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The hospital dialogue (repeated from our last post)
This is taken from an actual conversation that took place between the daughter of a patient (call her Sarah) and the patient’s physician (Dr. M) at a major Boston hospital.
Sarah began by saying, “It’s so upsetting to see my father in this condition. I know this is not how he wanted to spend the last days of his life.”
“I’m very sorry,” replied Dr. M, emotionless.
“I think it’s finally time to take him off the respirator.”
“I can see how you’d feel that way now,” said Dr. M, “but this new medication may start to improve his quality of life.”
“At this point, that’s just not enough. He’s never going to get to the point where life is worth living again.”
“Wouldn’t it be better to wait and be sure?”
“We’ve waited so long already,” said Sarah, whining now, “and nothing has helped!”
Still very calm, Dr. M said, “The morphine has helped to make him more comfortable, and his breathing seems a little easier today.”
“Look,” said Sarah, exasperated, “I just can’t talk to you about this anymore!”
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Explanation #2. Blaming the Topics
If you don’t blame a communication breakdown on the people, you might be tempted to blame it on the topics being discussed. Perhaps some things are so hard to talk about that a certain amount of frustration — or even bitter fighting — is simply inevitable. From this perspective, nobody’s to blame because no better result was possible. The conversation was doomed from the outset.
What might be wrong with a topic? Possibilities include:
- It’s inherently contentious and divisive
Liberals and conservatives have irreconcilable differences on this issue. Marketing and manufacturing will never see eye to eye on budgeting priorities. The management and union workers have such conflicting interests that they could never come to agreement.
- It’s highly charged emotionally
Nothing would have made that bad news easier to hear. You can’t expect to give tough critical feedback to people and still have a friendly relationship with them. The decisions they’re making could put both of their jobs at risk — of course things got a little heated.
- It’s too complicated or boring
With any issue this complex, there are bound to be misunderstandings. Nobody could lead an engaging discussion on tax policies. Staff meetings are always going to be dull.
Unfortunately, that explanation gets us no closer to finding a solution than the people-blaming approach. When you identify the subject matter as the source of your trouble, you’re basically admitting defeat. There may be some difficult conversations you can simply avoid — for instance, not mentioning the subject of religion when you’re around a particular colleague, or avoiding political debates with your parents. But most of the time avoidance is not an option. Whenever you have a real problem you need to resolve — your employee is making costly mistakes, your department is facing tough layoff decisions, your spouse is threatening to leave you, one of your kids has started doing drugs, or your dying father is suffering in the hospital — sidestepping the issue won’t make it go away.
The Real Reason Why Communications FailFocusing on difficult people or difficult issues doesn’t just leave us without solutions. It also distracts us from the true cause of our problems — not who’s talking or what they’re talking about, but how they’re talking to one another. We can understand why any conversation succeeds or fails just by looking at the particular combinations of words and voice tones that people are using: their communication behaviors.
No matter whom you’re talking to or what you’re talking about, the specific behaviors you use will have a strong impact on the way your ideas get received? Say you’d like to plan a vacation with your spouse or friend, but you’re not sure whether she will agree to go. There are many different communication behaviors you could use to express those thoughts:
“It’s been such a drag working so hard with no time away. We never have any fun.” (Complaint)
“I know you think we can’t afford to take a trip right now…” (Mind-read)
“…but there are some great deals available.” (Yes-But)
“Don’t you think we could both use a vacation?” (Leading question)
“I think it would be good for us to get away.” (Opinion)
“I’d really like to take a vacation this summer.” (Personal information)
“Can you think of any ways we could save up some money for a trip?” (Broad question)
It makes a big difference which of those statements or questions you use. While some may help get you to Aruba for a week, others are more likely to get you into an argument.
You can think of communication behaviors as the packages that carry our ideas out into the world. Often we’re so focused on the content of what we’re saying that we’re completely unaware of the package we’re sending it in. We fail to notice that our brilliant idea is wrapped up in the conversational equivalent of a stink bomb or a sign that says “kick me” — making it highly unlikely that our message is going to come across in the way we intended. Our failure to understand this sort of effect can also cause trouble on the receiving end; we may be so distracted by the packaging of somebody else’s message that we can’t see the valuable information it’s carrying. For instance, it’s extremely difficult to take in feedback that’s given in the form of a personal attack or sarcastic comment, even when that feedback could potentially be very useful.
Let’s return to our hospital scenario. When we stop looking at the people and the topic and instead focus on the actual behaviors that got used, we can see exactly how the conversation went downhill. There are eight patterns of behaviors that account for the majority of breakdowns in communication. Almost all of them occurred in this one short dialogue:
1. Yes-but: a token agreement followed by a different opinion
Dr. M: “I can see how you’d feel that way now, but this new medication may start to improve his quality of life.”
2. Mind-reading: assumptions about someone else’s thoughts or feelings, stated as a fact
Sarah: “I know this is not how he wanted to spend the last days of his life.”
3. Negative predictions: negative speculations about the future, stated as a fact
Sarah: “He’s never going to get to the point where life is worth living again.”
4. Leading questions: questions that make it obvious what the right answer is supposed to be
Dr. M: “Wouldn’t it be better to wait and be sure?”
5. Complaints: frustrated, whining, or resentful comments implying that people or circumstances are unfair
Sarah (whining): “We’ve waited so long already and nothing has helped!”
6. Fact/Feeling split: a pattern in which one person focuses only on feelings, while the other focuses only on facts
We can see this throughout the dialogue. Sarah expresses feelings both directly (“It’s so upsetting to see my father in this condition”) and indirectly (whining and raising her voice). Dr. M’s responses show no emotion at all. He sticks to the facts (“This new medication may start to improve his quality of life”; “The morphine has helped to make him more comfortable”).
7. The blame game: a conflict escalates to the point of open hostility
Sarah: “Look, I just can’t talk to you about this anymore!”
With this perspective, we don’t have to know anything about Sarah or Dr. M to understand why they ran into problems. No matter who’s talking or what they’re talking about, this combination of behaviors spells trouble. What’s more, we can now see a clear path to making some improvements. There’s no need to avoid the topic or change people’s personalities. All that’s necessary is a shift in behavior — and either person can make that happen. We’ll show you how — stay tuned for our next post!
Regarding #2 (mind-read), I have heard many people state something like you wrote. Most of the time it has been a projection/mind-read. I can also envision a situation where Sarah and her father had a conversation about his desires regarding end-of-life; when she truly knew he didn't want to end up being kept "alive" on a machine. In that instance would you still code it as a mind-read or as a fact? As I write "fact" I realize that although Sarah may be repeating something her father said, the accuracy or truth of that statement can't, under the circumstances, be checked (which I believe is part of the definition of a fact). Hmmm.
ReplyDeleteGreat question. What makes something a Mind-read is not whether it's true or false, or even whether the person speaking knows whether it's true or false... It's how the idea is stated. If Sarah said, "My father has said he doesn't want to spend the end of his life on prolonged life support," or something else similar, that would be a fact. The way it's stated now, we don't know where it's coming from (something he said, something she inferred from what he said, something she just imagined, etc.). This creates noise (ambiguity). It fits nicely into the definition of Square 2 (obscuring) behaviors: Assumptions presented as fact; statements that are ambiguous in topic, content, or source.
ReplyDeleteThank you for such great clarification. I am constantly reminded of the nuances of SAVI by your clarifications. Once again, it's more about the "how" and not the "why" or "what". Thanks.
ReplyDeleteOh good! Glad that was helpful. These questions help us to get clearer as well. It's always useful to go back to those definitions (whether for behaviors or squares or rows). And you're absolutely right on the how vs. why or what.
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