Author: Anne Bogardus, Founder and former caregiver
Communication is one of the most important skills a family caregiver must master. Whether it’s communicating with an aging parent who seems to reject everything you say, communicating with a doctor who dismisses what you tell them because you are not a “professional,” or communicating with siblings about changes in a parent’s behavior or medical status, effective communication is needed. There is more to it than the spoken word though—only seven percent of the communication we receive is verbal, which means that non-verbal communication makes up the other 93 percent.
Caregivers find themselves having to master communications skills in different situations, including:
- Advocating with medical staff for a parent’s care needs
- Persuading a parent to do what they need to do: bathe, eat, see the doctor, etc.
- Updating siblings on changes in a parent’s behavior or medical condition
- Asking for help
While these situations are different in many ways, there are five core communication skills that, when mastered, will improve communication in any situation:
- Pick the right time
- Select the most appropriate environment
- Listen before you respond
- Think how your words will affect the other person
- Be aware of Non-Verbal Communication
Pick the Right Time
One way to create an atmosphere which makes a positive result more likely is to pick an appropriate time for the conversation. Do not start a conversation when you are already stressed out or angry if you want to have a positive outcome. Similarly, pick a time when the other person is more likely to be relaxed and willing to listen. Do not start a conversation when the other person is stressed, worried, angry, or on their way to an appointment.
For doctor appointments, if there is something specific you need the doctor to address, you can give a note to the receptionist when you check in so the doctor has time to read it before meeting with your parent. I used to do this with my dad’s primary care physician, and it worked great. At the end of each appointment, the doctor came out to tell me what action he took based on my note, along with any changes he made to my dad’s care. Since my dad had dementia, he couldn’t remember what the doctor said, and unfortunately was adamant for a long time that I not be in the appointment with him.
Select an Appropriate Environment
Just as timing is important, a calm, relaxed setting can affect the outcome of a conversation. For example, having a conversation in a noisy, crowded environment can make it difficult to hear or concentrate on what is being said. If the topic of the conversation is personal or could be seen as a challenge, fear of what others who overhear might think or say can inhibit people from responding with their true feelings or concerns.
Listen Before You Respond
One of the greatest obstacles to effective communication is feeling heard and understood by the person you are speaking with, and this works both ways. Just as you want to be heard and understood, your parent, sibling, or other person wants the same from you. In families, this is not always easy to do, because we often assume, based on past history, that we know what the other person is going to say, or what they “really” mean when they say something. This can even happen with people we don’t know that well and it’s important to be aware that we could do this unintentionally so we can take steps to avoid it.
One way to find out if you understand what someone else has said is to use a technique known as “reflective listening” that provides a way to check your understanding of what you heard with what the person meant. To do this, you listen carefully to what is being said with an awareness of their feelings or emotions, and reply with a statement something like, “What I’m hearing you say is that you are upset because mom is in the hospital and you don’t understand how she fell.” Now, admittedly, if your sibling has just started yelling at you, blaming you for not taking better care of your mom, this technique may not be easy to summon in the heat of the moment, especially when you feel attacked and are already very worried about your mom. If you can remember to use this technique in a stressful situation, you will see that it can help calm a person who is upset. Here’s a video that demonstrates how this can work. Admittedly, these are actors working from a script, and doing this in real life may not work quite as quickly in a high-stress situation, but it does work.
You may be thinking “Well, this is great for the other person, but what about me? I also want to be heard and understood!” Of course, and rightfully so! One way to make this happen is to take the first step in practicing reflective listening, model the behavior as described in the previous paragraph, and then ask the other person to do the same. Using the same scenario as above, when you are sure you understand what your sister said, you could say something like, “I’m just as worried about mom’s fall as you are. She’s having a lot more difficulty walking steadily now, and doesn’t want to bother me, so she doesn’t call me to help her when she needs to get up. I’ve told her it’s not a bother, but she still wants to feel independent.” Once you have made your statement, you can say, “I want to be sure you understand where I’m coming from, so could you tell me what you heard me say and then how you feel about it?”
Reflective listening may not be a magic cure for every situation, but it is one way to improve communication with family members and others you encounter as part of your caregiving journey.
Think How Your Words Will Affect the Other Person
I’m sure you’ve experienced someone verbally attacking you for reasons you don’t understand. Think about how that makes you feel, and then decide if that’s how you want your words to affect another person. If not, when you feel yourself becoming stressed or angry, take a deep breath, and as my mom always used to tell us when we were kids, “Count to ten before you say something you’ll regret.” It is very easy to respond with angry, defensive words when you feel verbally assaulted by someone. The usual result, though, is that the anger continues to build until it spirals out of control and people stop talking to each other.
One way to avoid this is to use “I” statements instead of “you” statements. “You” statements come across as blaming and accusatory which makes meaningful communication difficult at best. “I” statements focus on your own thoughts, feelings, and emotions. For example, continuing with our example, “I feel afraid when you tell me I should take better care of mom because I’m doing everything I can to take the best possible care of her. What I want is to be able to convince mom that she needs to let me know when she needs something so I can help her and keep her safe. Can you help me brainstorm some ideas about ways to do that?”
Be aware of your feelings and emotions. If you notice that you are becoming stressed and tense or angry, the best course to take may be to postpone the conversation until a time when you and the other person are calm.
Be Aware of Non-Verbal Communication
There are many ways we communicate without speaking—and these methods often convey more accurately what a person means. For example, if someone says yes while they shake their head, which do they mean? Yes, they agree to what you are saying, or no? Most non-verbal communication is received subconsciously, based on a variety of cues, such as tone of voice, gestures, physical proximity (personal space), or eye contact. These cues can be perceived in many ways—they may be seen as indifference to what is being discussed (reading the newspaper during a conversation), threatening (invading personal space), interested (maintaining eye contact), and many others.
To the extent it is possible, it’s important to be aware of what you are communicating non-verbally, not just what someone else is communicating.
As caregivers, we wear so many hats and have so many demands placed on us that communication skills are rarely something we think about. After all, we know what we are saying and what we need from others, we all speak the same language (usually), and those with whom we need to communicate understand how stressful caregiving is, so they should understand, right? Unfortunately, not really. We need to be clear about what we need, open to listening and allowing others to express their feelings and needs, and willing to compromise when possible. At times, we may just need to agree to disagree, especially with our siblings and aging parents. Mastering these five communication skills can help you do just that.