You can always be misunderstood

There are two aims in any conversation: unambiguous expression of your own position and complete comprehension of the other person’s views. We should always remember that neither of these aims is a realistic goal.

A client told me of an ante-natal appointment at which her midwife said “So, your first child was deformed and your second child was killed: let’s hope it’s third time lucky, shall we?”

While it is difficult to imagine anyone not being offended by such insensitivity, it is equally hard to believe that the midwife was being intentionally cruel. If she thought at all about her comment, she may have imagined she was being warm & humorous: rapport-building.

While serving as a Member of the Finnish Parliament, communications researcher Osmo Wiio proposed his “laws of comunication”, including:

  • If communication can fail, it will
  • If communication cannot fail, it still most usually fails
  • If communication seems to succeed in the intended way, there’s a misunderstanding
  • If you are content with your message, communication certainly fails!

Clients are often mystified by someone’s negative reaction to what seemed, to them, to be a reasonable statement or request. In discussing such situations, we usually conclude that it is possible to misunderstand even the most clearly worded request and to be offended by even the most innocuous statement: what the speaker says may have little to do with what the listener hears.

Clients who are anxious or depressed may be less able to attend to either expression or comprehension with the same care & attention as their therapist. Therapists’ comments & questions, however clearly articulated, may still be misinterpreted because the client is not paying full attention or has information of which the therapist is unaware (but which the client may think the therapist knows).

Misunderstandings & unfortunate comments can be worked through given time and effort, but neither of these will be forthcoming from a therapist who thinks that their own communication is unambiguous.

Use your casenotes as a Foley file

Making notes of information incidental to the case enhances interactions. The more personal details you retain, the more intimate the interaction and the greater the sense of personal attention.

Compare & contrast the following:

Last time you said you were going on holiday with your husband and daughter but you were worried about the journey: how well did it go?

Two weeks ago you said you were going to Greece with David & Sally but you were worried about the flight: how well did it go?

Item one says: I was listening. Item two says: I was really paying attention.

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Slow speech makes for clear communication

Speaking more slowly can improve communication between therapist and client. Slow speech is more comprehensible and more considered.

Anxiety is characterised by rapid speech. Therapists, especially trainees, may be anxious in sessions, but may also feel the need to speak more quickly in order to pack more into the time available. This can backfire by making the therapist seem anxious.

Following rapid speech demands greater attention. When listening, we are attempting to make sense of what is being said. The more time we have to consider what is being said, the more likely we are to understand what we are hearing.

Clients are by definition functioning less than optimally. Anxiety, depression, pain, fatigue and medication effects can impair concentration and therefore affect clients’ ability to follow and make sense of what we are saying.

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Eye contact tells you when to speak

Steady eye contact from a client is your prompt to speak. Attending to eye contact helps us to minimise interruptions of the client’s train of thought and to be more comfortable with silences.

In 1:1 conversation we spend 50% of our time looking at the other person. It is important to remember that this is an average across two distinct roles: speaker and listener.

When listening, we look for 50–90% of the time. We can see expressions and gestures, the non-verbal modulators of the spoken word. More importantly, we can see if the other person shows signs of finishing, so that we can have our turn.

When speaking, we look from 10–50% of the time. We need to know that the other person is listening, but we can reassure ourselves of this with a quick glance. When we have the floor, it is more useful to look away from the other person, minimising distractions from our train of thought.

It is difficult to be sure when someone has finished speaking. A pause may be for reflection or may be the signal that you have the floor. In ordinary conversation between equals, interruptions are inconsequential, easily remedied in the to & fro of the chat.

Interruption by a therapist can discourage a disclosure. A client who has stopped speaking may be awaiting a response or marshalling their thoughts. Speaking just as the client is about to can distract at best; at worst, it can be taken to mean that the forthcoming disclosure was unwelcome or irrelevant.

You will know it is your turn to speak when they look steadily at you. A quick glance need only be to check that you are still listening. A steady gaze indicates that a reply is now expected.