When Empathy Helps—and When It Hurts
Can being too empathetic be emotionally draining? Understanding the difference between affective empathy, cognitive empathy, and compassion may be the key to preventing burnout.
By Anna Wong and Corinne Kneis
Not all empathy is created equal. Affective (or emotional) empathy can leave clinicians drained, while cognitive empathy and compassion sustain us and our patients. Healthcare often celebrates empathy as the heart of good care. But when we absorb too much of a patient’s emotions, we risk burnout and blurred boundaries. Shifting toward cognitive empathy and compassion helps us stay grounded, preserve our energy, and guide patients more effectively.
How This Looks in Practice
Imagine a storm…
Affective empathy pulls you into the hurricane. You feel every gust and downpour. Your client’s storm becomes your own.
Cognitive empathy and compassion place you in the calm eye of the storm. From there, you can clearly see what your patient is experiencing and offer steady guidance, without losing your footing.
This distinction is critical: when we remain in the eye of the storm, we are close enough to connect deeply, but grounded enough to help effectively.
Types of Empathy & Compassion
Affective empathy = Feeling with.
This is the emotional resonance you feel when you sense another’s pain, grief, or fear. It’s why you might tear up during a sad movie or feel a knot in your stomach when a patient shares a traumatic story. Neuroscience links affective empathy to the brain’s mirror neuron system and the anterior insula — networks designed to mirror others’ states.
Affective empathy intensifies with relational closeness, similarity, and self–other overlap. When patients remind us of loved ones, share our age or background, or mirror our vulnerabilities, their storm can feel inseparable from our own. While this deepens rapport, it also increases the risk of empathic strain, over-identification, or blurred boundaries.
Cognitive empathy = Understanding with.
Here, you step into a patient’s shoes mentally while keeping one foot firmly planted in your own reality. You can recognize, “Of course they feel trapped after losing mobility,” without drowning in the feeling yourself. This allows for clear thinking, sound clinical judgment, and steady presence. Cognitive empathy is like keeping your footing in your own boat—close enough to understand, but balanced enough to steer.
Here, you step into a patient’s shoes mentally while keeping one foot firmly planted in your own reality. You can recognize, “Of course they feel trapped after losing mobility,” without drowning in the feeling yourself. This allows for clear thinking, sound clinical judgment, and steady presence. Cognitive empathy is like keeping your footing in your own boat—close enough to understand, but balanced enough to steer.
Compassion = Acting with care.
Compassion integrates understanding with the motivation to help. It’s what drives you to match strategies to a patient’s current capacity, advocate for their needs, or simply sit in silence so they feel less alone. Unlike affective empathy, compassion is energizing when grounded in self-awareness and self-compassion. It channels caring into sustainable action.
This is why what’s often labeled “compassion fatigue” is more accurately empathy fatigue. It’s not compassion that wears us down — it’s unregulated affective empathy.
Take-Away Action
Use the STORM tool to stay in the eye of the storm:
S – Situate: Notice whether you’re caught in their storm or in your calm center.
T – Touch base: Ground yourself with breath, posture, and sensory awareness.
O – Observe & name: Label emotions without suppressing them.
R – Respond with perspective: Offer guidance without trying to rescue.
M – Maintain presence: Let your caring come from steadiness, not overwhelm.
Just as storms are a natural part of weather, emotional storms are a natural part of human connection. As helping professionals, we cannot always avoid being near the storm, but we can choose how we meet it. The difference lies in whether we are pulled into the hurricane itself or remain steady in the eye of the storm.
References:
Bloom, P. (2016). Against Empathy: The Case for Rational Compassion. Ecco.
Bloom, P. (2017). Empathy and its discontents. Trends in Cognitive Sciences, 21(1), 24–31.
Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2013). Functional neural plasticity and associated changes in positive affect after compassion training. Cerebral Cortex, 23(7), 1552–1561.
Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current Biology, 24(18), R875–R878.
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Mazel.
Skovholt, T. M., & Trotter‑Mathison, M. (2024). The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self‑Care Strategies for the Helping Professions (4th ed.). Routledge. (Chapter 12: The Eye of the Storm Model of Practitioner Resiliency)
About the Authors
Anna Wong, PT, MScPT, MAPP
Anna is a physiotherapist, well-being educator, and founder of Clinician Wellness Hub. She is an adjunct lecturer at the University of Toronto. She develops training programs on positive psychology, behaviour change, and clinician well-being. For more info, visit: https://www.clinicianwellnesshub.com/
Corinne Kneis, LCPC, EdM, MA, MAPP
Corinne is a Licensed Professional Counselor specializing in anxiety, ADHD, relationships, life transitions, and grief. She holds Master’s degrees from Columbia University and the University of Pennsylvania, teaches in positive psychology, and offers trauma-informed, evidence-based care in person in Philadelphia and virtually across Pennsylvania and Maryland. For more info, visit: www.flourishtherapyservices.com.