The Empathic Communication Coding System (ECCS) analyzes empathy in medical encounters as a two-step sequence. First, the patient creates an empathic opportunity — a statement of an emotion, a progress (achievement), or a challenge (difficulty). Second, the provider responds, and that response is rated on a seven-point scale (0-6) for how much empathy it conveys, from denial of the patient's perspective (0) to a shared feeling or experience (6).
In this scale the three opportunity types (EMO, PRG, CHL) are highlighted in the patient's speech, and the Empathic Response Level (ERL) is coded on the provider's reply, carrying the 0-6 rating as its severity. Note that Level 6 (shared feeling) is not held to be "better" than Level 5 (confirmation) — only conceptually different.