Confrontation and communication styles

Communication styles can be categorized in different ways. Understanding a patient's style can help you communicate better — including delivering bad news.

THREE COMMUNICATION GROUPS

According to psychologist Karen Horney, people tend to fall into one of three easily detectable groups: Assertives, compliants, and withdrawns. Your style of confrontation may vary with these categories.

• Assertives. An assertive type is accustomed to straightforward communication, so you can assume a firm tone in your voice and make a direct statement, such as: "Mr. Patient, I'm going to give you the straight story. You have a serious problem with your structure, not life threatening at this point, but there's a lot of damage and degeneration, and this will take an extensive program of care ..."

• Compliants. For compliants who are more relationship-driven, a warmer and more supportive tone is appropriate: "Mrs. Patient, I'm really glad you chose us to take care of you. Based upon your test findings, you do seem to have a rather serious problem with your spine and nerve system, and it may take some time and a very thorough program of care to ease your discomfort and resolve the condition the best we can ..."

• Withdrawns. For withdrawn types, use less language and more feelings and be more indirect: "Mr. Patient, sometimes people come in here with simple problems to help, and some are more difficult. Yours is going to be a bit more challenging than usual because you really have a lot going on here, which you may have already realized ..."

METAPROGRAMS

People also tend to act based on typical behavior patterns, known as metaprograms. For example: People tend to move toward pleasure or away from pain, have an internal or external frame of reference, or tend to see similarities or differences in things.

You may want to move the person toward benefits and away from consequences until you really learn the way his/her system is set up. For example: You could say, "If you do the things I ask you to do and avoid doing the things I ask you not to do, I see no reason you shouldn't respond beautifully to our program of care."

A person with an external frame of reference tends to gather input or feedback to know something is true. Capitalize on that tendency by saying, "In spite of the severity of your problem, many people with similar conditions have responded well to our program of care, and I expect you will also; otherwise I couldn't accept your case in good faith."

A person with an internal frame of reference knows something is true by gut feeling. You can say, "When you think about the kind of challenge you have here, you probably already figured out you're better off having experienced professionals to support you in your healing process, and you may even be getting the feeling that we're the ones to help you."

If someone tends to see the similarities in things, comment, "This may be shocking or surprising for you, but many people have similar conditions to this ..."

If the patient sees differences, you would say, "Every case is dealt with individually. In spite of the severity of your condition, you can expect personalized care that is based on your unique situation."