Beyond Positivity: Why Attunement Matters More In Healthcare

Quick take

Have you ever felt like a health professional was being friendly, but not really present? That’s the issue at the heart of this blog. While positivity is often encouraged in healthcare, it can become a surface-level performance – especially when professionals are stressed or rushed. Toxic positivity may look cheerful but can leave clients feeling unseen.

That’s why we need attunement instead: the ability to truly tune into someone’s emotional state and respond with empathy. Attunement means slowing down, listening, and adapting to what the client needs in the moment.

It’s not about always being upbeat – it’s about being present. Making small shifts like pausing, listening, and creating space for real emotions may lead to deeper connection and better care for clients.

A culture of positivity

Have you ever had a health professional greet you with a cheery “Hello!” – but something felt off? Maybe their tone was upbeat, but their eyes were glazed over, their body was turned away, and their next task was clearly top of mind. You sensed they weren’t really listening. It was positivity, yes – but it felt hollow.

This kind of interaction is surprisingly common in healthcare. Many health professionals and workplaces are trained into a culture of positivity. We’re implicitly taught to smile, to be upbeat, to keep things light. It’s the ‘good vibes only’ approach, where difficult emotions are quietly discouraged, and discomfort is smoothed over with a spoonful of sugar.

But what happens when positivity becomes a performance? When it’s used to bypass real connection, or to protect ourselves or protect the system from the emotional weight of our work?

The problem with “busy positivity”

In the literature, this phenomenon is often referred to as toxic positivity – the tendency to suppress or deny negative emotions in favour of relentless optimism (Cross, 2022; Michailidou, 2023). While positivity may be helpful in moderation, or maybe helpful for some people, it becomes toxic when it invalidates real feelings or pressures clients to ‘look on the bright side’ at all times, at all costs. Not surprisingly, this type of emotional suppression and forced gratitude has also been linked to poor outcomes for health professionals, including feelings of burnout (Shipp & Hall, 2024).

In healthcare, this can show up as what I call busy positivity. It’s not malicious or even conscious. Often, it’s just a coping mechanism. When health professionals are rushed, overwhelmed, or emotionally fatigued, they may default to a cheerful tone in hopes of smoothing over interactions. A quick smile, a light joke, a high-pitched “Hey there!” – and then straight into the checklist.

I’ve witnessed this many times firsthand. During a hospital stay, I watched nurses approach my daughter’s bed and silently grab her arm to take observations. When we both looked startled, they offered a chirpy greeting – almost as an afterthought. They didn’t make eye contact or explain what they were doing. They didn’t pause to notice my daughter’s fear. Their smiles felt like a shield – they seemed busy, distracted, and we felt like just another task on their list.

As therapists, we can fall into the same trap. When a client isn’t engaging, we might double down on charm. We may try to be funny, warm, engaging – anything to win them over and get through our agenda. But in doing so, we risk centring the interaction around ourselves – are we getting through our goals? Are we getting enough positive feedback to feel good about our work?

This is where toxic positivity becomes all about us or the system – and the client is left in the background. Those forced moments aren’t really about helping the client – it’s often more about helping ourselves to feel competent, liked, and effective. Or it may be that our workplace has “expectations towards absolute resiliency” in their staff, and so there is no room for more difficult feelings to be expressed by anyone (Shipp & Hall, 2024, p. 3153). Toxic positivity can quietly shift the focus away from acknowledging difficult human experiences, for both clients and healthcare professionals.

The case for attunement

So, what’s the alternative?

One answer may lie in attunement – a concept rooted in empathy, presence, and responsiveness. In our research, numerous spirituality studies highlighted the significance of these types of non-verbal and relational skills, which often possess an intuitive nature(So et al., 2023).

Attunement is the ability to tune into another person’s emotional state and respond in a way that makes them feel seen, heard, and understood. Psychiatrist Dan Siegel describes attunement as allowing our internal state to resonate with another’s (Siegel, 2007).

Attunement – two key shifts

1. A Change in Mindset

Attunement begins with a reorientation of focus. Instead of centring our focus on ourselves or our workplace – we centre the client. We recognise that this is their healthcare journey, not ours. We are the sidekick, not the hero. The supporting actor, not the lead.

We also recognise that client healthcare journeys take a toll on health professionals and make space for this in our workplaces. This mindset shift helps us let go of the need to ‘fix’ or ‘cheer up’ our clients (or ourselves). Instead, we aim to witness and support – to be present with whatever they are experiencing, without rushing to change it. And to give ourselves space to process what we ourselves are witnessing.

2. A Change in Actions

Attunement also changes how we behave. It means creating a work culture where health professionals enter a room quietly, sensing the emotional tone before speaking. It means matching our greeting to the client’s energy, rather than defaulting to a loud and cheery “HELLO!” It means pausing before launching into our to-do list, and checking in: Is this what the client needs right now? Is there something else more pressing for them?

Attunement is flexible. It listens before it speaks. It adapts, rather than dictates. It’s not about appearing to be perfect – it’s about being present.

Why attunement matters more than positivity

In a healthcare system that often prioritises efficiency over empathy, attunement can feel counter cultural. But it’s not just a ‘nice to have’. It’s essential. Research shows that attunement can deepen communication, improve therapeutic and caregiver relationships, and lead to more tailored client outcomes (Kroier et al., 2020).

Attunement doesn’t mean we never smile or offer encouragement. It just means we do so with awareness. We don’t use positivity as a shield to bypass pain – instead, we use presence to meet it.

In practice: small shifts, big impact

You don’t need extra time to practice attunement. You just need intention. Here are a few ways to start:

• Pause before you speak. Notice the emotional tone of the room.
• Match your energy. If a client is quiet or distressed or happy, slow down and notice.
• Ask, don’t assume. “How are you feeling about today’s session?” can open more discussion than “Let’s get started!”
• Be okay with silence. Sometimes, holding space is more powerful than filling it.
• Reflect, don’t redirect. Instead of “At least it’s not worse,” or “I heard this other, more terrible story…” try “That sounds really hard.”
• Make space for difficult emotions in teams. Be aware of work cultures that push for rock hard resilience. Advocate for colleagues to step out and take a moment, if something is too much. Being real should start in the healthcare team.

Conclusion: From performance to presence

Healthcare doesn’t need more positivity or more ‘fixing’. It needs more presence. More listening. More attunement.

When we let go of the need to be upbeat and instead focus on being with our clients – wherever they are – we create space for real connection. Not just for them, but for us too.

Let’s continue the conversation

At The Spirit of Care, we help healthcare professionals build confidence in supporting the spiritual and existential needs of clients. Through training, workshops, and resources, we create space for conversations that are often overlooked, but deeply human.

If you’d like to learn more about how this work can support your practice or organisation, please get in touch here.

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References:

Cross, K. L. A. E. (2022). Platitudes and toxic positivity. J Palliat Med, 25(8), 1168-1169. doi:10.1089/jpm.2022.0295

Kroier, J. K., McDermott, O., & Ridder, H. M. (2020). Conceptualizing attunement in dementia care: a meta-ethnographic review. Arts Health, 1-17. doi:10.1080/17533015.2020.1827276

Michailidou, E. (2023). Toxic positivity: The pressure to always feel happy as a health care worker and how to deal with a negative review in the hospital workplace. The importance of mentoring. British Journal of Healthcare and Medical Research, 10(3), 277-280. Retrieved from https://doi.org/10.14738/bjhmr.103.14865

Shipp, H., & Hall, K. (2024). Analyzing the concept of toxic positivity for nursing: A dimensional analysis approach. J Adv Nurs, 80(8), 3146-3157. doi:10.1111/jan.16057

Siegel, D. (2007). The mindful brain: Reflection and attunement in the cultivation of well‑being. New York: W. W. Norton.

So, H., Mackenzie, L., Chapparo, C., Ranka, J., & McColl, M. A. (2023). Spirituality in Australian health professional practice: A scoping review and qualitative synthesis of findings. Journal of Religion and Health, 62(4), 2297-2322. doi:10.1007/s10943-023-01840-5

FAQs on Attunement in Healthcare

Q: What is attunement in healthcare?
Attunement is the ability of healthcare professionals to tune into a client’s emotional state and respond with empathy, presence, and sensitivity.

Q: How is attunement different from positivity?
Positivity focuses on maintaining an upbeat tone, which can sometimes feel dismissive. Attunement, on the other hand, prioritises authentic connection by meeting people where they are emotionally.

Q: Why does attunement matter for clients?
When clients feel seen and understood, they’re more likely to trust their healthcare providers, share openly, and experience improved care outcomes.

Q: Can attunement help healthcare professionals too?
Yes. Practising attunement fosters genuine connections, reduces burnout caused by emotional suppression, and builds healthier team dynamics.

Q: How can I start practising attunement in my work?
Begin with small shifts: pause before speaking, notice emotional cues, listen without rushing to fix, and make space for silence when needed.