Sarah has been feeling nervous all morning. She is scheduled
to meet with parents of a young child recently evaluated for speech
and language delays. She worries that the conference will be
difficult, that her information will be painful for the family to
hear. The parents were so optimistic about their child's
development at the intake. Surely the results of a significant
delay will be a shock to them. Will they respond with guilt about
what they "should" have been doing as parents or with fear that
their child won't be successful in school? What if their sudden
emotions translate into anger, distrust or denial? Sarah rehearses
in her mind what to say, but nothing seems right. She remembers
with unease another recent conference that was tense and
dissatisfying. It shook her confidence and left her uncomfortable
Our work as speech-language pathologists and audiologists
requires us to communicate with families who are grappling with
life-changing news, ongoing stressors and hard realities. How do we
prepare ourselves for potentially challenging conversations so that
we can best serve our clients?
We often gear up for a difficult conversation by trying to
figure out what to say. We imagine that if we prepare the right
words ahead of time, we will be better able to provide support and
avoid conflict. But as useful as well-chosen words can be, those
words are not the place to begin our preparation. Rather, we should
start by examining ourselves.
We need to examine what we are bringing to the
conversation because our emotional and mental states will affect
its mood, direction and meaning. We want to reduce the likelihood
of hindering the communication with our own ego, fears or
impatience, as well as to increase the chances of bringing an
authentic "best self" to the interaction.
One of the best ways to prepare is to ask ourselves questions
and reflect on our responses. Through this process (aided by
writing out our responses), we can explore possible issues before
they catch us by surprise in a conference.
- What makes you fearful or nervous about this conversation? What
are you most worried about?
- What personal issues or memories are evoked as you anticipate
- What "hot topics" or loaded comments come to mind around this
- When have you handled a difficult conversation well? Poorly?
How might your attitude, affect or behavior have played a role in
- What would you most like to happen in this upcoming
conversation? What might you do that would contribute to this
happening? What might you do that would impede it?
We ask ourselves questions to uncover our feelings, beliefs and
associations toward the anticipated exchange. We remember
experiences that we can draw upon for encouragement and caution. As
we do this, we firm up our boundaries, becoming clear on our own
concerns and feelings, separate from those of the family. We
identify what we have to offer the family and how we may help. We
become alert to our strengths as well as our vulnerabilities.
Once we have done our "inner homework" to increase our awareness
of ourselves, we may wish to think through or rehearse possible
conversations. The goal is not to create an exact script but to
explore different ways the interaction may unfold. Every different
turn in the conversation offers us a chance for more readiness-both
to offer appropriate help to the client and to stay alert to our
own reactions and attitudes.
Of course, even with the best preparation we may still be
surprised by emotion, discomfort or insecurity during the
conversation itself. Here are tips to keep in mind for difficult or
- Breathe and observe your body language. Lower your shoulders
and uncross your arms! If you notice anxious thoughts, breathe more
- Listen with respect and patience. Strive to understand, to
appreciate what the client is going through, and to find something
to connect with for further discussion.
- Know that the client's emotional experience may feel
uncomfortable to you. Instead of trying to escape (through excess
words or cutting yourself off emotionally), sit still and imagine
the emotions are a wave that will flow over you safely. The wave
does not have to knock you over.
- Remember that when people are distressed, information is of
less use than quiet support. Your tone of voice, calm presence and
emotional availability are key. Do not deny information if it is
requested—some people find it a comfort even if they don't remember
it—but offer it gently and simply. Avoid persuading, convincing or
arguing, which will only block connection and resolution.
- Be willing to acknowledge incompletes, to yourself and the
family. "I imagine we are not done with this conversation" or "This
has been a good first step. I know there is more to come."
When we quiet our own anxieties through reflective preparation,
we remember that most situations are imperfect, and that even
uncomfortable exchanges hold positive potential. We then are better
prepared to listen to the client without trying to impose our
agenda or push away uncomfortable feelings. Finally, keep in mind
that any conversation is but one slice in the client's experience.
We may never know its impact or what comes after. Our job is to
make this conversation the best it can be, and to trust its place
in an evolving life story.