“I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between ‘them’ (the afﬂicted) and ‘us’ (the healers)…. We are all in this together, and there is no therapist and no person immune to the inherent tragedies of existence.”
– Irving Yalom
This week, like all of you I am sure, I’ve needed to employ my very best communication skills. I engaged in motivational interviewing skills to help my 80-year-old mother make the decision to forego her weekly bowling league and spent the day yesterday listening, normalizing, and empathizing with the staff and patients at my clinic, who were struggling with a wide range of fears: others’ panic-driven behaviors, ICE activity, the vulnerability of elderly parents, and always… economic uncertainty.
Since most of us have already moved this week to partially delivering patient care by phone (or video conference), I wanted to send along some telephone-speciﬁc empathic communication strategies, in case it is helpful to you or your colleagues. You can scroll down to see this information or if you’d like a PDF you can download it HERE. It’s also available on my resources website, under the Empathy & Stigma tab.
Many of us are BH leaders and clinicians and have been scrambling to understand the legislative, operational, logistical, legal and clinical considerations in delivering these phone and video-based behavioral health services.
Please join us for a free webinar on Friday March 27, 12:30pm – 1:30pm PST addressing these important issues:
You can also dial in using your phone.
United States: +1 (312) 757-3129
Access Code: 841-343-917
Lizzie Horevitz PhD, LCSW, Chief Behavioral Health Ofﬁcer at Marin Community Clinics and Lead Consultant for EM Consulting will share her on-the-ground knowledge and tips for consent, billing and documentation. Elizabeth and Lizzie will also facilitate a discussion about clinical best practices on telephone and video services, so bring your questions and your expertise to share! Feel free to share the webinar information with anyone you think would beneﬁt.
I’m thinking about all of you warmly, my fellow helping professionals- sending care and good energy to you all as you care for your families, patients and communities.
CEO & Principal Consultant
When We Can’t See Each Other:
Empathic Communication on the Phone
Most of us, at some point, have read that body language accounts for the majority of communication. This is accurate! Studies have found that when we are communicating with someone, words account for about 10% of the overall message. The tone of voice accounts for about 40%, and body language accounts for the remaining 50%.
As helping professionals (and as family members!) we likely unconsciously and consciously show care and empathy during conversations by maintaining eye contact, mirroring others’ facial expressions and mood, leaning towards them, smiling, nodding, and sometimes touching them.
As people who understand the deep importance of empathic communication in relationship-based care, and the development and maintenance of the therapeutic alliance, how can we mitigate the loss of 50% of our communication, in order to continue to be effective, helpful therapists?
The following are some tips, hints and tricks for engaging in high quality, connected conversations on the phone – with patients, family members and friends.
- Set the foundation: This is the most important sentence in this document: We are unable to listen and communicate skillfully when we are doing something else. Avoid talking on the phone while looking at a computer, paperwork, or anything else that draws attention. Avoid typing while communicating on the phone. For me, looking down at my lap works the best, helping me focus just on the person I’m talking to. Sometimes walking outside can work well too, as long as the walk is quiet and doesn’t take any concentration.
- Demonstrate attentiveness to others’ comfort: When someone is with us physically, we can assume it was a time that worked for them, and that they are alone. On the phone, it is important to begin by asking if this is still a good time to talk and if they are comfortable. Asking whether they feel they have sufﬁcient privacy is important too.
- Normalize: Initiate a conversation about the experience and process of phone communication. Just saying ‘I know it is a bit different, for us to engage in therapy/counseling/a visit this way. It can feel pretty odd. What are your thoughts, questions or concerns?’ We can also check in at the end, to ask about the experience.
- Reﬂecting listening becomes much more important, as we lose nodding and eye contact as ways to convey deep listening. Reﬂective listening is one of the empathic communication techniques that takes the most practice and skill to use effectively. If you’ve shied away from it before, telephone conversations are the time to dive in. Ideally, we are reﬂecting through summarizing, exact words, and double-sided reﬂections. Just as a reminder, reﬂective listening is repeating back to another what our understanding is of what they’ve said. It can start with stems like:
- It sounds like what you are saying is …
- What I hear you saying is…
- However, stems aren’t necessary. We can also just repeat back important words or phrases they’ve used:
- You just wanted a few more years with your grandson…
- You are devastated by the loss….
For more detail on this valuable, and somewhat difﬁcult skill, see the resources listed at the end of this document.
- Jump in quickly, to check-in. When we hear the other person trail off, move around; when they are answering open-ended questions with one-word answers, or there are long silences, we likely were unable to see the earlier cues and clues about how they are responding to the conversation. By the time we actually ‘hear’ this, it is time to say something. For example: ‘I wonder how you are feeling right now in this moment?‘
- Narrate your pauses and process. In person, others can see us look down thoughtfully, nod, look to the sky in consideration… on the phone, it is just silence, which might be misinterpreted. Comments like ‘I’m just thinking about what you just shared…’ or ‘I want to sit with that, for just a minute. It sounds so important, what you just said’ helps convey we are still with the other person and gives the other a visual picture of us in thought.
- Narrate your smile. We convey an enormous amount of goodwill, physically, by smiling, close proximity and eye contact. When we smile, for example, at the beginning of a conversation, or in response to what someone is saying, we can verbalize this. ‘I’m happy to be talking to you today; and ‘I have a big smile on my face right now, hearing you say that’.
- Afﬁrm strengths more often. Others are more vulnerable when they can’t see us. They can’t immediately ‘see’ how we are responding to them, or how much we care. Particularly with people, we don’t have a long history with us, afﬁrming strengths is a powerhouse when it comes to conveying empathy and non-judgment. Stating things like ‘I’m so impressed you were willing to give this phone thing a try’ or ‘I can hear how much effort you are making to keep your family safe during this time’ frequently can assure others we have positive regard for them.
For more detail on these and other empathic communication strategies, see the resources tab.
Feel free to share, attribution is appreciated but not necessary.