Can This Conversation Be Saved? Part 3 (Conclusion)

This is the final piece in our series “Can This Conversation Be Saved?” If you missed the previous entries, view them here: Part 1, Part 2

How Bad Conversations Turn Good
We saw in the last post that our difficult hospital conversation included several specific types of challenging communication behaviors — from mind-reading to leading questions to yes-butting. Using the SAVI system, we can come up with strategies to combat the negative effects of each one of these. If Sarah or Dr. M had possessed those skills, their conversation probably would have gone in a much better direction. Here’s one possibility:

Sarah: 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.
Dr. M (with feeling): I’m really sorry. I hear how difficult this is for you.
Sarah: It is so hard. I’m starting to think it’s finally time to take him off the respirator.
Dr. M: Many people consider that option when several different treatments have failed, and they start to lose hope. Are you feeling that way?
Sarah: Yes, I am. I’m feeling totally hopeless and also feeling guilty — I don’t want to prolong his life just to save me from the grief of losing him.
Dr. M: I can see how hard it is to face all these decisions, not really knowing what’s going to be best for your father.
Sarah: I just don’t know what to do.
Dr. M: We do have a support group here to help family members deal with these types of issues. It sometimes helps people to know they’re not going through it alone. Is that something that would interest you?
Sarah: I’m not really comfortable in groups, but I could use someone to talk to.
Dr. M: Would you like me to set up an individual counseling session?
Sarah: I’d really appreciate that. Thank you.
Dr. M: Great. I’ll set up an appointment for you. And as you prepare to make a decision, I want to be sure you have accurate information about your father’s new medication and the types of effects it can have. Is now a good time to discuss that?
Sarah: Sure.
Dr. M: Okay, let me tell you what the studies show…

Can you tell what changed here? You may have noticed that Dr. M’s side of the conversation sounded quite different. Be careful how you think about that difference. Many communication frameworks focus on abstract principles: Consider multiple perspectives. Own your story. Be respectful. And so on. There’s no need to talk about principles here. If Dr. M comes across as more respectful or considerate, it’s because he changed his behavior — what he actually did. This is a key point to remember: Principles do not change conversations. Actions change conversations.

Dr. M did very specific things that helped Sarah feel heard and understood. For instance, instead of arguing with Yes-buts and leading questions, he mirrored her emotions (“I hear how difficult this is for you”) and asked questions (“Would you like me to set up an individual counseling session?”). Starting out in this way also left Sarah more receptive to hearing his ideas about the new medication.

Now, Dr. M is not the only one with the power to transform this conversation. Suppose Sarah had the skills to change her own behavior. The dialogue might have sounded something like this:

Sarah: 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.
Dr. M: I’m very sorry.
Sarah: I think it’s finally time to take him off the respirator.
Dr. M: I can see how you’d feel that way now, but this new medication may start to improve his quality of life.
Sarah: So you’re saying you think this new medication may make a difference for him. How big a difference?
Dr. M: If he responds well to the drug, it could extend his life for several months. It could also allow him to return home, as long as he had 24-hour care available.
Sarah: Oh God, that would make a huge difference to Dad — he hates hospitals. He always said he’d rather die at home. How long will it be before you know if it’s working?
Dr. M: Most people respond within a few days, but it could take up to two weeks to know for sure. I’ll check in with you every day to let you know what’s happening.
Sarah: Thank you! This is the first sign of hope we’ve had in a long time.

Again, what made the difference here was not principles, but actions. After a person has been Yes-butted — in this case, hearing Dr. M say, “I can see how you’d feel that way now, but…” — the most natural response is to argue back. It takes skill to resist doing that and try something else instead. What Sarah did was to paraphrase Dr. M (“You think this new medication may make a difference for him”) and ask a question (“How big a difference?”). By using this approach, she not only avoided an argument, but also gained important information that helped ease her distress and give her new hope.

Part of our aim in our work is to give new hope to the people we train (including readers of our blog). Once you understand the factors that cause your conversations to succeed or fail, it is possible to dramatically improve them — even in cases where the people and issues you’re facing seem overwhelmingly difficult. We’ve seen it happen hundreds of times, in families, couples, and all sorts of organizations. Even after a discussion begins to go downhill (for instance, with Dr. M’s Yes-but), there’s almost always a way to turn things around. In fact, some of the most successful and transformative conversations start out with personal attacks, defensiveness, whining complaints, or sarcastic jabs. The key is that at some point, someone needs to take the initiative to start doing something different. That someone can always be you. At any point in a conversation, from any position in the conversation, you have the power to intervene and change the course of events. You just have to know how.

The Key to Change: Conversational Fitness
One point we keep emphasizing is that the way you understand what’s going wrong will determine the steps you can take to bring about change. If you blame your communication problems on irreconcilable differences, you may want to just go into hiding — or at least into denial. If you blame them on someone else’s emotions and personality, you may want them to go into therapy. But as soon as you shift your focus to behavior, it’s clear that you have a much more effective option: go into training.

Now, when we talk about training, we don’t mean the type of training where you sit passively in a seminar while a lecturer explains all the general rules and principles that good communicators ought to follow. The type of training we’re talking about is more like an athletic workout or sports practice than an academic class. Imagine trying to become skilled at basketball just by being told what to do and watching experienced players do it. You obviously wouldn’t get very far. To master the game, you need to get out on the court, get the ball in your hands, and try doing those things for yourself. In communication, too, what matters most is your level of hands-on skill: your conversational fitness. You need to be able to respond effectively right at the moment when something sets you off — when your boss yells at you, your colleague shoots down your great new idea, or your spouse starts rehashing the same old complaints you’ve heard hundreds of times before. This is no easy task. We all have at least one or two fixed habits that we’ve developed over the years, whether it’s a tendency to defend ourselves (“I couldn’t help it”), to catastrophize (“This will be a disaster!”), to use sarcasm (“Yeah, right, like that’s going to help”), or to Yes-But everyone else’s suggestions (“That’s nice, but we can’t afford it”). Changing those habits takes active, focused practice.

What type of practice works best? Thanks to recent research in neuropsychology, we can now answer that question with greater precision than ever before. Due to the way the human brain functions, it takes particular types of activities and experiences to change the way we communicate. (See our earlier post for a little more detail.) The book we’re now in the process of writing (from which these last three posts are drawn) will put those ideas into practice with an intensive training program for mastering all the most difficult conversations. As we go along, we’ll continue to adapt this new material into blog form. We hope you’ll enjoy it — we’re excited to share all these ideas with you!