CONNECTING WITH OTHERS THROUGH

EFFECTIVE COMMUNICATION
Tara S. Pearce, PT, DHS

2/6/2023 1
OBJECTIVES

  Describe therapeutic communication strategies

  Integrate “I” messaging into communication scenarios
  Develop active listening techniques
  Demonstrate assertiveness during therapeutic
communication
  Recognize useful feedback regarding communication

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FACTS ABOUT THERAPEUTIC
COMMUNICATION

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 WHAT IS THERAPEUTIC
COMMUNICATION?

Interpersonal exchange that

culminates in someone being It expresses support, provide
helped to overcome stress, information and feedback,
anxiety, fear, or other corrects distortions, and
emotional experiences that provides hope.
cause distress.

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JUST THE FACTS….

  Impossible not to communicate

  None of us are “born communicators”
  Effective communication:
  Learned skills/ability
  Backed by science
  Patterns/frameworks do exist
  Does not assure a positive outcome
  Requires work, time, and effort ALWAYS

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JUST THE FACTS

  Communicants tend to mirror others behavior

  Paralanguage aspects are the most influential on what is
communicated

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 GENERAL GUIDELINES FOR
DIFFICULT COMMUNICATION
SITUATIONS

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 GENERAL
GUIDELINES
  Reflect upon your
own communication:

  What is your
paralanguage saying?

  What are your words

convening?

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GENERAL GUIDELINES

  Show respect
  Practice acceptance
  Be empathetic
  Show concern
  Practice objectivity
  Enhance awareness

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PREREQUISITES OF FUNCTIONAL
COMMUNICATION
  Perceives appropriately
  Learn the prevailing language and symbolic systems
  Acquire and correct information when necessary
  Integrate experience into a comprehensive whole, resolving
contradictions when and where they occur
  Sort out and eliminate interference from internal and
external environmental “noise”

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 “Oh, it can’t be all that bad.”
“Adults should know better
LESS THAN
HELPFUL than to act like children”
RESPONSES ”You’re acting like a child”
TO
PATIENTS/ “You’re over-reacting”
CLIENTS
“That can’t actually be out
that happened.”
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 THERAPEUTIC
COMMUNICATION

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ELEMENTS OF THERAPEUTIC
COMMUNICATION
  The practitioner:
  Speaks with outer clarity
  Is fully present
  Listens
  Develops trust
  Shows empathy

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EMPATHY

  Objective awareness of and insight into the thoughts,

feelings, and behaviors of another
  This includes their meaning and significance

  Increases connectedness

  Decreases alienation

  Facilitated by using active listening

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CASE # 1 A new graduate PT had been practicing for 6 months
after graduation in an inpatient rehab feeling more
confident in his/her/their knowledge, skills, and ability.
One of the PT’s favorite patients was a 14 yo who had
been transferred 2 months ago secondary to MVA. The
patient was not wearing a seatbelt and went through the
front windshield. The patient sustained a SCI/TBI and
was in a vegetative state upon admission.
The driver of the car, the patient’s mother, escaped injury
but was feeling tremendous guilt. The mother and patient
had been arguing at the time of the accident. The driver
was distracted and ran a red light resulting in the
traumatic event.

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 Last week, the patient began to respond to
light and sound. Yesterday, the patient
opened eyes and looked at the PT for the
first after after being transferred from bed
to chair. The PT was feeling elevated and
hopeful the patient would soon to be able
to respond to simple, one-step verbal
commands.
CASE # 1
The mother visited daily and was often
present during PT sessions. During today’s
PT visit, the mother seemed particularly
discouraged. Even though the patient was
showing signs of improvement, she was
still unable to engage in functional mobility
in a manner as before the accident.

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At the end of the PT session, the mother asks to speak to the PT
alone. As they step out into the hallway, the mother turns to the PT
and shouts, “You’re not helping. No one is helping my child get
better. I’ve asked around and found out that you’re a new therapist.
No wonder my child isn’t improving. If you knew what you were
doing, my child would have gotten better by now. I want you to stop
seeing my child and I want a more experienced PT to take over
carrying for my child.”

CASE # 1
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CASE # 1

How would you

have felt?

How would you

have responded?

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THERAPEUTIC COMMUNICATION
STRATEGIES
 When provider has problem:
Use of ”I” statements
 When the patient/client has problem:
Active listening
 Assertiveness
 Feedback

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2/6/2023 20
  Conveys congruence
  What I say matches what I do and what I feel
  Open, honest, genuine, and authentic
  Communicated with sensitivity
  “I” messages
  Necessary when you feel emotion, you own the problem, and
want to get the problem solved.
  Does not point blame to others
  Does not guarantee the other person will respond in a helpful
manner.

“I” STATEMENTS
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“I” STATEMENT EXAMPLE

  PT Aide has neglected to clean up after patient care for 2

days in a row.
  “You” messaging:

  ”I” messaging:

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 ROLE-PLAY SCENARIOS

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 The patient has arrived for
outpatient PT late which has set
your schedule back by 30 minutes
all day.

CASE # 2 What would a “you” message look

like?

What would an “I” message look like?

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 The patient has been non-
compliant with wound care
dressing changes. Now the wound
has become infected with
maggots.
CASE # 3
What would a “you” message look
like?

What would an “I” message look like?

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 The patient
seems depressed
What would a What would an
and has been
“you” message “I” message look
reluctant to
look like? like?
speak up for
several days.

CASE # 4

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 ACTIVE LISTENING

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2/6/2023 28
ACTIVE LISTENING

  Form of therapeutic listening

  Listener is concentrating exclusively
on the patient/client’s words
  Paraphrase the speaker’s words
  Clarifies that you have caught the
intended meaning
  Process what you’ve heard prior to
thinking about what to say

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3 STEPS OF ACTIVE LISTENING

1. Restate
  Repeat words of the speaker as you have heard them
2. Reflect
  Verbalize both the content and implied feeling
3. Clarify
  Summarize or simplify the sender’s thoughts and feelings
  Resolve confused verbalizations in a clear, concise
statement

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EXAMPLE – RESTATEMENT

Patient/client:
”I get so frustrated that I never have a day free from my back
pain.”

Healthcare provider:
“I heard you say that you are frustrated because the back
pain never leaves you. Is that correct?”

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 EXAMPLE –
REFLECTION
Patient/client
“This pain has been going on for
months. I just can’t go on any
longer.”

Healthcare provider
“You’re exhausted and feeling
defeated from the constant
pain?”

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 Patient/client
”When the doctor told me I needed
physical therapy, I knew that you
would be the person who would
ACTIVE help me get rid of my pain. But it’s
LISTENING - been two weeks now, and the pain
CLARIFICATION just keeps coming back. I am afraid
that I’ll have this pain forever. I’m
not sure what it is that I’m
supposed to do. Do I just have to
live with this or will somebody
please help me?”
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 Healthcare Provider
”When you first came to physical
ACTIVE therapy, you thought the pain would be
LISTENING - relieved immediately. Now, you realize
CLARIFICATION that getting rid of the pain is going to
take longer than you expected and is
more than a matter of somebody just
fixing it?”

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ACTIVE LISTENING RESTATEMENT

Patient/Client
“I used to be able to jog for a whole hour, but now my joints
start to ache.”

Healthcare provider

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ACTIVE LISTENING REFLECTION

Patient/Client
“Yesterday was a good day, but today I feel the same old
way.”

Healthcare provider

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ACTIVE LISTENING CLARIFICATION

Patient/Client
“I almost didn’t make it here. I got a horrible headache as I
was driving here. The traffic is so terrible in this city. Will it
ever end? There are new cars on the road everyday. I don’t
know if I can keep up driving with these headaches. Is there
anything you can do for me?”
Healthcare provider

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COMMUNICATION STYLES

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CLASSIC
COMMUNICATION STYLES

  Manipulative
  Passive-aggressive
  Submissive (Passive)
  Aggressive
  Assertive
 MANIPULATIVE

  Asking indirectly for needs to be met

  Making others feel sorry for them
  Voice is often patronizing, high pitch
  Verbal or non-verbal expression of
“poor me”
 PASSIVE-AGGRESSIVE

 Indirectly aggressive, patronizing

 Can be complaining or sulking
 Mismatch between words and
non-verbal behavior
 Sarcastic tone or overly sweet
AGGRESSIVE

  Demanding or abrasive
  Can be explosive, unpredictable, intimidating
  Loud voice, often with negative
facial expression
  Invade others’ space, fast or sharp gestures
SUBMISSIVE

 Apologetic, difficulty making decisions

 May blame others for events
 Does not express feelings or needs
 Low voice volume, lack of eye contact,
can fidget during discussion
 ASSERTIVE

  Most effective style of communication

  Respects rights of both parties
  Voice- medium pitch, speed, volume
  Posture- open, relaxed, no fidgeting
  Good eye contact, respect for
person’s space
KEY ELEMENTS OF ASSERTIVE

  Self expressive   Verbally appropriate

  Respectful of the rights of   Nonverbally appropriate
others
  Appropriate to person and
  Honest situation
  Firm and direct   Socially responsible
  Equalizing   Learned, not inborn
  Verbally appropriate

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 DESC RESPONSE

D: Describe the situation

E: Express your feelings about the situation: “I feel _____.”

S: Specify the change you want: “I’d like for you to____.”

C: Consequences. Identify the results that will occur: “In

that way____.”

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 CASE # 5

The nurse was standing at the nurses’ station reading the patient’s chart.
The patient’s physician came to the station and was searching for the
chart. When the physician saw the nurse was reading it, the physician
turned to the nurse and said, “Give me the chart, honey; that’s my patient
and I have to see the patient now.” The nurse felt as if he/she/they were
being treated in a nonprofessional way, to say the least. The nurse ffelt
degraded and humiliated. Before the nurse could stop, the nurse turned to
the physician and shouted, “My name is not Honey, and this is my patient
as well!” The physician looked up with amusement and returned, “Well,
well; what is your name then honey?”
The nurse felt as if the battle were lost and put the chart down and walked
away in anger.

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 CASE # 5

D: Yes, Dr. ______, I realize that this is your patient. She/he/their is

my patient as well; I am the nurse.
E: My name is ________. When you call me “Honey” it demeans me,
and I don’t appreciate it.
S: I’d like you to call me ___________ because I’d like to discuss this
patient with you as a colleague would. I would like you to treat me as
a colleague.
C: In that way, I feel the patient will receive better care because we
are working together in a more respectful and collegial way.
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CASE # 6 – DESC FORMAT

It’s the end of the day and you have 3 more patients
to evaluate before leaving. You’re going to need
some help or you’ll be working very late. How do you
ask for it?

  Submissive (Passive):
  Aggressive:
  Assertive
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CASE # 6

D: Describe the situation

E: Express your feelings about the situation: “I feel _____.”

S: Specify the change you want: “I’d like for you to____.”

C: Consequences. Identify the results that will occur: “In

that way____.”

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CASE # 7 – DESC FORMAT

You are a professional on the staff for over a year. You

still lack skill in one treatment technique that an aide
knows how to do flawlessly. In front of the patient, the
aide comes up to you and chastises you for not knowing
how to do even the simplest procedures. You are
embarrassed and decide to confront the aide.
  Submissive (Passive):
  Aggressive:
  Assertive

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CASE # 7

D: Describe the situation

E: Express your feelings about the situation: “I feel _____.”

S: Specify the change you want: “I’d like for you to____.”

C: Consequences. Identify the results that will occur: “In

that way____.”

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MYTHS ABOUT ASSERTIVENESS

  Using assertive language will automatically have

others like what I say and do what I ask
  Just using assertive words is all that is needed to be
perceived as assertive
  I use should assertive communication in all
situations
  One assertive reply is all that’s needed

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LEARNING TO ACT ASSERTIVELY

  Recognize situations where you are likely to communicate

ineffectively
  Identify the thought pattern behind these feelings
  Replace thought patterns with different ones
  Do this alone or with another trusted person
  Practice the new behavior that characterizes assertive
behavior

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 FEEDBACK

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FEEDBACK

  Method of communicating to help the receiver consider

modification of behavior
  Faculty/lab assistant to student
  Student PT or PT to patient/client/support system
  Student PT to clinical instructor
  Clinical instructor to student PT
  Supervisor to employee
  Useful if presented with objectivity by a trusted individual
  Should discourage defensiveness

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FEEDBACK IS LEAST HELPFUL WHEN

  Global or too vague

  Given too late to be impactful
  Judgmental
  When it’s perceived as a personal attack
  Given without any suggestions on how to improve
  Based on 1 time incident versus general trend
  Negative
  Obscured by attempts to protect feelings
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 FEEDBACK MOST
HELPFUL WHEN
  Specific
  Positive
  Supportive
  Given privately
  Timely
  Focused on behavior, not on
personality
  Checked for clarify

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CONFLICT MANAGEMENT

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WHAT IS CONFLICT

A situation in which two or more people cannot

agree on the actions that one person takes or
that he or she does not want the other to take.

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CONFLICT

 Three themes are most common

1. Perceived incompatibility of interests

2. Some interdependence of parties
3. Some form of interaction is needed

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CONFLICT

  Natural and inevitable consequence of growth and diversity

  Typically, an opportunity for mutually beneficial change

  Potentially growth enhancing

  Potentially destructive to relationships and self-esteem

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COMMON CONFLICT SITUATIONS

With people supervised

Peers
With authority figure

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   Avoid it - usually leads to more
conflict
  Accommodate it – use sparingly;
usually leads to conflict within self
  Competing – use when you have a
TYPICAL very strong conviction; difficult when
CONFLICT you are not in a position of power
MANAGEMENT   Compromise – Mutual give and
take; use when the goal is to get
past the issue and move on
  Collaborating – focus on working
together; use when the goal is to
foster a relationship
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DISC RESPONSE

  D: Describe the situation

  I: Indicate the problem that the behavior is causing. “When

_______ happens, it causes _____ to occur.”

  S: Specify the change you want: “I’d like for you to

_____________.”

  C: Consequences. Identify the results that will occur. “In that

way _______.”

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 CASE # 5 _DISC RESPONSE

The nurse was standing at the nurses’ station reading the patient’s chart.
The patient’s physician came to the station and was searching for the
chart. When the physician saw the nurse was reading it, the physician
turned to the nurse and said, “Give me the chart, honey; that’s my patient
and I have to see the patient now.” The nurse felt as if he/she/they were
being treated in a nonprofessional way, to say the least. The nurse ffelt
degraded and humiliated. Before the nurse could stop, the nurse turned to
the physician and shouted, “My name is not Honey, and this is my patient
as well!” The physician looked up with amusement and returned, “Well,
well; what is your name then honey?”
The nurse felt as if the battle were lost and put the chart down and walked
away in anger.

2/6/2023 66
CASE # 5 _DISC RESPONSE

  D: Describe the situation

  I: Indicate the problem that the behavior is causing. “When

_______ happens, it causes _____ to occur.”

  S: Specify the change you want: “I’d like for you to

_____________.”

  C: Consequences. Identify the results that will occur. “In that

way _______.”

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CASE # 8

A powerful physician refers a patient with low back pain to you, a

physical therapist, and specifically orders the following: PT
Evaluate and treat with heat and massage. No exercise, no
mobilization Upon evaluation you realize that this back pain is
the result of an acute muscle spasm that occurred recently and
was facilitated by poor body mechanics and weak flexor and
extensor muscles. Your professional knowledge requires that you
treat with ice and teach exercises to address the current problem
and educate to prevent recurrence.

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CASE # 8 DISC

  D: Describe the situation

  I: Indicate the problem that the behavior is causing. “When

_______ happens, it causes _____ to occur.”

  S: Specify the change you want: “I’d like for you to

_____________.”

  C: Consequences. Identify the results that will occur. “In that

way _______.”

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 CASE # 8 DISC RESPONSE

  D: I’d like to talk to you about our patient with back pain.
  I: The referral for heat and massage is a logical place to start for a chronic
problem. My examination revealed this to be an acute spam that the literature
indicates responds faster and more effectively to ice. Likewise, the patient’s
back extensors and abdominals muscles are weak. The patient could benefit
from pain management strategies, gentle exercises to strengthen the core
muscles, and eventual education on proper body mechanics.
  S: I’d like you to approve my plan for acute pain management, gentle pelvic
tilt and bridging exercises with further instruction on core strengthening and
proper body mechanics later when the pain is better controlled.
  C: That way perhaps we can help the patient recover and gain strength and
knowledge to prevent reinjury.
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MANAGING CONFLICT WITHIN
YOURSELF
  Identify a conflict
  Jot down brief notes

  Get the perspective of a “trusted” other.

  Consider the following:
  How important is the issue?
  Does the issue seem worse when you are tired, angry, etc.?
  What is your role in this issue?

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MANAGING CONFLICT WITHIN
YOURSELF
  Pick at least one thing you can do about the
conflict
  Identify at least 3 courses of action
  For each course of action, develop 3 pros and 3 cons
  Select an action. If there is not one clear option, select
the one that will not hurt, or be the least hurtful to
yourself and others.
  Discuss the course of action with the “trusted” other.

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MANAGING CONFLICT WITHIN
YOURSELF
  Do something about it:
  Wait at least one day to allow a cooling off period – if
possible.
  Take the action
  Have in mind a date when you will act again if you see no
clear improvement.

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MANAGING CONFLICT WITH ANOTHER

  Know what you don’t like about yourself

  Write down 5 traits that really bug you when you see them in others.
  Be aware that these traits are your “hot buttons.”
  Manage yourself. If you and/or the other is getting heated
up, stay calm by:
• Speaking to the other as if they are not heated up.
• Avoid using “you” – this comes across as blaming.
• Nod your head to assure them you heard them.
• Maintain eye contact with them.

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MANAGING CONFLICT WITH ANOTHER

  Move the discussion to a private area, if possible.

  Give the other time to vent.
  Don’t interrupt them.
  Verify that you are accurately hearing each
other.
  Ask them to let you rephrase what you are hearing.
  To understand them more – ask open ended questions –
avoid “why” statements – leads to defensiveness.

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MANAGING CONFLICT WITH ANOTHER

 Repeat the above step - this time for them to

verify that they hear you.
  Use “I”, not “you.”
  Talk in terms of the present as much as possible.
  Mention your feelings.

 Acknowledge where you agree and disagree.

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MANAGING CONFLICT WITH ANOTHER

  Work the issue, not the person.

  Ask: What can be done to fix the problem?

  Thank the person for working with you.

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CASE # 9

For the past two weeks, the

PTA that you work has been
taking many “short cuts” with
providing the treatment
programs you delegate.

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 CASE # 10

You are a relatively new PT for a patient who experienced a

spinal cord injury and has complete paraplegia. You have been
pleased with how the patient has responded to your attempts to
teach wheelchair mobility skills.
During one session, the patient lashes out at you saying, “You
don’t know what you are doing. You keep wasting my time with
wheelchair stuff and we aren’t working on walking at all. I’m
tired of this. I want a more experienced PT.”

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CASE # 11

An edict comes down from above

that all staff must treat at least 4
“units” of patient care per hour. You
believe that this is unreasonable and
that it interferes with establishing a
therapeutic presence with your
patients.

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 QUESTIONS ??

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