Theoretically the concept of empathy includes four components: the cognitive, emotional, behavioral, and moral empathy. In empathy training it is challenging to develop the emotional and behavioral empathy. Empathy is about human interactions. If there is a lack of real interpersonal interaction experience in the learning process, students will face many barriers and gaps in practice in the future. Empathy is the ability to understand and empathize with people. It is the basic capacity of psychology students, and it is necessary to learn in actual interpersonal interaction.

Theatre-based training provide such an opportunity for students to “encounter with others” in class, that is, a chance to have real contact with their peers. There are some theatre-based training approach related to empathy learning such as “improvisational theatre” and “playback theatre”. These two kinds of theatre approach have developed various lively games and exercises that help train empathy in the process of training actors.

Many studies explored empathy in medical education through theatre-based technique mostly focused on effectiveness rather than process. Therefore, there is less research data on how students experience the teaching process and how empathy occurs.

In the past ten years, the authors have used theatre-based training to teach empathy in universities and hospitals. This crossdisciplinary innovative teaching method is fresh and interesting, and can also produce impressive learning experience. After establishing a cross-domain pedagogy, the question that the authors are curious to explore is how students learn about empathy in theatre-based training?

The subjects included sixty-four undergraduate students from three courses in Department of Clinical Psychology in Fu Jen Catholic University. The allotted time of empathy teaching sessions in the three courses were: four 2-hour sessions for “The Skills and Practice for Helping People”, four 3-hour sessions for “Expressive Arts Therapy”, and six 3-hour sessions for “Drama and Interpersonal Exploration”.

The faculties of “The Skills and Practice for Helping People” and “Expressive Arts Therapy” included the two authors and three theatre teachers. The three theatre teachers who specialized in improvisational theatre and playback theatre led the sessions respectively, and the two authors assisted and observed in these sessions. The sessions of “Drama and Interpersonal Exploration” were led by another theatre teacher and the second author, and these sessions were observed by the first author. The theatre teachers used the modified training exercises from playback theatre and improvisational theatre in these sessions. The authors collected data from students’ feedback questionnaire, reflection writings, and comments in Facebook group of the course. Qualitative research methods were used to analyze these data.

The results indicated four themes illustrating the possible pathways that empathy leaning may happen. (1) Through watching and listening: when the stories were enacted or other actions of peers displayed, students learn as observers to watch and listen to the peer’s story, their own story, the interaction between them and peers in the training exercises .The watching and listening process facilitated emotions and thoughts related to empathy. (2)Through body action: when students enacted as actors or interacted with each other through physical actions, they perceived with their body and had feelings inside. As if the exterior body theatre initiated the imaginative inner theatre. (3) Through mutual feedback: when students gave and took feedback mutually after watching, listening or body action, they also learned from each other. Taking feedback helped modify the understanding, enhance the sense of achievement and motives of empathy. Giving feedback helped clarify one’s own feeling, be appreciative of others’ empathetic behavior. (4) Through experience combing: when students narrated or wrote about the course experience, they reflected on the experience and constructed the meaning. Students stayed focus, integrated their feeling and thoughts, and made meaning of the course experience and past experience.

The four pathways are related to the four components of empathy: cognition, emotion, action, and morality. “Watching and listening” triggers students’ emotional resonance and cognitive understanding of the targets they are observing. The learning component includes both “emotional empathy” and “cognitive empathy”. “Body action” means that students directly practice “empathetic action” with their body movements. It is also easier to trigger physical sensations and resonance reactions by using the body to engage in interactive positions. Therefore, there are more of “emotional empathy” learning when students participate with their body action. “Mutual feedback “ allows students to learn as empathizers on the one hand and as being empathized on the other. Both positive mutual feelings are helpful to enhance students’ affirmation and motivation to practice empathy, which leads to the learning of “moral empathy”. “Experience combing” helps students integrate all the previous learning feelings and thoughts, and have a deeper meaning toward empathy in the four components of empathy.

We suggest educators aiming to teach empathy to design the curriculum in reference to these four pathways, especially the focus of “body action” could help students “get up and move” and learn from their actions instead of only learning from lecture. “Body action” is not necessarily a dramatic performance, but can be a simple exercise, such as retelling the story and gazing at each other’ eyes for few minutes. The key point is that after “watching and listening” and “body action”, teachers need to facilitate students to go through “mutual feedback” and “experience combing” in a way that students feel comfortable with. The focus of “mutual feedback” is to encourage students to give feedback in an appreciative way after the exercise. Teachers can use feedback questions such as “what is the part they have tried to do”, “what they have done well”, and “what they feel touched”, so that the feedback improves their confidence and motivation. The focus of “experience combing” is to encourage students to use group discussions or class writing methods to collect their feelings and thoughts, and to generate deeper meanings related to their own lives. When these meanings are intertwined with students’ lives, the course experience can create an impression and accumulate the energy for behavior change.

These four pathways point out that the characteristic of applying theatre-based training in empathy education is to trigger profound thoughts and emotional reactions through the observation of real story performance and interpersonal interaction, and through one’s own physical action experience, to clarify the empathy experience with peer feedback, and to reflect on the experience to obtain new learning meanings.

The insight and new understanding generated in the classroom will motivate students to change the way they interact with others outside the classroom, including their family or friends. This kind of application and change that continues outside the classroom is appealing to educators. If educators have the opportunity to continue the teaching of the last mile, they can successfully complete the fourth stage of Kolb’s experiential learning cycle—active experimentation. It is recommended that future courses explore the topic of application and practice. After all, transforming students from classroom learners to practitioners in life is the ultimate goal of education.

Further research is needed to focus on how the cultivation of empathetic classroom atmosphere and the focus of instruction influence empathy learning, and how to apply empathy learning experience in daily life.