Navigation and a Couple Tips for On-line Modules Navigation Instructions: Whenever you see words in this color and style in the module click on it for additional information De-escalation and Management of Aggressive Behaviors Module 6 Active and Empathetic Listening For most people violence is resorted to only after attempts to resolve a problem through communications have failed. Listening is your most important communication tool for de-escalating aggression.

Active listening is a communication technique that requires the listener to feed back what he hears to the speaker, by re-stating or paraphrasing what he has heard in his own words, to confirm what he has heard and moreover, to confirm the understanding of both parties. Empathic listening a method of listening that involves understanding both the content of a message as well as the intent and emotion of the sender and the circumstances under which the message is given. Consider these two definitions: While some communication experts make a distinction between these two terms, they are often used interchangeably, as we will do in this module. The concept is well known, simple, and yet not commonly used. The next few pages will give you an opportunity to review your own understanding of empathetic listening.

Patient: “I’m really nervous about this operation.” “You shouldn’t worry, the doctor knows what he’s doing.” Let’s review some principles of empathetic listening in the content of these statements Correct, this is not Empathetic. Empathetic listening is focused on understanding the other person fully before attempting to resolve a problem or relieve unpleasant emotions, as this response does. While it is appropriate at times to provide information to relieve a person’s anxiety, to do so before expressing understanding often has the effect of minimizing what the person is feeling (the phrase, “I know how you feel…” does the same thing), or may convey to the person that you’re not interested in hearing about their feelings. Also, this response assumes the anxiety is related to fears about the abilities of the doctor, when it may be related to any number of other factors. Empathetic or not? (Click on your answer) YES NO

Correct. Empathetic listening restates what is heard as well as unspoken emotional content, as this response does. What follows this statement is crucial. Silence is often an important part of empathetic listening, to give the person opportunity to express self more fully. Avoid excuse making, minimizing or premature problem solving. You don’t yet know in this example if the husband is wanting more for his wife, or is just expressing his concern. Visitor: “My wife just got pain meds but she seems so uncomfortable” “You’re really concerned about her being comfortable…” Let’s review some principles of empathetic listening in the content of these statements Empathetic or not? (Click on your answer) YES NO

Patient :” I know you don’t care. You just want to get out of here.” “I’m sorry, are you feeling ignored?” Empathetic listening uses questions to clarify one’s understanding, as this response does. “Feeling ignored” might be a wrong guess, but as with interpreting body language it’s important to validate one’s guesses about what is going on. It’s important, however, that you do not use leading questions to lead the other. An apology is not, strictly speaking, part of empathetic listening, but it is an important part of responding to an upset individual. Let’s review some principles of empathetic listening in the content of these statements Empathetic or not? (Click on your answer) YES NO

Patient :” If I don’t get answers soon someone’s going to pay.” “We’re doing the best we can, we’ll get your questions answered real soon.” The statement contains what can be interpreted as a threat. In any such case it is important to clarify what is meant. For example, ask directly, “Someone’s going to pay? How do mean that?” or “It sounds like you’re ready to do something?” Empathetic listening is often though of as just being “touchy- feely”. It can be, but it can also be direct and confrontational, as in this case, where clarification and understanding are important, in order to assess if there is a risk of violence. Let’s review some principles of empathetic listening in the content of these statements How did you do? Let’s look at some additional principles for empathetic listening Empathetic or not? (Click on your answer) YES NO

Provide the speaker with your undivided attention. This is one time “multi-tasking” or “rapid refocus” will get you in trouble. Be non-judgmental. Don’t minimize or trivialize the speakers issue. Read the speaker. Observe the emotions behind the words. Is the speaker angry, afraid, frustrated or resentful. Respond to the emotion as well as the words. Be Quiet. Don’t feel you must have an immediate reply. Often if you allow for some quiet after the speaker has vented, they themselves will break the silence and offer a solution. Verify your understanding. Ask clarifying questions and restate what you perceive the speaker to be saying. The Process of Empathic Listening can be summarized in five steps

  The Concept of the “Humanizing Question” comes from the work of Patterson, Grenny, et al and their books Crucial Conversation s and Crucial Confrontation. The humanizing Question is, “Why would a decent, rational person do such a thing?” (or, “act that way?”) The goal of asking the humanizing question is two-fold. First, it helps ensure that you won't fall into an emotionally driven state and debilitate your cognitive-processing ability You only gain control of your emotions (and with them your ability to think and act rationally) by assuming that you're not currently under attack. When you wonder why a reasonable, rational, and decent person would do what the other person just did, you also invite an element of safety into the conversation. You say to yourself, "I don't know what caused that behavior, but I don't think it's due to stupidity or malice."   So, first, we ask the humanizing question not merely to humanize the other person, but to remain human ourselves.   Use the “Humanizing Question” to enhance empathetic listening

   Second, by controlling our emotions, we also make it safe for the other person to talk openly and honestly. We make conversation a better option for expressing his distress.   Now it's important to realize that we don't give others the benefit of the doubt because they are always decent and rational. In reality, others purposefully act in ways that are indecent, irrational, harmful or selfish, at times.   Asking the humanizing question keeps your emotions under control, so that you are able to focus on addressing the distress or the unmet need of the other person.   Use the “Humanizing Question” to enhance empathetic listening Experience has shown that most of the active listening principles discussed in this module are familiar to most people, with the exception of the “Humanizing question” which is new to most people. Experience has also shown that this principle is one of the most powerful for enhancing one’s ability to handle difficult situations with people.

State the obvious, the observable and what has already been said. This is the starting point for responding empathetically . The important distinction is to differentiate between observation and interpretation or judgment.   Do not be defensive even if comments or insults are directed at you.  They are not about you. Do not defend yourself or anyone else from insults, curses, or misconceptions about their roles or behaviors.   Respond selectively.  Answer information seeking questions no matter how rudely asked, (e.g. “Why do I need to fill out these g-d forms”?) This is a real information-seeking question.  Do not answer abusive questions (e.g. “Why are all the counselors here a_ _holes”?).  This sort of question should get no response whatsoever.    Empathize with feelings but not with the behavior (e.g. “I understand that you have every right to feel angry. It is not okay for you to threaten me or my staff.”).   Do not solicit how a person is feeling (Don’t ask, “how does that make you feel?”) or interpret feelings in an analytic way.   Additional principles:

Active listening occurs to varying degrees, but in each cases focuses on understanding the speaker.

Empathetic listening relates to each of the other de-escalation skills Situational Awareness Self Management Nonverbal Communication & Managing Space In order to gain an accurate assessment of a situation you must have an understanding of the emotional state of those involved. Empathetic listening verifies your understanding, and brings what might have been unspoken without it to the surface. Empathetic listening requires you to suspend your own preconceptions, and your desire to” have your say”, and to focus on the speaker. Also in an emotionally charged situation, sincere interest in the other person helps you to manage your own stress. In empathetic listening, includes reflecting your observations of nonverbal cues. Your response will include your tentative interpretations of what is happening emotionally and nonverbals to reinforce your attention to the other, while responding to any warning signs.

Empathetic listening skills are developed through practice An mentioned earlier, most people (of those completing this module) are very familiar with the principles of empathetic or active listening. However, if you were to eavesdrop on these same people in normal social interactions, you would soon realize that empathetic listening is not a common part of everyday conversation. While this is part of what makes it such a powerful communication tool– the fact it is not common, because it is so familiar, (and simple) it is common for people to under estimate how difficult it can be in a stressful situation, and overestimate their own skill level. There’s only one solution to this: practice. Make the conscious intent to use empathetic listening in your everyday interactions. It doesn’t have to be all the time, but from time to time, make the effort. It will pay off in a crisis situation.

“Violence is the language of the unheard." - Martin Luther King, Jr. Recall that in most cases people prefer to resolve conflict through communication rather than aggression. People use aggression when they feel they are unheard, or don’t believe their problem will be resolved through dialogue. Empathetic listening is a means of keeping dialogue open.

Empathetic listening requires you to suspend offering a solution, even when you are familiar with the problem. T F Empathetic listening require you to reflect only what is specifically stated by the other person. T F Empathetic listening includes asking questions to lead the other person to a different perspective. T F “I know how you feel...” is, generally speaking, a good way to express empathy. T F Empathetic listening requires that you focus only on the feelings of the other person, and not be confrontational. T F