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Inspiration: Episode #: Episode 20 | Partners in Pain (Part II) – Empathy as a Skill Set of the Mind Your Body podcast with Dr. Nevo.

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TL;DR: Empathy is a learnable skill, not a fixed personality trait. Nursing scholar Theresa Wiseman identified four teachable attributes of empathy. When partners of people in chronic pain practice these, they can directly support nervous system regulation and reduce pain. Caregiver burnout comes from practicing the wrong kind of empathy. There is a better way.

At a Glance

• Empathy has four learnable attributes: perspective taking, staying out of judgment, recognizing emotion, and communicating understanding [2]

• Cognitive empathy (understanding without absorbing) is sustainable. Affective enmeshment is not.

• Your regulated nervous system is a biological intervention for your partner’s pain [3]

• The phrase “What can we do?” signals partnership to the nervous system in ways “What can I do?” cannot

• Caregiver burnout is a biological consequence of enmeshment, not a character flaw

Partners of my chronic pain patients often say some version of this: “I’m just not a naturally empathetic person.” They say it with resignation, as if empathy were eye color, something you’re either born with or you’re not. I want to challenge that directly, because it’s one of the most damaging beliefs I encounter in my work.

Empathy is a skill. Like any skill, it can be learned, practiced, and refined. That distinction matters enormously, because it means the partner sitting across from me in my office, the one who feels helpless watching their loved one suffer, has room to grow. And their growth can meaningfully change the trajectory of their partner’s pain.

In Part I of this series, I wrote about how chronic pain reshapes a relationship, and how the person without pain often carries a silent grief of their own. This piece is about what to do with that. How do you show up in a way that helps rather than harms? How do you offer presence without absorbing the suffering? The answer starts with understanding what empathy actually is.

Empathy Is a Learnable Skill

Brené Brown, whose work has shaped how I talk with patients and families about connection, defines empathy this way: “Empathy has no script. It is simply listening, holding space, withholding judgment, emotionally connecting, and communicating: you are not alone.” [1]

Notice what’s missing from that definition. There’s no requirement to fix anything, solve anything, or fully understand every detail of another person’s experience. The mechanism of empathy is presence, not performance.

Brown builds her framework on the research of nursing scholar Theresa Wiseman, who identified four attributes of empathy [2]. When I teach partners how to support someone in chronic pain, these four attributes are where I start. They’re learnable. They’re practicable. They change what happens in the room.

The Four Attributes of Empathy

What Are the Four Attributes of Empathy?

1. Perspective taking. This is the cognitive ability to see the world through someone else’s eyes. It’s about understanding, not agreement. You don’t have to validate a version of reality that feels hard to accept. You have to understand it.

The practice starts with open-ended questions. “What is that experience like for you?” is a good one. My patient Sarah, whose story runs through this series, taught her partner what she calls the golden question: “What does your body need today?” That single sentence honors her as the expert on her own experience. Her body is a source of information she’s learning to read, not a problem to be diagnosed by someone else. When her partner asks that question, he steps into her world instead of pulling her into his.

2. Staying out of judgment. This one is harder than it sounds. Judgment shows up in small, well-intentioned ways. “Have you tried working out?” “You’re always overstimulated.” “But you look fine.” Each of those sentences, however kindly meant, carries the same message: your experience doesn’t match what I expect, so I’m questioning it.

Sarah told me once: “I feel like he forgets that I am younger and sometimes expects me to be healthier because I am younger.” That’s judgment operating quietly in the background. An assumption about what her body should be doing based on a number.

Staying out of judgment means accepting someone’s experience as real without needing to understand it, explain it, or fix it. You don’t have to know why the pain is worse today. You just have to accept that it is.

3. Recognizing emotion. This is emotional intuition, and it’s the attribute partners most often tell me they feel they lack. It’s teachable. It starts with paying attention to what’s nonverbal.

Sarah’s cues are specific and readable once you know what to look for. She shifts positions constantly when she’s in pain. She goes quiet and isolates, saying “Oh, it’s okay” in a flat voice. She’ll say directly, “I’m very overstimulated right now.” She crashes hard, passing out on the couch at five in the afternoon.

Her four-year-old son has already mastered this. He looks at her and says, “You okay, Mom? I’ll just be right here with you.” He’s reading her nervous system before his conscious mind has any framework for doing so.

From a polyvagal perspective [3], what he’s picking up on is the difference between sympathetic activation (agitation, restlessness, irritability) and dorsal vagal shutdown (withdrawal, numbness, dissociation, extreme fatigue). His neuroception, the automatic threat-detection system in his nervous system, catches the shift in hers even when she’s masking with words. Adults can learn to do the same thing. It takes attention and practice, nothing more exotic than that.

4. Communicating that understanding. This is where partners freeze, afraid of getting it wrong. Being a little off is okay. The attempt to understand, and the willingness to be corrected, is what creates connection. You don’t have to nail the interpretation. You just have to try, and stay open when you miss.

Physical touch matters here too. Placing a hand on someone’s forearm during a difficult moment triggers oxytocin release [4]. Research shows a partner’s touch on the forearm produces higher oxytocin levels and is rated as significantly more pleasant than touch from a stranger. The body does work the words alone can’t.

Sarah’s ideal response from her partner during a flare is often wordless. A hand on her arm. A quiet “Do you need me to run a bath?” Taking over dinner or bedtime without being asked. These are all ways of saying: I see you, and I’m here.

Key Point: The four attributes of empathy are cognitive tools, not personality traits. Practicing them changes the relational experience of chronic pain.

The Golden Question: What Can We Do?

Why “What Can I Do?” Falls Short

There’s one sentence I want every partner of a chronic pain patient to learn. “What can I do?” sounds caring, but it hands the entire problem back to the person in pain and asks them to manage their own care logistics. That’s exhausting when you’re already exhausted.

“Let me know if you need anything” is too vague. It puts the burden of asking on someone who often doesn’t have the bandwidth to identify what they need, let alone name it.

The question that works: “What can we do?”

That one word, “we,” shifts the whole frame. It’s partnership language. It says: you’re not carrying this alone, I’m in it with you, we’ll figure it out together. A small linguistic change with a measurable nervous system effect.

Key Point: Language signals safety or threat to the nervous system. “We” activates co-regulation. “I” or vague offers can reinforce isolation.

Cognitive Empathy vs. Enmeshment

Why Caregivers Burn Out (and How to Stop)

I need to draw a careful line here, because too many caregivers collapse under the weight of empathy practiced incorrectly.

Brown distinguishes between two neurological systems that get lumped together under “empathy” [1]. Cognitive empathy is perspective taking. You understand what someone else is feeling without needing to feel it yourself. This is sustainable. You can offer it every day for years.

Affective empathy, sometimes called enmeshment, is absorbing the other person’s emotion as your own. When you enmesh, your brain’s pain centers actually light up. You are, neurologically, in pain alongside them. That’s not sustainable.

Compassion works differently. It’s action-oriented, and it activates the brain’s reward centers. Doing something for someone you love, even something small, feels meaningful even when the situation is hard. That’s a workable fuel source.

A person drowning alongside someone else can’t function as their anchor.

To every caregiver reading this: caregiver burnout is not a moral failure. It’s a biological consequence of enmeshment. If you’ve been running on empty, resentful, so depleted you barely recognize yourself, you haven’t failed as a partner. You’ve been practicing an unsustainable form of empathy. The way forward is to stop absorbing and build boundaried cognitive empathy instead.

Key Point: Enmeshment is neurologically costly. Cognitive empathy is the sustainable alternative, and it can be learned.

Your Nervous System Is the Intervention

How Co-Regulation Works in Practice

Most partners of chronic pain patients don’t know this, and learning it tends to change everything.

Your nervous system affects your partner’s nervous system, and theirs affects yours. This is co-regulation [3], and it’s biological, not metaphorical. One regulated nervous system can help stabilize a dysregulated one. Mothers do this for infants. Skilled therapists do this for anxious patients. You can do this for your partner during a pain flare, once you know how.

There’s a catch. You can’t co-regulate someone else when your own nervous system is dysregulated. Walk into the room anxious, frustrated, or shut down, and your nervous system broadcasts that state. Theirs picks it up. This is what played out between Sarah and her partner for a long time. His discomfort with her pain registered as threat. Her pain increased. His discomfort deepened. A cycle that fed itself.

Breaking it starts with you. Four steps:

1. Check your own state first. Ventral vagal is safe and calm. Sympathetic is anxious, activated, frustrated. Dorsal is shutdown, numb, withdrawn. Regulate yourself before entering the room. That might be a few slow exhales in the hallway. Two minutes outside.

2. Offer your regulated presence. Your calm state is the intervention. You don’t need to say the right thing. You need to be in the right state.

3. Use ventral vagal cues. Soft eye contact, a relaxed face, open posture, a calm voice, gentle touch. The other nervous system reads these signals of safety automatically.

4. Honor the window of tolerance. During a pain flare, that window shrinks. Reduce stimulation. Simplify decisions. Skip asking them to pick dinner or choose a movie. Create calm in the environment.

Key Point: Regulated presence is a clinical-grade intervention. Your nervous system state is information your partner’s body receives and responds to.

Riding the Wave Together

How to Be Present on Good Days and Bad

Sarah said something recently I keep returning to. “There is constant change. People don’t know how to ride that wave.”

She’s right. Chronic pain isn’t a straight line. It moves, sometimes gently, sometimes hard. Partners often try to control that movement. That’s not possible.

The shift is this: the goal isn’t to control the wave. It’s to ride it alongside the person you love.

On good days, be in them. Sarah described a day at Disneyland where her partner kept asking: “Are you flared? Can you walk up this hill? Are you sure?” His anxiety, however loving, reinforced her hypervigilance and turned a good day into something she had to pass. Good days are not audits.

On bad days, stay. You don’t need anything wise to say. Sit next to her. Put a hand on her arm. That’s it.

In Part III of this series, I’ll get into what ties all of this together: compassion paired with boundaries. Loving someone through chronic pain takes both, and neither holds up well without the other.

Key Point: Chronic pain is non-linear. The partner’s role is consistent presence, not outcome management.

Frequently Asked Questions

Can empathy really be learned, or is it more of a natural ability?

Empathy has teachable components. Theresa Wiseman’s research identified four specific attributes, all of which are cognitive and behavioral skills that can be developed through practice [2]. Natural inclination varies, but the skill itself is accessible.

What is the difference between cognitive empathy and emotional enmeshment?

Cognitive empathy means understanding someone else’s emotional experience without absorbing it as your own. Enmeshment means their emotion registers neurologically in your own brain’s pain centers. Cognitive empathy is sustainable long-term. Enmeshment leads to caregiver burnout [1].

How does my nervous system state affect my partner’s pain?

Through a process called co-regulation [3], one person’s nervous system state influences another’s. A regulated, calm nervous system can help stabilize a dysregulated one. The reverse is also true: an anxious or shut-down partner can amplify a pain patient’s threat response, which can increase pain perception.

What should I say to a partner in a pain flare?

Often, less is more. Physical presence matters more than words. A hand on the forearm, which triggers oxytocin release [4], a calm voice, and a simple offer like “Do you need me to run a bath?” tend to be more regulating than lengthy reassurances.

Why does “What can I do?” feel unhelpful to someone in chronic pain?

It places the cognitive load of identifying, articulating, and requesting help on the person who is already depleted. “What can we do?” distributes that load and signals partnership rather than delegation.

Is caregiver burnout a sign that someone doesn’t love their partner enough?

No. Caregiver burnout is a neurobiological consequence of sustained enmeshment, absorbing a partner’s pain as your own. It has nothing to do with love. The remedy is shifting from affective enmeshment to boundaried cognitive empathy.

What are ventral vagal cues and why do they matter?

Ventral vagal cues are signals of safety the nervous system reads automatically: soft eye contact, relaxed facial expression, open posture, calm voice, gentle touch. When a caregiver offers these consistently, the chronic pain patient’s nervous system can begin to down-regulate its threat response, which supports pain reduction.

Key Takeaways

• Empathy is a skill with four learnable attributes: perspective taking, non-judgment, recognizing emotion, and communicating understanding [2]

• Cognitive empathy (understanding without absorbing) is sustainable. Enmeshment is not.

• Your nervous system state directly influences your partner’s nervous system, making your regulated presence a real intervention [3]

• “What can we do?” signals partnership. Vague offers signal distance.

• Physical touch, specifically forearm contact, triggers oxytocin and supports nervous system co-regulation [4]

• Caregiver burnout is a biological consequence of enmeshment, not a failure of love or effort

• On good days and bad, consistent presence is the entire assignment

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About the Author:
Dr. Zev Nevo is a double board-certified physiatrist, chronic pain survivor, and founder of the Body & Mind Pain Center. He helps people with persistent pain rebuild capacity and confidence using an evidence-based, trauma-informed mind-body rehabilitation approach.

Listen: Mind Your Body Podcast
Learn & Join: Mind-Body Rehabilitation Community
Visit the Clinic: Body & Mind Pain Center

Medical Disclaimer:
The information in this article is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. New or changing pain symptoms should always be properly evaluated by a medical professional.

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References

[1] Brown, B. (2010). Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. Gotham Books. brenebrown.com

[2] Wiseman, T. (1996). A concept analysis of empathy. Journal of Advanced Nursing, 23, 1162–1167. https://doi.org/10.1046/j.1365-2648.1996.12213.x

[3] Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton & Company. amazon.com

[4] Uvnäs-Moberg, K., Handlin, L., & Petersson, M. (2023). Oxytocin and social touch: context matters. eLife. Linköping University & University of Skövde. pmc.ncbi.nlm.nih.gov