Communication that makes a difference

                                                                 Introductory notes:

There are many guides for carers. They have often been written in countries far away from Aotearoa. They address the way communication is effective in those cultures. Many of the guides are models, modalities or frameworks to assist health professionals. They are often built around a premise which promotes a chosen format for assisting others.

What follows here is an attempt to move away from theory and frameworks for helping others. Questions and statements are there to promote self-reflection. It is hoped readers will build their own guides for successful conversations. In Aotearoa we consider cultural preferences to be crucial. Each conversation will be built around who we are, where we have come from and the community life we share.

                     Preparation for meeting as a carer ‘in relationship’

‘Before I welcome people or they welcome me into a meeting, I need to prepare my ‘self’.

It is important to attend to my feelings, expectations and thoughts, about the people (or the person) I am about to meet.

It is important to review what is happening in my life, in family settings and in my friendships.

I ask myself, ‘Am I relaxed and ready to attend to people or am I tense, stressed or hurried?’

It is also important to ask, ‘How will I use my knowledge and skills in this caring situation?’

It is wise to ask, ‘How will I set boundaries in order to keep myself and other people safe?’

Is there a chance I am drawn to the person I am about to meet in a way that challenges my boundaries?

Is it possible this person might remind me of someone who has kept criticising me, someone who rejected me, someone who loved me and left me, someone who wanted to hurt or restrict me?

Will I be tempted to be unnecessarily ‘parental’, ‘authoritative’ or ‘educative’ with this person?

Am I expecting this person to meet some needs that my friends or family don’t seem to be able to meet?

Am I hoping to keep this person as a close friend outside of my acknowledged role?

Am I inclined to be judgemental of this person because the way they behave or the way they see life reminds me of people I disapprove of?’

Am I expecting this person to be ‘like me’ with similar views, goals, understandings and approaches to people?

Do I have a fixed idea as to how people ought to be helped or explore their self development?

                                      In the presence of others

‘When I agree to meet with people, I take my ‘presence’ into their presence. My cultural being is there in the room.   

When meeting with others who are linked with cultures other than my own, I need to discover how they wish to be greeted, what helps them feel comfortable and the elements that might connect with my own culture.

In Aotearoa it is appropriate to speak of my origins, places I call 'home', mountains, oceans, rivers that connect me to my 'self', ancestors, family and what I might call 'my spiritual self'.

The person I have just met may wish to tell of their own origins and connections.

The way I see life and people is guiding me.

The views of others are important to acknowledge.

My relationships with other people in my life affect me as I begin the meeting.

It is worth considering whether I am assuming a ‘professional’ stance, one that gives the impression I know more than others or that I have special knowledge or insights.

In order to be totally present, I need to live ‘in the moment’. I need to be as authentic as I can be.

My thoughts are best placed in the background while I pay attention to their thoughts.

My emotions are best placed alongside their feelings.

It will help if I am relaxed enough to present an image that aligns with the energy life has to offer, a holistic awareness and a focus on that which is possible.’

It will help if I use theory, patterns or insights from my own education tentatively and with careful consideration.

Important insights come from within our meeting, not from outside our meeting.

                                     The first moments of a relationship

How do we meet each other well in situations that may turn out to be awkward, stressful, encouraging or challenging?

Perhaps the best way to prepare is to develop a heightened awareness:

Awareness of atmosphere, darkness and light, optimism or pessimism and energy and stillness, are probably as important as self- awareness or awareness of process.

What is my way of being alert? (Some carers are alert to ‘atmosphere’ whereas some focus on meanings. Other people are alert to movement or sounds and some are alert to age, ethnicity or gender. Other people notice how a person is dressed or how they present physically.) Others are alert to movement and spaces, colours, and the way the outside world impinges on what is happening inside.

There are others who are good at sensing that an amount of distance needs to be created between people.

What are my needs as a carer when it comes to having enough space in conversation, quietness, room to move and the protection of my privacy?

To what extent am I open to social, cultural and spiritual issues which may cause tension and difference?

Am I accepting of all kinds of behaviour or are there limits to my acceptance of the way people live, behave or relate to others?

Am I more inclined to focus on practical solutions for people? Am I more interested in human development, psychological growth or cultural and social development?

When I relate to people are they likely to see me as a teacher, a guide, a counsellor, a parent, an authority, a supporter, a peer, a wise person, a friend or a fellow traveller?

                                           Developing awareness

First meetings are crucial. First impressions tend to guide the conversation and it is important to remember that first impressions may not be the best guide.

Every first meeting holds history within brief moments.

I am not just ‘myself’ when I meet with someone. I am my ancestors, I am the place where I was born and I am connections with land, mountains, rivers and the sea.

I am a reflection of events my ancestors initiated or experienced and I am a reflection of celebrations and tragedies mirrored in the faces of many people.

When I enter the meeting room, I need to find ways to communicate everything I have allowed myself to be, supported by my beginnings, my history and my social and cultural experiences.

The main skill lies in catching momentary thoughts and feelings, acknowledging them and then following them through.

Creativity occurs when important moments are acknowledged.

Many things occur in an instant in time and these need to be noticed.

The person being met in relationship is like a song waiting to be sung in duet form. The carer’s task is to detect beauty in the song and to sing within the duet.

The skill lies in continually asking the question, ‘What is happening now?’ (That is an entirely different question from, ‘What is the problem here?’)

Attention is then given to the way parts of the song story are joining together. It is important to be alert to what is waiting to be added to the song.

                           Helping is developmental and takes time

There is no greater privilege, no greater honour than to be invited into the corridors of another person's mind.

The moment of engagement with a person is a privilege. The excellent carer will approach this moment with confidence and with a sense of wonder.

Caring is a meeting place. It is not a treatment centre or an agency which facilitates social change.  

Helping is not the central focus and effective meeting is everything.

To be a carer who accepts an invitation to open the door in the first corridor and tread softly, hand in hand with the other person who just might know where they are going, is a person charged with huge responsibility.

Helping involves making sure people are agreeing to being helped.

It helps to offer a pathway or a number of pathways by checking with the person and then taking slow but sure steps into the future.

The first contact opens the door for further discussions, assistance and manaakitanga.

Carers who keep asking the question, ‘Who am I for this person I’m helping?’ will be able to keep caring whilst managing stress, annoyance and occasional rejection. The answers to that question will help carers know whether they are too close and whether someone else would be better placed to care.

Can the carer keep suitable boundaries in place?’ Answers to that question help the carer decide whether the relationship is too intense. They also help to encourage both the carer and the person being helped to review who they are for each other and what might enhance the relationship by keeping it safe, clear and encouraging.

Caring that does not have an ending can be rewarding for those being cared for and for the carers. For those being helped, being close to someone who is ‘always there’ makes the promise of new life possible.

The way to keep caring in long lasting professional situations is to keep asking what is happening, what is expected and whether each person understands each other well.

                                             Questions for the carer

Questions (to myself as a carer) are a guide:

How is this meeting taking place?

Who am I as distinct from the other person?

Who is speaking, who is touching emotion?

Who is imagining events and places and people?

Who is entering an inner world and who is exploring an outer world?

When might I speak and make a difference?

When might I connect one thought with another, one expression with another, one emotion with another?

When am I noticing references to darkness and references to light?

When am I focusing on ambivalence? (Two or more factors being held in the mind and/or emotions at the same time)

Am I able to stay centred on the way the story is being woven?

Am I aware of forces and influences that exercise power?

How do these two people exist together in the world?

How is this story we are weaving together affecting us both as we make choices?

What needs to happen in order that forces around us both are changed, acted on, questioned, challenged, or accepted?

What of the future as it carries the meanings from the past and is created by the present?

Who will walk with this other person when I am not by their side?

How will these moments together be used to make a difference to both our worlds personally, socially, culturally and within life generally?

                                Words, emotion, creative conversation

It helps to ‘begin with what is and not with what might be.’

If someone has asked me to go with them on their journey, I need to notice the signs of motivation and look past the signs of resistance. 

What is there is the desire for connection.

                                           Speaking with each other:

While it is true that people communicate through presentation of the whole self, most begin by speaking. The desire to connect through language is paramount for the person who can use words.

As each word is offered the person being cared for is listening to establish whether the words have meaning for the person listening to them. Even within lengthy and convoluted phrases, people monitor whether the carer can hear the words and sense the atmosphere as language unfolds.

Carers who can hear and visualise at the same time are carers who are sensitive to words set in a scene very similar to a movie set. Places, plots and people in the drama are being recreated.

There is intense activity hovering around one word or phrase. The scene has to be filmed and acted again and again. So many ways of viewing characters and events are possible that many cameras are needed in the mind. 

The complications are both stimulating and demanding.

                                                           Emotion:

Words are connected to emotions. When the scene around one word or phrase finds its own artistic formation, emotional power is available and primed for release.

Now is the time to wait and be alert, while the person being helped brings a kaleidoscope of feelings in through sounds in the words. This is the moment of possibility that can capture the imagination of the carer.

                                                    A creative act

The release of imagination is at the heart of the creative act.

The aim is to connect with the whole person. It is an artistic process. It is not a ‘search for the self ‘nor is it a matter of resolving issues.

Nothing dramatic or cathartic needs to happen. The creative tension necessary for true connection will best come from a dual encounter.

The carer engages the other person in a process that links association patterns. Moving from one thought to another, the task is to focus on links between thoughts and feelings.  

It takes quite some time to learn how to focus on the connection between words and not on each word or image.

Carers with promise are people who are fascinated by connections rather than separate facts or issues or events.

Carers can develop and be stimulated by imagery.

There is never a right word, a helpful response, a useful summary. Instead, there are artistic experiments, sensitive explorations, fascination with nuances and spontaneous courage.

*All of this may occur whilst listening to the first sentence or the first tentative phrase that has been offered.

As sentences become a story-line they give rise to uncertainty and ambivalence. It is the warp and the weft of these concepts that holds the key to insight.

Carers who allow themselves to wait with uncertainty, contemplate ‘not knowing’ and ‘not being able to see’ will be able to sit with people in that place. 

Words, emotions and visual images begin to merge. People being helped seem to be waiting for an insight on the horizon but, for the moment, they are content to wait.

These moments are crucial because they pose powerful questions:

• ‘Is it possible to live without answers and without being sure?’ ‘Is there enough psychological and philosophical energy within our mind to wander in emptiness?’
• ‘Can the urge to survive overcome the need to drift into nothingness?’
• ‘Is there a way of explaining the rush of feeling or can it remain indefinable?’ ‘If the person’s mind is rested will there be no hold on life?’
• When we stay with a person who is exploring such ambivalence, we both find immense satisfaction in allowing the confusion to happen.

It helps when people look at two or more psychic messages at once and watched them float in the eye of the soul.

                                                  Our story and theirs

When entering into communication with someone and moving about in their atmosphere, carers may need to monitor their own reactions.

It helps to enter the atmosphere by relaxing into the story without losing our own perspective.

Caring demands more than an understanding of how people function, it reminds us of our own history, traumatic experiences and pathways through relationships. Caring takes us back into our own stories, expectations and fears. It is not easy to listen to people without wanting them to believe what we believe, live as we live and resist what we think is wrong, damaging or harmful.

Caring is anthropological, historical and ‘spiritual’ so when we hear another person’s story, we often (mistakenly) think they come from a similar set of understandings about the world.

At times the body of the carer may shake with the power of the drama unfolding and tears may flow as a result of images hitherto unimagined.

It is possible to allow oneself to be immersed in someone else’s story and, at the same time, keep monitoring our own reactions, beliefs and self-awareness.

If the carer is to make an entry onto the stage and hold the limelight for even a short time it helps to remember that one step will shift all players into different positions.

The carer holds a single focus while the other person is affected by the presence of many people.

Sometimes questions don’t need answers, problems don’t need immediate solutions, people may not need immediate rescue from despair.

The excellent carer will value the essence of the story and wait for the right time to offer a pathway to healing.

In the end, one story produces another. People can be assisted to live in the middle of the story without feeling that new chapters must be written every day.

Carers too, can wait with hope. That helps people wait for new insights, new friendships, new strengths that help them move forward.

Many hours are spent following the details of events, the fabric of social interaction and detours that seem endless.

Most carers are tenacious people. They know it is important to believe that the most convoluted story will produce surprising meanings. Moments of terror and moments of intense pleasure are made up of small details that are remembered as being crucial.

It is tempting for the carer to try to understand immediately what the story means. Each piece of the jigsaw will carry meanings for people that the carer cannot know in advance.

The focus on the uniqueness of each client's story makes caring exciting. 'As long as I remain expectant and surprised at each new link someone makes, then my whole system is energised with the expectation of something important in the next sentence.'

There is, however, more to the story than perception, emotion and events. Stories are set in scenery which includes other people, social and cultural tapestries and happenings that defy explanation.

The carer’s task includes visualising scenery and making it live in the present. As effects surrounding the other person are mentioned they point to elements that must be considered as crucial.

This part of the work demands a sense of theatre. The stage is changed often in the drama and players are subject to shifting illusions, real dangers, exciting risks and darkness over land forms.

The creative moment brings new life. As a child is born there is intense focus.  If the mother loses concentration she is exhorted to refocus.  She gathers her thoughts, her physical self, her emotions and her desire for resolution and completion. Nothing else matters. There is only one important task and that is to bring together sources of energy and assist them to serve the primary function, to give birth.

The creative moment cannot be defined. We are used to defining by separating and partialising. In musical notation, we know which notes will sound harmonious when put together but we cannot define the harmony itself. It just sounds harmonious.

All the threads need to be woven together by the person being helped. When the moment comes, the magic belongs to that person. The new child of imagination needs to be nurtured and the unique process that gave birth can be explained only by the person being helped.

Carers need to be ready to sit in the shadows. This is not a moment for intrusion. It is, rather, a moment for not knowing and not needing to know.

To sit in a room where imagination has been born and creative insight has been introduced is to experience the wonder of new life.

Insights can be nurtured with a single word of encouragement or acknowledgment.

We are well advised to hold the moment without resorting to explanation.

Creative moments can last only while every aspect is focused. The person in the audience who claps before the pianist has relaxed her hands from the keys has broken the creative moment.

The parent who lifts the drawing from the child's table before the crayon has been dropped has interrupted the flow of imagination. So, it is with the quick carer who is looking for immediate understanding and intrudes with a question too soon.

Creative insight demands delayed celebration. Words can wait, the explosion of intense pleasure can wait and the task of finding meaning can wait.

Two powerful forces will be there together as laughter and sadness stream through the body.   

The excellent carer will be content to wonder as forces that cannot be controlled change the destiny of people who were finding life difficult and disappointing rather than enhancing and uplifting.

The excellent carer will resist diagnosis, analysis, prediction and definition.

                                 Offering insights, wisdom and guides

There are times in caring when it is appropriate to share one's own thoughts. There are moments when people wait for words that will encourage new thoughts and make them soar.

‘In my life encouraging voices have spoken to me in crucial moments. Significant people were courageous enough to offer a sentence that imprinted itself on my mind and stayed in my soul.

• My childhood vocal tutor told me never to neglect my natural voice.
• My supervisor gave me permission to tell a particular client that I could imagine their future.
• My therapist and mentor told me to have children when I wanted children and not to wait for the right time.

They were all mentors and sages. They were not predicting my future they were using what was obvious and highlighting its importance. Each of these wise people took a risk. It is the kind of risk that might be taken when caring.'

The sharing of an insight that touches the future and may make it possible is appreciated. Supporting a talent, a decision or a wish to help someone reach out for new stimulus or vision provides hope.

There are often important words floating in the mind which have come to the surface because the carer has been immersed in the person’s story. These words may well predict scenes that could be part of the person’s future or they might highlight new ways for energies to be used. They are not there as definitive visions of what might be, they are encouragers so new confidence is gained. 

'I am able to risk saying what might be, only if I sense it as an authentic observation. I have learnt it is not helpful to risk an idea that has come from someone else.

I have also learnt I ought not risk ideas drawn from theory or technique. It is the artistry that is crucial. The carer as artist will know the moment to introduce thoughts of future possibility, confirmation of creative energies and support for healing actions.

The message will be destroyed if it is offered in parental terms but if offered as a fellow traveller it will sound like genuine permission. Permission is offered tentatively with confidence. 'I believe I know when a person trusts me enough to listen to my words, ponder them in the light of their own truths and act on the power of affirmation rather than the content of the message. It is a message that will make sense in the world of contemplation.'

The impossible may be seen as possible.  

                                                    Confidentiality

The central question to ask when managing confidentiality is, ‘Who needs to know the details of someone’s story?’ People tell their stories to carers with an expectation the story will be held in confidence unless permission is given to tell someone else about it.

After helping someone, carers may meet someone else who says, ‘How is John or Mary getting on?’ I heard about the difficulties they are facing’. Carers know they must keep the story confidential but it is hard to reply without breaking confidentiality.

It is helpful to check with the person being helped as to whom they trust, who they would want to know what is happening and which details of the story must be held in confidence.

There are exceptions:

• It may be important to encourage the person to talk to members of their whanau or another carer because others need to know.
• The person may be at risk of harming themselves or someone else, in which case it will be important to gain their permission to alert family, friends or a health professional. In these difficult situations the question to ask is ‘How can we keep everyone safe?’
• Carers are advised to immediately consult with their supervisor, a colleague or a team leader when life is at risk or someone is likely to be harmed.

• People contemplating harming themselves or someone else ought not to be alone until the risk is not present.
• Information that has legal, criminal or social harm implications ought to be discussed immediately between the carer and a professional support person.

Gaining permission to tell someone’s story or alert someone to details is a sensitive task. Sometimes it is helpful to accompany a person when they need to let a health professional or an official know their story.

Sometimes whanau hui or a meeting with significant people present can open the situation and establish avenues for healing.

Carers are encouraged to build networks that include health practitioners (doctors & nurses), agencies that attend to social and personal issues and culturally attentive people who can open doors for others. If practitioners in these networks know who carers are and know their mahi they are more likely to be immediately responsive to need.

                                               Endings and time limits

Carers are often unsure when to end a conversation with people. Health professionals have appointments that last for a certain time, such as fifteen minutes with a general practitioner. Other carers don’t have time limits and conversations stay open.

It helps to develop parameters around conversations. Clear guidelines can often be set and appreciated by people in need. ‘I can see you for an hour but then I will be leaving. We will probably see each other again but for today that is the time I have available.’

In caring conversations, it is common for people to mention what might be the most important detail just before the carer is about to leave. This is a management moment. ‘That is an important issue you have raised. Is there anything about that that seems urgent for you?’ ‘I have to go now but I will call you tonight or connect with you very soon.’ ‘Let’s attend to the urgent matters together and make a time to follow all the other things through later.’

The promise to return if needed, is important.

Endings remind people of other endings in their lives. It may help to enquire as to whether other endings are being recalled and enquire as to how endings have been managed before.

Ending a helping relationship might trigger feelings of rejection. These too, can be recalled and discussed.

It may be possible to arrange another carer who can keep the relationship going in a different manner.

                                              The aim of the journey

There is an aim to caring friendship.

Each carer will have a different understanding of purpose and aim.

The aim is to design a situation where people can approach each other with caution, and explore the notion of ‘how to be in this world’.

In the final analysis, the carer is there to hold the meaning of the interaction in such a way that people begin to view life differently.

The aim is to bring possibilities together without predicting outcomes.

The process, if based on carefully timed curiosity, finds the unexpected and the unrehearsed to be of infinite value.

The aim is to seek. What one finds often is unexpected treasure.

The central question will be, ‘Have fundamental truths been explored and unique atmospheres created?’

The carer will have become part of movements the other person makes. Their thought patterns will be echoed in the other person’s thoughts.

Feelings will have been shared in a way that causes immediate perception.

Both persons will begin to sense possibility, hope and a new vision.

                                                 Advisory comment

The above words are an attempt to describe what happens when people meet successfully as individuals. Group and community occasions need additional elements. There are other ways to describe human interaction. Philosophical, spiritual and cultural paradigms use different language. There will be different explanations, concepts and language used by different cultures.

Roy Bowden