People who experience pain can have trouble saying what they want to happen – and difficulty hearing what other people really have to say. OK, I agree it’s a problem for us all – but
- pain interferes with the capacity to attend to and process information, and
- people with pain are often engaged in systems such as compensation or the health system
- and communicating with their families (who are often also under strain)
so it’s good to help people learn to hear what is being said, and to be able to respond honestly and ‘assertively’.
Assertiveness is, however, a loaded word. I asked the group participants today what they immediately thought of when they heard the word ‘assertiveness’ and they said being bossy, dominant, pushy – and one person said it reminded her of hairy armpits!
So here are two activities that can be helpful so people develop skills for hearing and communicating.
The one minute silence
Pair off, sitting opposite each other.
If appropriate, hold the hands of the person and look into his/her eyes (this is best carried out with people in an intimate relationship – otherwise, simply looking into each others eyes is fine).
For one minute, one of the dyad can talk about anything he or she wants to. The other partner must listen without saying anything. After one minute, swap roles.
As above (and following on from the above activity). The first person in the dyad talks for one minute about an issue that has been bothering them, while the second listens. After one minute, the person listening says ‘So you mean…’ and paraphrases the key issue. The first person can say ‘that’s it!’, ‘no, you haven’t got it’, or ‘nearly’, but gives no further information. The listener must continue with paraphrasing until the first person says ‘that’s it!’.
Then the pair swap roles.
- What was it like to be listened to? (first interaction)
- What was it like to really listen?
- What was it like when the person was trying to interpret/paraphrase what you said?
- What was it like to paraphrase what the person was trying to say?
I often then follow with the ‘DESC’ process to help with two things – (1) identifying what the ‘real’ issue is in a conflict (describing) and being clear about the emotional impact of that behaviour (expressing); and (2) then stating what exactly the person would like to have happen.
For those of you who haven’t encountered this process it’s as follows:
D= Describe the situation, being specific about one situation or event. e.g. ‘when I asked you about getting a dog, you walked out of the room’
E= Express your emotional response, keeping to ‘I’ messages. e.g. ‘I felt ignored and ‘cut off’.
S= State what you would like the other person to do, being specific about their action (but not about the outcome you want). e.g. ‘Could we meet to talk for 20 minutes this evening about the dog?’ (eg not presuming that the person will agree with your request to get a dog!)
C= Consequences – stating what consequences will be either for you or the other person. e.g. ‘And that way I can feel that we’ve been able to clear the air’ or ‘And that way I won’t keep on asking to talk about it again’.
This article by the London Pain Consultants outlines the rationale for effective communication, while this article discusses very briefly the place of assertiveness in developing confidence for self management.
For me, self management implies that the people we work with will be actively engaged in stating what they want to have happen with regard to their lives and health, and as a result they will be changing their behaviour, and doing things differently. This necessitates communicating these changes to other people, and doing this openly and honestly.
I find I carry out quite a lot of cognitive restructuring and challenging during sessions on communication skills – because it does seem that people are unwilling to ask others to do things differently, or to put up with them doing things differently, if they have not entirely convinced themselves of the benefits.
As a result, sessions on communication can often be quite intense CBT sessions – talking alone doesn’t do the trick, it must be accompanied by role play or practice!
I’m keen to hear what you think about communication, and whether (and how) you incorporate this into your pain management. Drop me a line and let me know! And if you’ve enjoyed this post, don’t forget you can subscribe using RSS feed, and can bookmark my blog and visit regularly. I’m posting roughly every day/every other day, so there’s plenty to read!