Cross-Cultural Empathy: The Impact of an Undergraduate Play Therapy Course ()
1. Introduction
For many students, college provides ample opportunities for cross-cultural experiences. Apart from residing and studying alongside peers from various regions within the country, students may also find themselves in the company of classmates from diverse corners of the globe. The United States stands out for hosting the highest number of international students globally. According to the 2023 report jointly released by the Institute of International Education and the U.S. Department of State’s Bureau of Educational and Cultural Affairs, new international student enrollment experienced a remarkable surge of 14% in the 2022-2023 academic year. This increase comes on top of the significant 80% rise observed in the previous year. For first-year U.S. college students, a lack of prior exposure to different cultures can contribute to a limited understanding of alternative viewpoints. Given that undergraduate students are typically transitioning from adolescence, a stage characterized by egocentrism, it becomes particularly crucial to facilitate their progression from self-centered perspectives to an appreciation of diverse viewpoints (Nelson & Baumgarte, 2004). Developing empathy plays a vital role in this transformative journey.
1.1. Empathy and Child-Centered Play Therapy
Empathy is considered to involve both cognitive and affective understanding of another person’s experience (Tenglund, 2001). Rogers (1985) defined empathic understanding as a process of “entering the private perceptual world of the other and becoming thoroughly at home in it...being sensitive, moment to moment, to the changing felt meanings which flow in this other person” (p. 4). In this study, the researchers opted to utilize child-centered play therapy’s (CCPT) incorporation of empathy as a foundational approach for teaching and assessing empathy moving forward. In CCPT, empathy is defined as being open and sensitive to the child’s experience and able to enter fully into the child’s world (Cochran, Cochran, Nordling, McAdam, & Miller, 2010; Landreth, 2012), as well as always understanding a child’s behavior “…by looking through the child’s eyes,” (Landreth, 2012: p. 62). CCPT requires adults to avoid leading, judging or questioning the child’s behavior and, instead, to follow the child’s lead with thoughtful reflection of the child’s actions, thoughts and feelings. Taking the perspective of the child requires adults to step away from themselves and enter the child’s phenomenological world. This departure from the typical adult-child interaction patterns helps to create a space for a more focused effort to empathize. This approach has also been found easily transferrable to other populations other than children (Baggerly, Ray, & Bratton, 2010; Landreth & Bratton, 2019).
1.2. Child-Centered Play Therapy Research
Research on the benefits of CCPT has revealed myriad academic, social and personal benefits for child clients (Bratton, Ray, Rhine, & Jones, 2005; Blanco, Ray, & Holliman, 2012). Bratton, Ray, Rhine, and Jones (2005) conducted a meta-analysis of CCPT and found that among individual studies, a CCPT intervention was “equally effective across gender, age, and presenting issue” (p. 385). In addition to its therapeutic benefits for clients, CCPT has also proven beneficial for those learning and practicing the concepts and skills associated with the approach. Crane and Brown (2003) found substantial gains in students’ levels of empathy towards the children they practiced play therapy skills with. Two additional studies on CCPT in examined its effectiveness with Chinese parents and found a significant increase in parents’ empathic interactions with their children, as well as increases in parental levels of acceptance towards their children (Chau & Landreth, 1997; Yuen, Landreth, & Baggerly, 2002). Other studies on CCPT with Korean and Native-American parents saw increases in parental empathy and communicating acceptance to their children, as well as increases in positive child behaviors (Jang, 2000; Glover & Landreth, 2000). Vavreck and Esposito (2012) found that fifth graders who learned basic CCPT skills reported an increase in patience with their younger siblings, as well as increased empathy for their teachers. These important gains in empathy and acceptance in relationships prompt a closer look at the potential for CCPT skills to transfer to other human encounters, and especially cross-cultural ones. Because of CCPT’s emphasis on responding empathically to children, along with its prior success in increasing empathy for those who learn it, the authors of this study wanted to determine if learning CCPT would help to increase cross-cultural empathy among undergraduate students.
2. Method
Procedures
The undergraduate play therapy course consisted of 19 students enrolled, the majority of whom were majoring in human services. The course met 3 times per week for 70 minutes each class period. The focus of this introductory course was on basic theory and practice of CCPT. The CCPT skills learned in the course included reflecting the child’s feelings, actions and thoughts, avoiding questions, avoiding labels, and setting limits. Using Landreth’s (2012) Play Therapy: The art of the relationship as the main text, these CCPT skills were taught through modeling by the professor, role-playing with classmates, and reading case examples of play therapy sessions. Additionally, students completed 25 hours of service in the local community working with 3 and 4-year old children from lower income families. During their service hours, students practiced their CCPT skills during interactions with the children. The students also reflected on their service-learning experiences in journal entries and class discussions.
To assess students’ growth in cross-cultural empathy, the students were given pre- and post-test vignettes, adapted from Nelson and Baumgaurd (2004). The vignettes discussed either a work-related or friendship-related scenario, in which the target person’s response to the event assumed a perspective inconsistent with U.S. norms. The pronouns in the vignettes were edited so that the main character “Lee” matched the personal gender identified by the reader in demographic surveys completed earlier. We chose to give each participant two vignettes (one pre-test and one post-test), each of different cultural dimensions. Students who received a work-related vignette for the pre-test received the friendship-related vignette for the post-test and vice versa. The vignettes read as follows:
Work-Related Vignette.
For almost a year, the accounting division of XYZ company had been plagued by unsatisfactory performance and low employee morale. A new supervisor, Lee, was put in charge of the division and he worked diligently to turn things around. In the quarter following his appointment, output increased sharply and the work group began operating like a cohesive team. It was clear that Lee’s hard work and innovative management approach was responsible for the positive changes. At the company’s annual banquet, Lee was singled out and given an award to recognize his hard work. Lee was mortified by the individual attention and wondered why the division as a whole was not recognized for their success. The incident left Lee feeling depressed and dissatisfied at work.
Friendship-Related Vignette.
Lee was generally pleased with her first weeks back at the university after the summer break. She had met a new friend, an exchange student from another university. They were spending nearly every moment of their free time together, and were becoming very close. Lee enjoyed introducing her to family and other friends, and taking her around to all of the interesting places near campus. She was certain their friendship would continue even after her new friend had to return home at the end of the school year. Recent developments in their friendship, however, were causing Lee some concern. Her friend had the habit of talking and being friendly to everyone she met. It was clear that she was very popular with everyone on campus. Lee was beginning to feel somewhat anxious about the future of their friendship.
The researchers devised five open-ended questions for students to address after reading each vignette. These questions target various dimensions of empathy, including relating to another person, avoiding passing judgement or assigning blame, and encouraging reflection on one’s own feelings in response to another person. The questions were as follows:
1) How similar do you think you are to Lee?
2) Do you think Lee was to blame for his or her bad feelings? Why or why not?
3) How much of Lee’s distress was due to the unpleasantness or difficulty of the situation?
4) Do you feel that Lee’s emotional reaction was appropriate for the situation? Why or why not?
5) What emotions did you feel while reading this vignette?
The researchers ranked the empathic behaviors in order of levels of empathy, using some of the constructs from Wang et al.’s (2003) Scale of Ethnocultural Empathy. Figure 1 shows the levels of empathy as a triangle with five layers, each conveying more empathy than the last:
Working upward, the framework begins with Referencing a similar experience to another’s. In this lowest level of written empathy, the subject writes that they have experienced something similar to the target’s current experience. However, they remain in their own frame of reference in this experience, rather than trying to understand the target person’s experience. The next level of written empathy is Attempting to understand or rationalize the thoughts and feelings of another. This type of empathy can be seen when the subject uses their writing to try to understand the target, but still misses some nuances of the target person’s subjective experience. The subject may also try to rationalize the thoughts and feelings of the target by creating a backstory to help explain the targets’ thoughts and feelings. This is considered a lower level of written empathy because it is
Figure 1. Jordan & Folmar’s (2018) written expression of empathy model.
based on assumptions, rather than the actual experiences of the target. The third level of written empathy is Understanding the thinking and/or feeling of another. The subject writes that they understand the target’s thinking or feeling, but they do not fully experience those thoughts and feelings as their own. This differs from the second highest level of written empathy, Perceiving the world as someone else does. In this level, the subject states that they not only understand the target, but actually expresses that they are viewing the world and situation in the same way as the target. This level of written empathy focuses on expressing a similar thought process to that of the subject. The highest level of written empathy is Feeling the other’s emotions as their own. At this top level of written empathy, the subject takes on the emotional perspective of the target and feels the same emotions as the target.
Using the above framework, the researchers compared the student’s written responses to the cross-cultural vignettes from the beginning of the course to those written at the end of the course in order to determine if there were any changes related to cross-cultural empathy. The two researchers, in collaboration with a third coder, analyzed the responses to identify dominant themes. Subsequently, they convened to discuss and reach consensus on the final themes emerging from the students’ responses.
3. Results
3.1. Before CCPT
In the responses to the vignettes distributed on the first day of class, students’ written expressions of empathy remained at the lowest levels, and in some cases, their responses lacked empathy entirely. For example, in the first question: How similar do you think you are to Lee?,” student responses varied in how similar they felt to Lee, however, what was interesting was how they explained their similarities or differences. One student wrote: “I’m similar because I think credit should be given to everyone.” This would qualify as the lowest form of empathy, referencing a similar experience to another’s. Another interesting response to this question was: “I think I have some potential to be like Lee, however I am comfortable with myself and friendships.” This response would also be considered the lowest form of empathy, but also implies passing some judgement on Lee as being uncomfortable with his- or her-self and friendships. A third student wrote: “I would say I am not similar to Lee because her reason for being upset is not a good one”, which is lacking empathy entirely, and includes some judgement. Instead of considering potential reasons for Lee’s emotions, from Lee’s perspective, this student seemed to compare Lee’s reaction to how he or she would have personally reacted, concluding that Lee’s response was therefore not a good one.
Question 2: “Do you think Lee was to blame for his or her bad feelings? Why or why not?” prompted students to grapple with who or what is to blame for Lee’s situation. Most students wrote that Lee was not to blame for his or her feelings at the beginning of the semester. However, there was no evidence of students attempting to understand why Lee might have felt the way he or she did, or attempting to feel the thoughts and feelings of Lee. These responses did not meet the criteria for empathic.
Question 3: “How much of Lee’s distress was due to the unpleasantness or difficulty of the situation?” yielded some interesting responses. Most students did not consider Lee’s situation difficult. Some of the responses included: “the situation was not difficult because she was awarded for her good deeds” and “there was no unpleasantness…because recognition is something that most people pursue.” These statements demonstrate the students were viewing this situation through the cultural lens of U.S. norms, where it is a widely held belief that a person’s individual achievements should be honored. These responses would be considered the second level of empathy, because, although the students were attempting to understand the situation, they were not viewing it from Lee’s perspective at all. They maintained their cultural views and therefore saw the situation as a positive one, versus how Lee appeared to see it.
When students were asked Question 4, if Lee’s reaction was “appropriate”, the majority of students disagreed with her response. In fact, students wrote statements such as “she shouldn’t have been so upset.” There were also instances of students writing what Lee’s emotional reaction “should” have been. For example, one participant wrote: “In the moment, gratitude would have been more appropriate.” Another student wrote that Lee’s emotional reaction was “a little extreme” and that she “completely over-reacted.” These responses were considered non-empathic, since they completely negate Lee’s behavior as inappropriate and over-reacting.
The final question, Question 5, asked participants “What emotions did you feel while reading this vignette?” The emotions that students reported feeling ranged from “pity” to “confusion” to “annoyed.” None of these responses were coded as empathic, since they failed to mirror any of Lee’s feelings in the vignette.
3.2. After CCPT
In the students’ responses at the end of the semester, we noticed references to Lee’s cultural background as possible explanations for behavior, more efforts to consider a potential backstory for Lee, i.e. “maybe she had gone through a break-up recently and therefore was sensitive to this issue”, and more instances where students refused to pass judgment. For example, in question 1: How similar do you think you are to Lee? We saw more students indicating that they felt similar to Lee, and fewer instances where students passed judgement on Lee. Instead, the respondents tended to simply answer the question about how similar they felt without stating that Lee was wrong or that he or she had over-reacted to the situation. This would be considered the lowest form of empathy, however, it was interesting to see fewer judgmental responses to Lee’s behavior.
For question 2: Do you think Lee was to blame for his or her bad feelings? Why or why not? students seemed to come to Lee’s defense at the suggestion of Lee being blamed for his or her feelings. An example of this is when one student wrote: “I don’t think you can blame anyone for these types of feelings because they often can’t be helped.” Another student said: “I don’t think anyone should be invalidated in their feelings.” While these responses do not exactly fit the levels in the model above, they do indicate a refusal to pass judgment, as well as an implied rationalization of Lee’s feelings. This was an important change to see, as these ideas simply were not present in the responses written at the beginning of the course.
Similarly, student responses at the end of the semester showed that multiple students created a backstory or explanation for Lee’s reaction. One student wrote, “She had seen the department put in hard work that complimented her own and she saw them not recognized…she wanted them to be credited their hard work as well.” This response showed that the participant clearly understood how Lee was feeling and was perceiving the situation in a similar way. Another stated, “She has issues in establishing social relationships… She overcame a barrier of making a new friend.” This was viewed as the third level of empathy because they are trying to understand Lee’s thoughts and feelings in the vignette.
Question 3: “How much of Lee’s distress was due to the unpleasantness or difficulty of the situation?,” also yielded some interesting responses. Students wrote about the potential unpleasantness and difficulty of the situation in more thoughtful ways, including: “I think the stress had a large part to do with the difficulty of the situation”, “I think most of [Lee’s response] was related to the unpleasantness”, and “I think the unpleasantness of the situation contributed to all of [Lee’s] distress.” These responses fit with the second and third levels of empathy, with students attempting to understand, and in some cases, believing that they understood, Lee’s reaction to the situation. Another participant wrote, “Accepting the award is like accepting the fact that she did the work without the help of anyone else.” This student went beyond reflecting what was written in the vignette and showed evidence of grappling with Lee’s dilemma, a strong indicator of empathy. The students were clearly thinking more about Lee’s situation and remaining open to the influence of outside factors on the situation, rather than just blaming Lee for her own responses. They were grappling with subtleties and nuances of the situation, noting how stress and discomfort could be related to each other.
For question 4, when students were asked if Lee’s reaction was “appropriate” or not, fewer participants invalidated Lee’s emotions and more students refused to pass judgment on Lee’s emotions. One student wrote very simply, “It is how she feels...period.” Another student stated, “I don’t think anyone should be invalidated in their feelings, whether you believe they are rational or not.” These responses were similar to the ones for Question 2, with students coming to Lee’s defense, noting that people’s feelings are their own. And, while the students did not elaborate or attempt to understand or experience Lee’s feelings as their own, their protective response to her feelings is encouraging, and another important change from the beginning of the course.
As noted previously, at the beginning of the course there were instances of students writing what Lee’s emotional reaction “should” have been. At the end of the course, however, this type of judgment occurred less frequently, and those responses still showed more understanding of Lee’s experience. For example, one student wrote in response to Lee’s unexpected award, that “He could have accepted the attention, then use that time to shine light on everyone that contributed to the company’s success”, highlighting their understanding of Lee’s situation. This response would be considered the fourth level of empathy, perceiving the world as someone else does, because, the student was considering potential courses of action that aligned with Lee’s desire to recognize his co-workers’ efforts.
Interestingly, consideration of Lee’s cultural background occurred only at the end of the course. One student wrote “I think Lee’s distress may have stemmed from cultural differences.” Another student took it a step further and wrote “I don’t think Lee is to blame for the bad feelings… I think Lee has been raised differently from most other people, but probably in a positive way.” While there were only two responses of this type, and both of these statements would be considered lower levels of empathy (the second and third levels), it was encouraging to see culture emerge in the students’ writing as a potential explanation for Lee’s behavior.
For question 5, some students were still unable to explain Lee’s perspective and expressed “confusion” or other non-empathic emotions. However, a response that came up more often on the post-test was “proud”. One student shared that they were proud because Lee was “accomplishing her goal.” While this is not an entirely accurate empathic response, this student was attempting to understand Lee and was more positive towards her. Another student wrote that they were proud because “Lee wasn’t accepting all of the credit for changes other people made too.” This response communicated a high level of empathy because this participant understood why Lee was not accepting the award and was able to feel the same emotional reaction at Lee. This response was considered the highest level of empathy, Feeling the other’s emotions as your own. Another student wrote that while reading the vignette she felt “emotions of sadness.” This reflects the way Lee appeared to be feeling in the vignette and demonstrates the highest level of empathy towards Lee as well.
4. Discussion and Implications for Future Research
While many of the changes in student writing over the course of the semester were subtle, the researchers were encouraged by the overall increase in empathic responses to the vignettes. The fact that students were considering Lee’s backstory and culture as potential explanations for behavior was indicative of the students’ efforts to understand, rather than to judge Lee. It was also encouraging to see students come to Lee’s defense, even if they did not feel the same way Lee did. Still, we cannot know for certain which factors influenced the students’ increase in empathic responses. After all, students who were studying CCPT were also taking other courses, doing service with local children and families, and involved in other activities. While we cannot determine if the CCPT class was the reason for this change in responses, this research warrants a closer look at CCPT’s potential for increasing empathy for diverse populations. The empathic skills learned in CCPT may be transferrable to a wide range of other situations. Anecdotal reports from students supported this possibility, as several shared at the end of the course that they had noticed an increase in their own understanding of others and efforts to empathize with other people’s circumstances.
Intentional, targeted written assignments related to students’ use of CCPT may have the potential to prompt students’ authentic examination of their own levels of empathy. For human services students especially, the ongoing development of empathic skills is invaluable. Future research may explore other methods of teaching and assessing cross-cultural empathy among students, as well as focus on other opportunities for written expressions of empathy and how these practices may transfer to other areas of students’ lives.