a bit more about what you mean by healthy empathy? And now we have this distinction between empathy and compassion. So, what is the role of empathy, healthy empathy, and what is the role of healthy compassion?

Tania: Yeah, so as we said before, empathy… if we would not have empathy, we would be somehow sociopaths, right? We would have a real problem because then we really don't care. We don't feel anything with the other, so we don't even know that there's something to do, right? We are cold robots, right?

The social glue is missing, right? So the healthy empathy is about... You are suffering, I feel your pain, but I know that it's not mine, right? I have a very healthy distinction between me and you.

I'm totally aware that I'm vicariously now feeling it for you, but you are the source of the suffering, not me, right? When you move from this healthy empathic response, where you are clearly, that's me, that's her, she's suffering, I can feel how it feels, but I'm not... I'm clearly here, right? There is a clear distinction between me and you.

The self-other distinction, we call that. In empathic distress, it kind of blurs away. Very often, it can happen if, for example, you are perhaps having had a very big trauma, and you have a patient on the other side. Dealing with the same trauma, or similar trauma.

Through the empathic shared networks in the brain, it activates your own trauma, and then you start really getting into empathic distress, meaning you are really in self-distress. It's about you now. It's about your survival.

Menka: Can't help anyone in that situation, right?

Tania: In that situation, you are coping with your own distress. You have totally lost this healthy vicarious emotion distinction. You are in the wash machine, we always say, you have to cope. And so, typically, when people are in empathic distress, they're not very pro-social.

It would be, oh, leave me alone with your stress, because you don't want to feel it, right? It's too much. Or they start really becoming self-absorbed, because they have to cope with their own distress, right? Or burnout happens if you have empathic distress on a long, long, long one, right?

Like, repeatedly over months and months, burnout doesn't happen from one episode of empathic distress, right? But in healthcare providers, that's one reason for the burnout, for the high burnout rates.

Menka: Is that similar to what people describe as compassion fatigue?

Tania: Yes, and that's a problem, because in the time when compassion fatigue was coined in the late 70s, there was no distinction between empathy, empathic distress, and compassion, the whole biology behind it. It was early days, right? So, when they say compassion fatigue, what they mean is empathic distress.

Menka: The.

Tania: It's empathic distress. Yeah, exactly. You would have to call it empathic distress fatigue, but there was... so, because what Mathieu said when he came out of the scan, I will never forget, he said, you cannot burn out of too much love. And compassion is too much love, right? So, you can never burn out of too much love. Yeah.

Menka: Is the answer to switch from empathy to compassion when you feel like you're getting to the point of that distress?

Tania: Yes, exactly. It is to find, oh, wow, the healthy empathic response is over. And now I'm starting to see that I'm wrapped up too much in the clients' narrative, or suffering, or whatever. And then, if you have learned how to switch in the other system, it's a total...

it's a care system, right? It's evolutionary. Affiliative care system. It's a system which allows us to bond with our children as father, as mother.

And also to form long-time bonds, trust, it's a very resilient system, right? Because it is purely altruistic, it's really about the welfare of the other. It's a very resilient system. So if you know how to switch into the system, then you protect yourself and the other, right?

And you protect yourself from running into distress.