Trauma-informed communications skills
I recently listened to a webinar on 'Trauma Informed Communications Skills and Setting Limits' by Olivia Butterworth, Deputy Director People in Communities NHS England and John Connoly, Lead Counsellor at Central London Community Healthcare NHS Trust.
We often hear about people who are called hard to reach or have multiple and complex needs. They can be very difficult. This webinar explored how we can respond in a more informed, more compassionate way. How our skills as an individual, through our spoken language, through our body language, throughout our approach and way of connecting with people, can really help people to feel safer in an engagement.
John leads a small counselling service in Westminster for homeless people. Due to unexpected reactions and people's behaviour, they started to think how they could change their approach in order to be able to help people rather than people walking away and not coming back. How could they express their needs in the face, maybe, of behaviour that's unsettling them or making them lose their focus, which is to help people?
Here is an abridged version:
There are many different kinds of trauma and there are many different kinds of reaction caused by trauma. People having experienced trauma will not necessarily become agitated or aggressive, intimidating, rather, can become very unassertive, very retiring and not really be able to express their needs.
So really, controlling our communication skills is all about us suspending our judgement about someone's behaviour, whether it's aggressive or retiring, and really passionately trying to understand that person. Why they maybe the way they are, and us finding a way to to express what it is that they need.
However, I will be focusing in on how to calm someone angry, who is really, at the end of the day, quite desperately frightened, and is possibly right next to us in the room.
Now there are many reasons why people become angry and people with complex trauma - several traumas experienced by a person usually over a long period of time - can display cycles of high conflict. These can be really unpleasant when they do happen. A high conflict cycle is a mistaken assessment of danger. Maybe the person was triggered before they came to us, maybe something happened in the waiting room but something has made them feel in danger. So their response is to become aggressively defensive. The important thing to remember here is that, once this cycle is set off, it overrules logical restraints or logic. Calling the police has absolutely no effect, or it actually makes things worse. What's needed is for that person to have some peace and quiet and to calm down. It's like a child having a tantrum. We have to sooth the child first and make them feel safe.
It might help us to think that it's unconscious behaviour and that's how they survived in the past. Let's not engage in battle. Logic no longer holds in these kinds of situations. It's important that we look after ourselves, our own mental health, not take it personally and not become angry ourselves. We can be helped to do that by having debrief meetings afterwards.
One approach to try and defuse cycle of high conflict is the CARS approach, which is:
Connecting - Using empathy, being attentive and being respectful and using body language to emphasise these things.
Analysing our options - Have we had an effect on that person? Is the person calming down? Are we making them worse? Are we beginning to feel unsafe? Do we feel we need to implement our local protocols or do we feel confident enough to carry on?
Responding to Misinformation - If we decide to carry on, we may identify that may be that person's got the wrong end of the stick, they've misunderstood something.
Setting Limits - Minimising a person's behaviour which is upsetting us and maybe others in the situation. Setting limits in a way that doesn't make things worse, but calms down, basically making the person feel understood.
The CARS approach can break a cycle of high conflict. In such a situation, the attack is personal. As an individual, we are blamed. But what we are seeing is a threat response. It's very difficult for us to remain calm and professional because our own threat/survival system becomes activated. And then we are very tempted to respond in an inappropriate way ourselves. The CARS approach is applying a series of tools to try and avoid us responding in a non-professional way.
The first step, Connecting is all about communication. Words convey 7% of the meaning. Body language 55% and Voice (tone, volume, pitch, rythym, etc), 38%. So 93% of meaning of words is conveyed with body language and voice. When we try to connect, we connect with empathy, attention and respect (EAR). We show those three things via our body language, our physical posture, our tone. our volume, our pitch etc. Our role is to calm the person down so that they can make use of our service.
So for example, "I can see you're upset. How can I be of help to you?". They might be saying something about a policy, or about having waited a long time. Don't enter into an argument about that. It's not going to go anywhere. "I know you've been waiting. Now, can I help you now?" Again, demonstrating through your body language, your facial expression, voice and facial expression. The focus is our concern about how they feel. So we listen in a non judgmental way. We hear their point of views presented. We try and understand the significance for them. Our focus is their feelings, their interpretation of what's happened to them. And we communicate this in a way that makes them feel understood, which usually leads to the person becoming calm.
We're demonstrating our attention. We're looking interested. We're looking concerned. We let the person finish what they have to say. Then we say back some of the essentials of what we heard, again, paying attention to body language. So we suspend judgement. Accepting someone's feelings doesn't mean that we agree with them. We're not being asked to agree with them. We're being asked to accept them and understand.
Responding to misinformation, be brief, informative, friendly but let's go on to setting limits. Accepting their feelings does not mean we have to accept that behaviour. And this is where you may have to come in and set limits. Our aim is to stop the behaviour e.g. someone's pacing around, very agitated. We must suggest alternatives. So for example, "Stop shouting, please. I see you're upset. It upsets me too." We're human. We're showing our humanity and our vulnerability. We're not threatening, we're actually vulnerable. Again, the focus is on helping that person. We may have to say this quite loudly, "Stop shouting, please. I see you are upset. It upsets me. Tell me what happened. So I can help you." You need to be confident obviously and show that you're not being aggressive. You're just being confident standing your ground. Allow silence to let a message sink in and restate your message. "When you when you pace. I find it hard to focus. Please sit down so I can help you." . "I understand you feel annoyed and you have to move. Could you pace over there."
Don't get side-tracked into arguments. Be respectful, don't respond to questions. The key is to repeat this cycle three times if possible, because it takes time for someone to calm down.
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Geoff Knott, 04/01/2023