CHAPTER 1
Can This Conversation Be Saved?
Communication breakdowns are bad news for our lives and work. At best, they’re a source of irritation and frustration. At worst, they can threaten our jobs, families, and friendships—and in some cases, even our health. Research suggests that failed communication is one of the leading causes of preventable medical errors.1
The Surprising Common Factor in All Communication Breakdowns
How can we go about improving our conversations? First we need to get clear about exactly what’s going wrong. We can’t solve a problem if we don’t know what’s causing it. However, when it comes to communication problems, the cause is often tricky to spot. Consider the following conversation between a physician (Dr. M) and his patient’s daughter (Sarah).2 As you read it, see if you can figure out what’s causing the trouble between them:
Sarah began by saying, “It’s so upsetting to see my father in this condition. I know this is not how he’d want to spend the last days of his life.”
“I’m very sorry,” replied Dr. M, emotionless.
“I think it’s finally time to take him off the respirator.”
“I can see how you’d feel that way now,” said Dr. M, “but this new medication may start to improve his quality of life.”
“At this point, that’s just not enough. He’s never going to get to the point where life is worth living again.”
“Wouldn’t it be better to wait and be certain? I’m sure you want to explore all the options.”
“We’ve waited so long already,” said Sarah, whining now, “and nothing has helped!”
Still very calm, Dr. M replied, “The morphine has helped to make him more comfortable, and his breathing seems a little easier today.”
“Look,” said Sarah, exasperated, “I just can’t talk to you about this anymore!”
What’s going on here? What made that conversation so difficult? When we present this dialogue in our training sessions, people usually come up with two different types of explanations: blaming the people and blaming the issue. In fact, these are the most common reasons people give for any type of communication failure. Unfortunately, neither explanation is particularly useful.
Explanation 1: Blaming the People
If you blamed the problem on Dr. M or on Sarah, you’re using the people explanation. From this point of view, communications fail because of psychological factors, such as attitudes, emotions, intentions, motivations, or personality traits. In the hospital case, we might decide there’s something wrong with Dr. M (he’s cold and insensitive, and doesn’t care about Sarah’s concerns), with Sarah (she’s too emotional or too pessimistic), or with both of them (they’re both too rigid and set in their views).
The psychological perspective has a strong intuitive appeal. It may seem like common sense—of course people’s bad attitudes, hidden agendas, and raging emotions ruin conversations; you can probably think of a few examples off the top of your head. However, this type of thinking also leaves us in a bind, with no good way to solve our problems.
Suppose you decide that the real trouble with your communication is someone else’s defensiveness or overemotional reaction. That’s not something you have the power to control. In fact, if you try to control it and force the person to change, you’re likely to make things worse. If you don’t believe us, ask anybody who’s tried to resolve an argument by saying things like, “Stop being so defensive,” “Calm down,” or “You need to relax.” (Imagine what would have happened if Dr. M told Sarah to be more rational, or if she told him to show some feeling.) Moreover, even if it were possible to make someone change—perhaps by convincing them3 to get coaching or go into therapy—that’s a long-term process. It’s not an efficient strategy for making your conversations work better right now.
Sometimes it may seem as though the only solution is to get the difficult person out of your life—quit your job, fire your employee, seek a divorce, and so on. If you haven’t gone through this type of thought process yourself, you certainly know people who have. You probably know more than one person who’s acted on that reasoning, only to end up having the very same conflicts a few months later in their new job or new relationship. And of course, it’s often not possible to exclude someone from your life. In our example, so long as Dr. M is caring for Sarah’s father, they have no choice but to talk to one another.
The Usual Suspects
When a conversation fails, it’s easy to blame:
The people. Difficult personalities, motivations, or emotional states
The topics. Touchy issues and irreconcilable differences
Explanation 2: Blaming the Topics
If you don’t blame a communication breakdown on the people, you might be tempted to blame it on the topics being discussed. Perhaps some topics are so contentious or emotionally charged that a certain amount of frustration—or even bitter fighting—is simply inevitable. From this perspective, nobody is to blame because no better result was possible. The conversation was doomed from the outset.
Sarah’s conversation with Dr. M, evaluating whether or not her father’s life is worth living, certainly falls into the category of highly charged topics. The question of taking a person off life support can stir up a lot of controversy and moral outrage, even when the person involved is a stranger. It’s easy to see how this contentious issue could be a big part of the problem.
Unfortunately, that explanation gets us no closer to finding a solution than the people-blaming approach. When you identify the subject matter as the source of your trouble, you’re basically admitting defeat. There may be some difficult conversations you can simply avoid. For instance, you could decide not to talk about religion when you’re around a particular colleague, or to avoid political debates with your parents. But much of the time, avoidance is not an option. Whenever you have a real problem you need to resolve—your employee is making costly mistakes, your department is facing tough layoff decisions, your spouse is threatening to leave you, one of your kids has started using drugs, or your dying father is suffering in the hospital—sidestepping the issue won’t make it go away.
Explanation 3: The Real Reason Why Conversations Fail
Focusing on who’s talking or what they’re talking about doesn’t just leave us without solutions. It also distracts us from the true cause of communication problems: how people are talking to one another. We can understand why any conversation succeeds or fails just by listening for the particular combinations of words and voice tones that are being used—the communication behaviors.
The Hidden Culprit
All communication breakdowns can be explained in terms of one common factor:
Behavior. The specific combinations of words and voice tones people are using
Whatever message you’re trying to get across, the communication behaviors you use will have a strong impact on the way your message gets received. You can think of communication behaviors as the packages that carry our ideas out into the world. Often we’re so focused on the content of what we’re saying that we’re completely unaware of the package we’re sending it in. We fail to notice that our brilliant idea is wrapped up in the conversational equivalent of a stink bomb or a sign that says “kick me”—making it highly unlikely that our message is going to come across in the way we intend. (See the following sidebar for an example from a business context.)
Failure to understand this sort of effect can also cause trouble when we’re on the receiving end of somebody else’s message; we may be so distracted by the packaging that we can’t see the valuable information it’s carrying. For instance, it’s extremely difficult to take in feedback that’s given in the form of a hostile accusation or sarcastic jab, even when that feedback could potentially be very useful.
Change Your Behavior, Change Your Results
Say you’d like to hire a new administrative support person, but you’re not sure whether your manager would support the idea. There are many different behaviors you could use to express your thoughts:
• “Everyone here is working so hard, and day after day we get more overloaded.” (Complaint)
• “I know you’re going to say we can’t afford to hire more staff.” (Negative prediction)
• “I realize that finances are tight right now, but hiring more administrative help would free us up to take on more projects and bring in more money.” (Yes-but)
• “Don’t you think we could use some more help around the office?” (Leading question)
• “The amount of overtime my team is working has doubled during the past three months.” (Fact)
• “I suggest we take a look at the budget and see if we can afford to hire an administrative support person.” (Proposal)
• “If we could find enough money in the budget to bring a new support person on board, would you support that decision?” (Narrow question)
It makes a big difference which of those statements or questions you use. While some may help get you approval for a new hire, others are more likely to get you into an argument.
Let’s return to our hospital scenario. When we look at the behaviors that each person used, we can see exactly why the conversation went downhill. In the course of this book, you’ll learn to recognize the six patterns of behaviors that most frequently cause breakdowns in communication. All of them occurred in this one brief dialogue:
1. Yes-buts. Token agreement followed by a different opinion.
Dr. M: I can see how you’d feel that way now, but this new medication may start to improve his quality of life.
2. Mind-reads. Assumptions about someone else’s thoughts or feelings, stated as a fact.
Dr. M: I’m sure you want to explore all the options.
3. Negative predictions. Negative speculations about the future, stated as a fact.
Sarah: He’s never going to get to the point where life is worth living again.
4. Leading questions. Questions that make it obvious what the right answer is supposed to be.
Dr. M: Wouldn’t it be better to wait and be certain?
5. Complaints. Frustrated, whining, or resentful comments implying that people or circumstances are unfair.
Sarah (whining): We’ve waited so long already and nothing has helped!
6. Attacks. Venting of strong negative feelings in a hostile or blameful way.
Sarah: Look, I just can’t talk to you about this anymore!
With this perspective, it’s easy to understand why Sarah and Dr. M ran into problems. The behaviors they used are enough to cause trouble in any communication. What’s more, we can now see a clear path to making some improvements. There’s no need to avoid the topic or change anyone’s personality. All that’s needed is a shift in behavior.
How Bad Conversations Turn Good
This book will give you the tools to turn around all of the most common difficult conversations, whether they’re driven by mind-reads or yes-buts or verbal attacks. If Sarah or Dr. M had possessed these skills, their conversation probably would have gone in a more positive direction. Here’s one possibility:
Sarah: It’s so upsetting to see my father in this condition. I know this is not how he’d want to spend the last days of his life.
Dr. M (with feeling): I’m really sorry. I hear how difficult this is for you.
Sarah: It is so hard. I’m starting to think it’s finally time to take him off the respirator.
Dr. M: Many people consider that option when several different treatments have failed, and they start to lose hope. Are you feeling that way?
Sarah: Yes, I am. I’m feeling totally hopeless and also feeling guilty. I don’t want to prolong his life just to save me from the grief of losing him.
Dr. M: I can see how hard it is to face all these decisions, not really knowing what’s going to be best for your father.
Sarah: I just don’t know what to do.
Dr. M: We do have a support group here to help family members deal with these types of issues. It sometimes helps people to know they’re not going through it alone. Is that something that would interest you?
Sarah: I’m not really comfortable in groups, but I could use someone to talk to.
Dr. M: Our support services department could set up an individual counseling session for you. Would you like me to connect you with them?
Sarah: I’d really appreciate that. Thank you.
Dr. M: Great. I’ll do that. And as you prepare to make a decision, I want to be sure you have accurate information about your father’s new medication and the types of effects it can have. Is now a good time to discuss that?
Sarah: Sure. Go ahead.
Dr. M: All right, let me tell you what the studies show . . .
Can you tell what changed? You may have noticed that Dr. M’s side of the conversation sounded quite different. Be careful how you think about that difference. It can be tempting to go back to focusing on psychological factors, thinking that Dr. M must have changed his attitude (becoming more open-minded), his emotional state (feeling more compassionate), or his motivation (attempting to help Sarah, rather than just push his own views). He may have done any or all of these things, but that doesn’t tell us why the communication went well. Plenty of caring people, with all the best intentions, have conversations that fail miserably. What turned things around was a change in Dr. M’s behavior—what he actually did. This is a key point to remember: Intentions alone do not change conversations. Actions change conversations.
Dr. M did very specific things that helped show Sarah that he understood her concerns and was receptive to hearing what she had to say. For instance, instead of arguing with yes-buts and leading questions, he mirrored her emotions (“I hear how difficult this is for you”) and asked straightforward, nonleading questions (“Would you like me to connect you with them?” “Is now a good time to discuss that?”). Starting out in this way also left Sarah more receptive to hearing his ideas about the new medication.
Now, Dr. M is not the only one with the power to transform this conversation. Remember that when he yes-butted Sarah in the original dialogue, she replied with a complaint. A more skillful response might have led to a much better outcome:
Dr. M: I can see how you’d feel that way now, but this new medication may start to improve his quality of life.
Sarah: So you’re saying you think this new medication may make a difference for him. How big a difference?
Dr. M: If he responds well to the drug, it could extend his life for several months. It could also allow him to return home, as long as he had 24-hour care available.
Sarah: Wow, that could make a huge difference to Dad. He’s always said he’d rather spend his final days at home. How long will it be before you know if it’s working?
Dr. M: Most people respond within a few days, but it could take up to two weeks to know for sure. I’ll check in with you every day to let you know what’s happening.
Sarah: Thank you! This is the first sign of hope we’ve had in a long time.
Again, what made the difference here were not just intentions, but actions. The most natural response to being yes-butted is to argue back. It takes skill to resist doing that and try something else instead. What Sarah did was to paraphrase Dr. M (“You think this new medication may make a difference for him”) and ask a question (“How big a difference?”). By using this approach, she not only avoided an argument but also gained important information that helped ease her distress and give her new hope.
Part of our aim in this book is to give new hope to you, the reader. Once you understand the factors that cause your conversations to succeed or fail, it is possible to dramatically improve them, even in situations where the people and issues you’re facing seem overwhelmingly difficult. We’ve seen it happen hundreds of times, in families, couples, and all sorts of organizations. Even after a discussion begins to go downhill (for instance, with Dr. M’s yes-but), there’s almost always a way to turn things around.
In fact, some of the most successful and transformative conversations start out with whining complaints, defensiveness, snide remarks, or personal attacks. What matters is that at some point, someone takes the initiative to do something different. That someone can always be you. At any moment in a conversation, from any position in the conversation, you have the power to intervene and change the course of events. You just have to know how.
Training for Change
One idea we’ve emphasized throughout this chapter is that how you understand what’s going wrong will determine the steps you can take to bring about change. If you blame your communication problems on irreconcilable differences, you may want to go into hiding, or at least into denial. If you blame them on someone else’s personality, you may want them to go into therapy. But as soon as you shift your focus to behavior, it’s clear that you have a much more effective option: go into training.
When we talk about training, we don’t mean the type of training where you sit passively in a seminar while a lecturer explains all the general rules that good communicators ought to follow. The type of training we’re talking about is more like sports practice than an academic class. Imagine trying to become skilled at basketball just by being told what to do and watching experienced players do it. You obviously wouldn’t get very far. To master the game, you need to get out on the court, get the ball in your hands, and try doing those things for yourself.
In communication, too, what matters most is your level of hands-on skill. You need to be able to respond effectively right at the moment when something sets you off—when your boss yells at you, your colleague shoots down your great new idea, or your spouse starts rehashing the same old complaints you’ve heard hundreds of times before. This is no easy task. We all have at least one or two fixed habits that we’ve developed over the years, whether it’s a tendency to defend ourselves (“I couldn’t help it”), to predict catastrophe (“This will be a disaster!”), to use sarcasm (“Yeah, right, like that’s going to help”), or to yes-but everyone else’s suggestions (“That’s nice, but we can’t afford it”).
What’s the best way to change a habit? Thanks to recent research in neuropsychology, we can now answer that question with greater precision than ever before. Due to the way the human brain functions, it takes particular types of experiences to change the way we communicate. In the next chapter, we’ll review that research and show how we can apply it to train our brains in the most effective and efficient way. In the following six chapters, we’ll put those ideas into practice. Each time we teach you a new set of strategies, we’ll guide you through an intensive training program designed to help you master those skills and transform your own challenging conversations.
Chapter 1 Notes
1. Hardeep Singh, Aanand Dinkar Naik, Raghuram Rao, and Laura Ann Petersen, “Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology,” Journal of General Internal Medicine 23, no. 4 (2008): 489–494.
Kathleen M. Sutcliffe, Elizabeth Lewton, and Marilynn M. Rosenthal, “Communication Failures: An Insidious Contributor to Medical Mishaps,” Academic Medicine 79, no. 2 (2004): 186–194.
2. We developed this dialogue for a training session we led at a major Boston hospital. It does not reflect one specific case but rather is an amalgam of several similar clinical conversations.
3. You may notice that throughout the book, we use the words they, their, and them as singular, gender-neutral pronouns. While some grammarians view this usage as unacceptable, we’ve found it preferable to the awkwardness of he/she, he or she, and other alternative phrasings.
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