I wrote this article for an assisted living magazine but the technique of “Redirection and Resolution” works in a wide range of situations where negative feedback needs to be managed in a calm, professional manner.
Asking the daughter of a new resident about how her mother was adjusting seemed like a benign question. The executive director felt confident the answer would be positive because, according to feedback from team members and the resident herself, the move appeared to be going well. But her daughter saw it differently. She said other family members thought her mom was very unhappy and she was receiving pressure from them to “take care of the situation.” How did the executive director respond to this unexpected information?
Unexpected negative feedback from residents or their families may trigger resistance, anxiety and trepidation. While this is a normal response to unwanted feedback, it is also a “moment of truth” in which the recipient can either intensify the concern or shift the conversation towards a better outcome.
One approach to shifting the conversation is called “redirection and resolution.”
This approach may not come easy when confronted with an unhappy resident or family member; effective redirection and resolution takes practice, patience, and flexibility. But it works because it is based on proven communication strategies that promote the collaborative pursuit of a solution.
Redirection and resolution is, in essence, a communication dance. Much like the waltz, which depends on three beats, this strategy consists of three steps: diffusing, discovery, and strategizing. Diffusing calms down resistance while discovery expands and clarifies the primary concern. Finally, strategizing identifies a consumer-favored approach to addressing their concern.
Diffusing, which helps preserve rapport amid stress, consists of three stages. The first stage of diffusing helps a recipient of negative feedback resist the temptation to overreact. Left unchecked, resistance triggers a cascade of escalating emotions that lead to angry and defensive responses. An effective way to short circuit this reaction is called “naming.”
Naming involves assigning a neutral name such as “unexpected information” or “new concerns” to negative feedback. The neutral name makes the feedback less personal and threatening, and it allows the recipient a way to calm down “hot thoughts” and remain professional. In this instance, the executive director should take a moment to privately rename the feedback:
• “My resident has an unexpected concern.”
• “My resident’s daughter has brought some new information to my attention.”
The second stage of diffusing consists of addressing the client’s need to be heard and understood. There is obviously a need for the daughter to tell the specifics of what is causing the concern. However, the executive director should be aware that there is a less obvious, but equally important need to recognize and connect with the adult child’s psychological agenda.
The developmental theme of middle age is an emerging crisis which, instead of a sudden occurrence, is an incipient shift in complexity and tone. Externally, the seminal event is usually sickness or death in the family, but it can also involve major upheavals with children, careers, aging parents, and core relationships.
Up to the early forties, the pattern of building a career, raising children, and other measures of success remains fairly predictable. Middle age disrupts and forever changes this pattern. The world begins to take a more somber turn as illness, loss of relationships, career changes, and poor outcomes being more frequent and unpredictable. As such, the middle years usher in a higher state of volatility as a list of daunting tasks related to these upheavals leaves little time to plan, resolve, or recuperate.
Each one of these upheavals unto themselves present a formidable challenge, but arriving in uneven clusters, as is the case in midlife, they can destabilize and exhaust even the most competent adult, highlighting the primary developmental task of middle-age adults: to maintain stability in world of increasing personal volatility.
Understandably, anything that destabilizes the job of “keeping everything together” is threatening and cause for alarm. An effective way to acknowledge this need is to ask open-ended questions embedded with language that expresses developmental empathy. Say:
• “Tell me more about the anxiety surrounding the situation with your mother.”
• “What do you think is destabilizing the situation?”
The third stage of diffusing is acknowledging the client’s concern without assigning blame, which reinforces the tone of mutual respect and desire for collaboration. Reassure the family member that their concern is being heard with phrases such as:
• “Your mother having second thoughts about changing residences is very upsetting.”
• “Despite your good intentions, the situation is causing conflict with your family.”
Remember: The goal of diffusing is to preserve rapport amid the stress of negative feedback.
Discovery, which helps the recipient of feedback to understand more clearly the concern, consists of two stages. The first stage of discovery involves using open-ended questions to gain more information about the concern. A good starting point is with a permission prompt:
• “May I ask you a few questions about the conversations you and your family have been having with your mother regarding this issue?”
Permission prompts set an inclusive tone for follow-up questions. There are three simple discovery prompts that are effective for follow up questions: tell me, what, and how:
• “Tell me more about your mother’s experience since she moved in.”
• “How is your family reacting to your mother’s concerns?”
The second stage of discovery involves reflective listening. Reflective listening takes the client’s answers to open-ended questions and reflects them back to signal they have been heard and understood correctly:
• “Based on what you have told me so far, you feel your mother is experiencing ambivalence about her decision to change living environments.”
• “You mother has changed her mind.”
Remember: The goal of goal of discovery is to explore and clarify the client’s primary concern
Strategizing, which consists of a collaborative approach to find a solution, has three stages. The first stage of strategizing explores the client’s perspective on what needs to be done to manage the situation. A good starting point is with a preference prompt:
• “What is your preference for approaching this concern?”
• “How would you like to approach this situation?”
Preference prompts provide an effective starting point to exploring possible solutions with follow-up questions. Based on the family member’s response to your preference prompts, a productive follow-up question may be:
• “Tell me more about how that would work.”
• “How does your family feel about this approach?”
The second stage of strategizing utilizes reflective listening to summarize and confirm the client-favored approach. As in the second stage of discovery, mirror back the family member’s response to questions to communicate that they have been heard and understood:
• “From what you have told me so far, you would prefer we set up a meeting with the family to discuss the ambivalence issue and ways we can collectively help your mother with this transition.”
• “You feel that we need to address your sibling’s concern first before we attempt to help with your mother’s transitions concerns.”
The third stage mobilizes the client-favored approach into an action plan.
• “Let’s schedule a family meeting later on this week.”
• “When can I meet with you and your siblings?”
Remember: The goal of strategizing is to identify a client-favored approach and map out an action plan.
While presented as a three-step process, redirection and resolution in practice is more fluid based on the give and take of conversations and changing circumstances. Circling back to diffuse a new concern that arises in discovery is common. Revisiting discovery with new information from other family members or changing directions when the client-favored approach proves unworkable is all part of the dance.
What is important to remember is that a successful resolution of consumers’ concerns depends on a willingness to diffuse, the patience to question and listen, and the flexibility to trust a client-favored approach to addressing concerns. By doing so, you can communicate respect for your residents and their family members, helping you to meet their needs.
Driving is a “hot spot” issue for aging parents. Attempts by family members to modify, restrict, or take away driving privileges are in direct conflict with the older adult’s need for control even if it results in unsafe decisions about driving. One of the problems is that adult children assume they hold the leading position for influencing the driving habits of their aging parents. They don’t. That position is held by the primary care physician. While families need to play an active role in monitoring driving safety of aging parents, they need the help of a physician to address the issue of driver safety. This is why we created the Car Front Mind Map.
The Car Front Mind Map offers families a one-page diagram to assess the safety profile of both the car and the driver. Once completed, this assessment helps families deal with driver safety issues in four ways:
It reduces the burden of not knowing the big picture. The Car Front Mind Map provides everyone involved in the care of an aging parent with up to date information about driver safety issues. Many times this information is fuzzy, incomplete or only known by a few.
It reduces the burden of caregiving handoffs. The Car Front Mind Map offers a quick reference guide for other family members who want to lend a hand with transportation, car maintenance, or other tasks. It is especially helpful for coordinating last minute change of plans.
It reduces the burden of integrating driver safety information. The Car Front Mind Map serves as an information hub for sending driving updates to the caregiving team.
It reduces the burden of orchestrating a driving crisis. The Car Front Mind Map becomes an important resource for coordinating a response to a significant change in driving status.
How to use the Car Front Mind Map
Set up a map for an aging parent and develop a safety profile. Provide copies to other family members and ask for comments and revisions.
Fax a copy of the Car Front Mind Map to the aging parent’s primary care physician. Your fax will become part of the medical file. It will indicate your interest in preserving driver safety. Use the same protocol for any significant change in driving status you feel the primary care physician should know about.
If there are concerning driver safety issues that require immediate attention, set up a meeting with the primary care physician and review the family’s observations. The primary care physician is an authority at identifying driver’s at risk, enhancing driving safety, and, if necessary, easing the transition to driving retirement.
I have been studying how to unlock the communication code of older adults for the last twenty-three years. My first breakthrough came early on with developmental psychology, a model based on age-specific tasks that are easy to understand, easy to use, and highly effective. As a result, the two tasks of the final phase of life, control and legacy, have earned their way into the vernacular of how to communicate with older adults.
However, in the last few years I have discovered two additional elements that combine with the developmental tasks of older adults to complicate rapport. Understanding what they are and how to engage them preserves effective communication in even the most trying circumstances.
One of these elements is the invasion of dilemmas in the second half of life. Dilemmas resist heroic attempts to keep everything together. Like an unruly Rubik’s Cube, alignment in one caregiver area seems to trigger chaos in another. Just when driving issues calm down, sibling conflict erupts over money. Just when housing accommodations get better, a parent falls and winds up in the hospital. In the face of this steady stream of dilemmas, the natural instinct is to work harder in search of the illusive mix that will stabilize this disruptive phenomenon. Ironically, upping the work ethic on dilemmas only seems to give birth to new ones, a sorcerer’s apprentice law of dilemma management that runs caregivers ragged. Now what?
The first rule of dilemma management is to reset expectations. There are no final, elegant solutions, just the dance with complexity. Unlike problems, win-win is not part of dilemma management, which is usually a messy process that requires patience and smaller bursts of sustainability. All of this argues for a different orientation, softer reins, and deeper acceptance. In the end, the predictable dilemmas of aging require a different skill set that is not intuitive but essential for everyone’s well being.
The other element is the deep-seated ambivalence older adults have to unwanted advice. This goes beyond the collision between developmental stages, though that is part of it. There are different psychological forces at work here, present at all ages, but markedly enhanced in the final phase of life. We are talking about ambivalence to change.
Choosing to engage ambivalence head, to tell older adults what and how to change, only intensifies and prolongs resistance. Like dilemmas, overcoming ambivalence to change requires a different set of skills. Instead of provoking resistance, we need to soften ambivalence and make room for the possibility of change. This is not an intuitive strategy or skill, but it can be learned with patience and practice.
David Solie Updates
- Dancing with Negative Feedback: Redirection and Resolution
- The Car Front Mind Map
- Caregiver Mind Maps
- Communicating with Older Adults: An Update
- David Solie on Communicating with Senior Housing Clients
- Dancing with Life Review…
- From Pleading To Informing…
- Dangling Conversations…
- The Pedigree Road Map™
- Final Words…
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David Solie’s new book Caregiver Mind Maps is being acclaimed as “tangible breakthrough” in communicating with aging parents...
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