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Lowering the Temperature of a Heated Discussion

        Yvette Erasmus, PsyD, discusses how to ensure conversations are productive and result in positive outcomes when problems or concerns arise.
        Having a loved one in a nursing home or other post-acute and long-term care setting is fraught with challenges and stresses, even in the best of circumstances. Family members experience many worries, concerns, fears, and even sometimes guilt about the new situation. They often have many questions as they adjust to a new normal. At the same time, residents may feel a sense of loss and uncertainty while practitioners and staff are often stressed, exhausted, hurried, and overworked.
        At the intersection of these varying emotional realities, interactions can become charged, heated, and volatile. So how can you bring the heat down and enable positive conversations, outcomes, and relationships? Here are some key practices that work.

        Assume Good Intent

        When people feel helpless or concerned, they often jump to blame and accusations to alleviate their helplessness and to feel like they are “doing something.” Unfortunately, this often leads to exhausting power struggles and an erosion of trust. If you notice yourself wanting to exert control over a situation or find yourself becoming triggered, first deliberately pause, take a few deep breaths, and ground yourself in the present.
        Then take a moment to gather more information and to ask for something that might help. For example, if you are upset that your mother says she didn’t get her breakfast, begin with curiosity and ask questions that can help you understand the context. Did staff not bring her a meal? Did she get a meal but declined to eat it? Does she prefer other types of food? Did she eat breakfast but may have forgotten?
        Understanding the context will help you refine your response to what is actually needed, and this way you can help others be more effective at helping you. When family and staff are united in their focus on the resident’s well-being and assume good intentions (even if learning may be needed), conversations will be more productive and focused on win-win solutions for everyone.

        Focus on Needs

        All human behavior is driven by underlying needs and our desire to meet those needs. Conflicts occur when we become attached to strategies to meet an important need, and conflicts can be deescalated and defused when we take the time to focus on the underlying needs that are “up” in a situation.
        When you’re upset, ask yourself: is this about my need for safety? Or perhaps is it about predictability, choice, trust, care, or purpose? Conversely, also consider what need the other person is trying to meet by what they did; perhaps it is a need for completion or ease. When we start any charged conversation by focusing on needs, we are far more likely to find strategies that can work for all people instead of getting stuck in power struggles.
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        Cooling down a heated conversation may be easier than you think.

        Hear What People Mean

        Hear what people mean — don’t get distracted by how they say it. Offering people grace is a powerful move. When someone is upset about something, focus on what is deeply important to them instead of tightening up around their emotional intensity. As soon as they feel seen, heard, and acknowledged, the intensity will defuse on its own.
        Don’t get distracted by people’s anger or frustration. When people raise their voices, they often have a deep need to be seen and heard. When you meet that need by acknowledging their feelings and repeating their concerns back to them, people will downshift and start to naturally lower their voice.
        When a loved one is upset, look behind their anger or sadness to the deeper needs they may have in the situation. Instead of panicking or having a knee-jerk reaction, relax your own nervous system, name their feelings, guess at their needs, and reassure them that you’re there to help and support them. Lead the conversation with a sense of shared humanity: “Can you tell me more about the problem?” “I understand you’re upset. Tell me what’s happening.” Then ground yourself in the question: What will help? Instead of focusing on what is wrong, put your energy into the solution.

        Questions to Ask Your Practitioner

        • I’d like to help the staff understand what some of my loved one’s triggers are. Who is the best person to connect with about this?
        • Who is the best person to talk to if I have a concern about my loved one’s care?

        What You Can Do

        • Clearly identify what matters to you about the situation. What are the underlying needs you’d like to go to bat for in the situation?
        • Ask questions to get the full picture before reacting in the moment.
        • Resist the urge to assign blame; instead ask for something that might help or could move the situation forward in a positive way.

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