Over the past few weeks I have been talking to some of our amazing Senior Nurses where I work about having difficult conversations with colleagues, team members, relatives and patients.
Now Senior Nurses are no strangers to difficult conversations, and are very accomplished at delivering emotionally charged messages to staff, relatives and patients. So why spend time talking to them about this subject if they are so experienced? Well I suppose it is obvious if you think about it for a moment. For about a year now we have all been put under a lot of pressure. Our lives and in some cases our livelihoods have been impacted by COVID-19. Having difficult conversations are now more the norm than the exception. On top of that we all have worries about, health, wealth and well-being that narrow our bandwidth and reduce our capacity to have measured, compassionate, direct conversations effectively. So that is why we were having a conversation about difficult conversations, because we all need to pay more attention now on how we impact on others, for all the reasons highlighted above.
When I was reflected on my week this morning, I wondered how many other people might be struggling with this particular aspect of COVID life. So I thought I might share with you some of the strategies I shared with my colleagues. Now you want get the rich conversation and shared stories, but you will get the headlines that hopefully will promote rich conversations with your colleagues. If you work at Hull University Teaching Hospital, then book on my Having Difficult Conversations webinar via the usual route. If you don’t and want to know more, email me (email@example.com).
The first thing to do before starting a conversation that is important as well as potentially difficult is to prepare.
Remember the old saying…”fail to prepare, then prepare to fail”. Or something like that, but you get the idea.
What is the purpose of the conversation
Be clear what you want from the conversation. This seems obvious but not always articulated. Sometimes a difficult conversation can be based on a visceral reaction (something we will cover later), so it is important to explicitly tell yourself what it is you want to achieve. Is it to raise the other person’s awareness, raise your own awareness, improve performance, or to promote action? If this conversation is particularly important it might be worth writing it down. If you write it down you can check if it actually makes sense and is really what you want to achieve. Getting your thoughts out of your head and on to paper, will help you make sense of what it is you want, and by reading it back to yourself you can check on how reasonable your thoughts are. Writing it out will help you refine your purpose and reduce the emotion that might be colouring your reasoning.
Gather all the information you need
Make sure you have all the information you need before starting the conversation. You might not be able to get all the information you will end up needing, but it is important to gather as much as you anticipate you will need. Be sure to separate facts from opinion. Be wary of taking opinion into the conversation, as this will encourage judgement and assessment, before the other party has had chance to hear the facts and add to them. It is important that we enter into any conversation in a position where we a able to listen to understand. Being armed with facts allows us to be more curious, and objective, and therefore encourages us to listen.
Prepare your mindset
Start by shifting your view of the conversation from a hurdle to a resource. When setting out your purpose it is important to see this not as something to be endured but something that will add something to your experience. Remember that the feelings of discomfort you are experiencing have more to do with you worrying about your performance than the impact on the other person. It is also worth remembering that if you behave emotionally, then this is likely to be matched by the other person, resulting in an unpredictable outcome. Therefore recognising the need for emotional regulation is essential.
Skills and Behaviours
To increase the likelihood of a successful conversation it is important to adopt certain skills and behaviours. The most wonderful thing about these skills and behaviours is that they are incredibly useful for any conversation that has a purpose.
The best way to persuade others is with our ears. If we want to get the most out of this conversation and ensure there is a helpful outcome from it, it is essential to listen to what they say without judgement. To listen without judgement we must listen actively. Active listening encourages greater understanding and raised awareness for both parties. Here are just a few techniques that will enhance your listening:
- Reflecting: This is when you repeat back to them exactly what they have said. This helps clarify what they mean and can be especially useful if they are using pressure words or being self critical. It is important to turn the statement into a question though. “You are rubbish at mathematics?”
- Paraphrasing: Again used to clarify understanding, but can be used to create depth of understanding by using your own words to describe what they have said. They may have said…”I don’t seem to be able to build rapport with new people”. Your response might be… “So are you saying that you struggle starting new relationships?”
- Summarising: When they have finished a section of their story it is often useful to summarise what they have said to stimulate more thought and to show that you are interested in what they are saying. I might use headlines such as…”so in summary building relationships has been hard, but you feel you are progressing well, you also tell me that some people are making life hard for you, is that right?”
At this point I just want to share with you a quote that I think will demonstrate the importance of hearing what the other person has to say.
“Being heard is so close to being loved that for the average person they are almost indistinguishable” David Augsberger
“Empathy is a way to connect to the emotion another person is experiencing; it doesn’t require that we have experienced the same situation they are going through.” Brene Brown
Empathy is such an important skill to use when having a difficult conversation, and the most wonderful thing is, that it is a natural by-product of active listening. If you are really hearing what they are saying you will show empathy. When you are paraphrasing and summarising you will articulate what you understand to be their emotion. “You tell me that you struggle starting new relationships, that sounds like it would make you feel isolated?” Showing empathy allows you to get it wrong, the critical aspect of empathy is listening and trying to understand their emotion. So if you get it wrong the other person will pick up on your genuine interest to understand their emotion and correct you. Comfortable use of empathy creates such a strong connection that it is very hard not to have a helpful outcome from your conversation.
Regulate your emotion
The first thing to do is recognise when you enter into a stressful situation, you amygdala (the part of your brain that regulates your threat response) will hijack you. You will lose access to your pre-frontal cortex (the part of your brain that controls reasoning). This is why it is vital to prepare for a difficult conversation, to be clear what the purpose is and that you have your facts straight. This will go some way to calm your amygdala.
If you are experiencing an acute stress response before or during the conversation, then square breathing can be really helpful. Or to be honest any kind of controlled breathing technique will be useful. I use square breathing. Which is; breath in for a count of 4, hold for a count of 4, breath out for a count of 4, and hold for a count of 4. Repeat until you start to notice your heart rate drop. Breathing techniques work by bringing you into the present, rather than worrying about the future or regretting the past.
When you are preparing for the conversations notice if you have cast yourself as the victim in this situation and cast them as the villain. Are you making statements like: “I have been supportive and kind there is nothing else I can do.” “They had every opportunity to make it right, they just don’t care enough.” If you do then try seeing yourself as an actor and them as humans in this situation. Ask yourself; “What am I pretending not to know about my role in this?” “Why would a reasonable , rational, decent person do what they are doing?”
When regulating our emotions it is important to label thoughts as thoughts and emotions as emotions. If you remember when preparing for conversations I suggested that you are clear what is fact and what is opinion this strategy can be very useful. Instead of saying, they are always resistant to change, they are so irritating, say I think they are resistant to change and that makes me feel irritated.
Using these techniques to regulate your emotion will help you prevent the amygdala hijack and reduce the risk of the conversation degenerating into an unhelpful argument.
Tell it how it is, with compassion
Don’t go around the houses. Be clear what it is want to say, then say it. Leave opinion, and conclusions out. Use active listening and empathy to understand their view and emotion. Articulate your emotion, allow them to listen and show empathy to you.
Being clear is being kind, we also must allow them to do the same, there is then a much greater chance of getting your message heard and creating a helpful outcome.
Remember we are all human
The other person :
- has beliefs, perspectives and opinions just like you
- has hopes, anxieties, and vulnerabilities just like you
- has friends and family just like you
- wants to feel respected, appreciated, and competent just like you
- wishes for peace, joy and happiness just like you
Stay safe everyone and be kind to yourself and others.