On the Design Risks of Empathy Fatigue

In our previous research, we have studied technology interventions intended to support families and children living with HIV. We found that while family members’ have good intentions to offer ongoing and empathetic care, these actions can inadvertently cause distress for the children[4, 16]. For instance, special accommodations or additional health checks, meant to be supportive and understanding of the children's emotions, are often interpreted by the children as discriminatory. Here is one exemplary data point of a parent discussing their HIV-positive children's situation: “They start comparing themselves with other children at home: am I a ‘different’ person at our home? Why am I treated differently? Why is everyone worried about me? Why does everyone feel compassionate toward me? Why can't this be done for [sibling name]?” [16]. In this example, children, rather than (or in addition to) care providers may experience empathy fatigue as the recipients of too much unwanted empathy.

HIV is a lifelong health condition; children do not want to be continually reminded of their situation by overtly empathetic gestures. Such experiences contribute to their sense of being singled out and different from their peers, ultimately affecting their emotional well-being and sense of belonging. These stories underscore the delicate balance parents face in providing care and support while protecting their children's dignity and sense of normalcy. This highlights the need to train caregivers and families to refrain from continual expressions of empathy with childrens’ difficult situations, avoiding overemphasis or highlighting differences. HCI researchers working in this area should sensitize themselves to the experiences of these children in order to avoid designing technology supports that inadvertently evoke this empathy fatigue in children. Moreover, training provided to parents through technology solutions should promote supportive, understanding behavior that maintains children's sense of normalcy and inclusion—likely focusing more on positive empathy with children's normal day-to-day life events—while educating caregivers about the unintended consequences of negative empathy.

Our research has also investigated online health communities (OHCs) across platforms including CaringBridge (a health blogging platform for patients and caregivers sharing critical health updates with their known support networks) [24, 25, 26] and Reddit (a platform that hosts a diverse array of communities of anonymous users, including social support-specific communities for many mental and physical illnesses [20]).

The above scenarios pertain to the people receiving empathy in a chronic or potentially fatiguing or damaging way. However, another consideration involves those providing empathy. Sad moments have occurred in our chaplain interviews when some participants encountering specific subreddit communities for the first time were brought to tears by the profound despair evident in the comments and posts: “The heartbreaking piece for me was in the original post from this person who said that their parent wasn't letting them have mental health counseling. As many times as this person has asked for that, they're not getting it. So I felt a lot of reactivity to what's happening in the house, what's happening in just this. This person is a byproduct of broken systems in the house. I feel hopeless, I felt heartbroken. [crying]” (P14, a Buddhist chaplain) [ongoing work]. One participant even needed to stop viewing the subreddit immediately, due to an inability to provide aid to the user who posted a suicidal plan at a specific hour, which had already elapsed by the time the participant was viewing the post:“I'm not sure what to do with that one, can we go to the cancer [page]? That suicidal one [post] was really hard [disturbing]!” (P05, spiritual director at a Catholic parish) [ongoing work]. Another participant shared the painful experiences of nurses in a delivery unit who empathize with infants and their families: “For the nurses who are in the delivery unit, NICU especially, they get very, very attached [with babies] because they'll know them for several months and they develop a loving relationship. And then there become awful stories [if these babies die]. And so I do a lot of care for these nurses because they are deeply impacted when they lose a baby.” (P08, a chaplain with a Humanist perspective and working on a delivery unit) [ongoing work].

These instances highlight a critical issue: healthcare and spiritual care professionals, already facing burnout and lacking time for self-care, are stretched to their limits. As mentioned in the introduction, this context is the origin of the term empathy fatigue. Therefore, a significant challenge is determining the best way to manage care providers’ empathetic capacities wisely. Given the significant emotional investment required for interactions, it is crucial for caregivers to establish self-care practices and learn strategies for disengagement and recuperation. The same can be said for researchers engaged in challenging emotional research [33]. Our current project aims to offer design implications for building online spiritual care communities, with the primary goal of expanding access to spiritual care for patients. However, our designs must also respect the emotional limitations of the care providers who will need to maintain these communities. We need to explore whether there are methods of providing care that limit the draining of the emotional energy of caregivers. For instance, we are considering how to conceptualize a support model that emphasizes practical, logical, and effective solutions rather than demanding continual, intense, empathetic engagement. An important design goal should be to offer meaningful assistance to users while minimizing additional emotional burdens on care providers.

We advocate for a critical shift towards integrating pragmatism with our empathetic endeavors. This approach envisions a model of support that is emotionally resilient and practically effective, aiming to preserve the essence of empathy—the deep understanding and sharing in the feelings of another—while ensuring the methods employed do not strain the emotional well-being of the provider or burden the reipient. Practically, this implies adopting a balanced strategy that utilizes technology to offer tangible support (for example, through the provision of supportive gestures, resources, information, or actionable assistance) in a manner that complements rather than overshadows the emotional component of empathy. This balanced approach aims to refine how empathy is extended, ensuring it supports without overwhelming, connects without isolating, and empowers both providers and recipients to navigate their emotional landscapes more effectively. Systematic investigations should evaluate the efficacy of such integrated support models and aim to identify the optimal balance between emotional empathy and pragmatic support that can sustain the well-being of both recipients and providers over the long term.

From a design perspective, researchers should consider how sociotechnical and UI/UX features may induce empathetic experiences, and ensure that those empathetic experiences are well-balanced. This will require identifying clear metrics for evaluating the success of such models, including impacts on emotional well-being, accessibility of support, and sustainability for providers. Additionally, the design and evaluation of digital platforms and tools that support this balanced empathy model deserve attention, with a focus on features that mitigate the risks of empathy fatigue and promote sustainable caregiving practices.

Moreover, future studies should explore the development and implementation of training programs for caregivers, community members, and even researchers [33]. These programs should focus not only on the provision of empathy in a manner that conserves emotional energy but also on strategies for self-care. Potential strategies could involve: training in emotional resilience; establishing clear professional boundaries; and implementing supportive workplace policies that foster an environment conducive to both emotional health and professional productivity.

In this paper, we presented three case studies that delved into the intricate role of empathy in HCI in sensitive healthcare contexts including: children living with HIV; online health communities on CaringBridge and Reddit; and the burnout of spiritual care provider. In these cases, excessive empathy lead to fatigue, distress, or even harm for both recipients and providers of empathy. Thus, although empathy is essential for creating user-centered designs that foster inclusivity and understanding, we showed that it can also have unintended negative consequences if not carefully managed. We discussed these cases studies in light of the broader literature on positive v.s. negative empathy, and we suggested moving toward a pragmatic view of empathy that carefully balances positive and negative empathy to avoid empathy fatigue, as well future research that can support this integrated model. By embracing this dual approach towards empathy, design thinkers can more effectively leverage its benefits while guarding against its pitfalls. This balanced approach is crucial for creating tools and solutions that are not only innovative but also sustainable, ensuring that the field of design remains both human-centered and health-conscious.