Developing Assertiveness Skills for Health and Social Care Professionals

Annie Phillips

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9781846199776
• eBook ISBN: 9781000552607
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Want to communicate clearly, honestly and directly, without avoidance or resorting to manipulative or aggressive behaviour? Learn how to be assertive and explore its advantages as the primary tool of effective communication skills in healthcare settings. If you work in health or social care as a manager or clinician, deal with people on a daily basis, and need these dealings to be thoughtful, effective and stress free, this is the book for you. It teaches you how to understand and alleviate barriers to effective communication, manage the stresses and conflicts, and develop the effective clinical, people and management skills you need to navigate successfully through a career in healthcare. It challenges the reader to re-construct their approach to communication and present themselves more confidently whilst encouraging investment in their personal and professional development. This highly practical guide, and its companion volume Developing Leadership Skills for Health and Social Care Professionals are essential tools for all health and social care professionals wanting to develop relationships with their colleagues, patients and clients including clinicians, practice managers, nurses, midwives, general practitioners, therapists, doctors, dieticians, psychological therapists, paramedics and health visitors.

Section 1

Assertiveness skills

CHAPTER 1

The importance of being assertive

Why is assertiveness so important? Assertive techniques help us to communicate in constructive and satisfying ways, to achieve workable results in difficult situations, and they can assist in resolving conflicts without aggression. These are essential techniques to understand and use in our roles in health and social care, both as managers and clinicians. In these roles especially, we juggle our skills as a clinician, teacher, carer, manager, support worker, facilitator.

Both men and women working in the caring professions need to learn to develop their assertiveness skills so that they can develop personally and professionally, to communicate effectively and confidently with both patients and clients and their working partners across the public and private sector: in education, social care, the police, local government.

Assertiveness is a skill that is particularly important for women. Women struggle in particular with their role as carer – they are much more likely than men to put themselves last, and can therefore find it harder to communicate their own needs or to develop themselves or their career. There are some noticeable gender differences. Both sexes draw constantly on their emotional and intellectual resources when dealing with clinical and managerial conflicts, and struggle to provide a good service with limited resources and sometimes little peer group support. However, women notably are more likely to feel guilty when they do not, or are unable to, live up to the caring image. If they identify with the image, they do not want to let others down, they easily absorb their concerns and worries, and they do not want to be a disappointment to people or be seen to be selfish. Women are socialised to want to be thought of as indispensable; our work can involve sacrifice, we find it hard to delegate and certainly do not want to offend. Although men generally find it easier to be assertive, some find it harder to develop the fine-tuned and complex verbal and non-verbal skills needed to listen and to communicate with empathy, sympathy and focus. They sometimes tend towards aggression rather than passivity, and may struggle to rein in or understand their own emotional responses if they have not been socialised to do so.

SOME FACTS ABOUT ASSERTIVENESS

Learning to be assertive has become a popular form of self-development; it is seen as an important component in cognitive behavioural approaches to tackling anger, anxiety, depression and poor self-esteem. I hope that through reading this book you will change your ideas; changing ideas influences behaviour, and changing behaviour leads to changes in ideas. Many psychologists and cognitive behavioural therapists have cited these behavioural approaches as crucial in change management.¹

In teaching assertiveness, I like to think we are looking at behaving with good intent, using some principles taken from mindfulness teachings.² Here, it is important that our motives are ‘good’:

• ➤ to behave with good intent, with the motivation to care for others and ourselves
• ➤ good interpersonal relating, saying kind not hurtful things
• ➤ good action – linked to behaviour that tries to heal not destroy
• ➤ right livelihood – linked to a choice of career and how we conduct ourselves at work
• ➤ right mindfulness – paying attention to ourselves and others ‘in the moment’ in a focused, compassionate way.

Thus, used well, assertiveness is not about behaving selfishly, but rather it is about using our skills of attention, reasoning, awareness of feeling and behaviour to build the attributes of compassion: sensitivity, sympathy, empathy, non-judgement, care; compassion for others and ourselves. Assertive people recognise their own limits and are able to call a halt before they burn out. They give themselves time to rest and replenish their energies, and recognise that their needs are no more or no less than those of others, but are equal.

Assertive behaviour can help with situations such as:

• ➤ complex communication: conflict, violence, manipulation, anger
• ➤ time management
• ➤ identification of obstacles to career or personal development
• ➤ relaxation
• ➤ overcoming work, people and time demands
• ➤ making and refusing requests
• ➤ handling criticism and compliments

• ➤ coping with rejection
• ➤ building self-esteem
• ➤ giving constructive criticism
• ➤ staff appraisals and disciplinary procedures
• ➤ negotiating
• ➤ goal setting.

Behaving assertively helps at both the professional and the personal level. It helps us to communicate directly and powerfully at work; and can also defend against aggression or defensive behaviour when hopes and plans are thwarted. Negotiation and compromise form the lynchpin in assertiveness training. The assertive person takes charge and acts in ways that invite respect, accepting their own limitations and strengths. This in turn leads to clearer communication, as others understand clearly what their needs and desires are and any potential confusion or discord is alleviated. If you are not sure whether you need to be more assertive, try the exercise in the Appendix at the end of this chapter.

There are many unusual management situations in the caring professions: clinical managers who are torn in many ways, balancing the demands of their staff with those of patients and managers, needing to uphold clinical standards while acknowledging financial pressures and the needs of the service overall; GPs, who now have to balance their professional and commissioning role; GP practice managers, unique in their role as representatives of general practice, acting as advocates for the staff and patients, leading and yet in turn ‘managed’ by their employers, the GPs and clinicians, all of whom have to find the very best for those using the service while working to the management and government agenda, balancing personal and professional needs, and managing tensions – what is best for people within the resources available. These unusual and diverse relationships can cause conflict. Assertiveness skills enable us to see our role more clearly and cope more readily with feelings of frustration or inadequacy. We need to be able too to express anger, frustrations and anxiety constructively in order to prevent further stress, improve management and improve services.

Eric Berne³ was one of the first psychologists to identify behavioural traits in communicating, which impacted on the success of the communication. He identified what he felt were four ego states.

FREE CHILD	ADULT
ADAPTIVE CHILD	CRITICAL PARENT

And four ways of interacting.

I’m ok	you’re ok	(adult)
I’m ok	you’re not ok	(the bully)
I’m not ok	you’re not ok	(the aggressive victim
I’m not ok	you’re ok	(depressed)

His term for what we would now call assertiveness was ‘adult’: the assertive response is ‘in adult’: a neutral and fair communication style. Within the next decade, psychologists working within behaviourist models, Beck et al. and Ellis,⁴ were building on this work to improve self-esteem and to help people fight depression. One of the first, and excellent, books on assertiveness was published in the early 1980s. Written by Anne Dickson, an American psychologist,⁵ the work is the source of much of the material subsequently written on assertiveness in this country. She...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• About the author
• Acknowledgements
• Introduction
• Section 1 Assertiveness skills
• Section 2 Assertiveness in practice
• Section 3 Clinical challenges
• Section 4 Applying assertiveness skills
• Index