Communication

CASE CHALLENGE 1

orsNutritionist, noted on the medical record that her patient.

n aG age 63. was 5' 11 tall and weigned 250 Ib. A retiree, he was nased with type 2 diabetes melitus. Joan stopped by his hosp-

room, introduced herself, and told him that the purpose of her visit was to dis-

his current food intake. During the conversation, Mr. Jones and his roommate

re watching a baseball game on television, and periodically commented briefly on

e nlavs and players. Finally, Mr. Jones said, "You need to talk with

1e does the cooking." Just then, the physician entered the room

You only have one chance to make a good first impression.

-Gary Dessler

troduction

Today's technology makes communicating easier. We are connected by texting, email, smart phones, instant messaging, Twitter, and Facebook. But for health professionals, relating to others in person is necessary. Face

to-face skills need to be developed for communicating with individuals, groups, and the public. The Academy of Nutrition and Dietetics recognizes expertise in verbal communication," as core competencies for communi-

cating effectively with patients, clients, customers, and other professionals.

Providing "accurate and truthful information in communicating with the

public" is required by the Code of Ethics. Communication skills are the foundation for interviewing counseling

and educating patients, clients, and the public, as well as for ettorts to

45Sist people in changing their dietary and health behaviors. Nutrition

COunselors and health professionals deliver nutrition care and education

na collaborative partnership with patients, clients, and caregivers. Patient dnd client-centered counseling as part of an intervention, tor example,

ures Competent communication, counseling, and education Skills. well-developed communication skills increase the likelihood or tu

POESSiOnal's success with clients and staff. Communication with otner

embers of the healthcare team is important in identifying those in need

OT nutrition care and then in communicating with patients and clen

ut nutrition-related issues. Those in food service management and

POSons coordinating human resources communicate with stan aia

25

1/COMMUNICATION SKILLS

others regularly. As

professionals adva

management,

communication

skills are essentia

with people.

This chapter introduces the interpersonal

cluding verbal and nonverbal communication, and listenings

of the communication process IS presented and discussed f

explanation of the inplications of the process for verbal.

listening behaviors. The impact of diversity on c

vance to higher level of autho nory m

26

ills are essential in rking effectivey l communication process, jn

mode wed by an erbal, and communication is addr

verbal, nonve

Communication Defined

A simple definition is that communication is "the process of acti.

information" and about transmitting verbal and nonverbal messa

which "meaning is co-created simultaneously among people." A Dro" sional needs the ability to use language that is appropriate to the clients

or staffs level of understanding, the ability to develop a relationship with

lients or staff, the ability to talk in a way that relieves anxiety, the abili to communicate in a way that ensures being able to recall information

and the ability to provide people with feedback. Effective communication requires that the message is understood clearly

as intended by the speaker; it achieves the intended ettect; and it is ethical and truthful." Differences in culture, gender, age, education, background. and other factors can be sources of misunderstanding. Effective and ethical communication requires listening carefully, understanding the persons story, and maintaining confidentiality.

Among the focus areas in the government's Healthy People 2020 initiative is to bring better health to all citizens. Communication contu utes to health promotion as well as disease prevention eftorts. Ine p 1S to use health communication and health information technology to improve population health outcomes and healthcare qualiy to achieve health equity Among the objectives are new opportun reach the culturally diverse and those with limited literacy skils e disparities in access to health information. Health literacy has been defined as "a constellation

rder

may

to the ability to perform basic reading and numerical tasks to frmation ctioning

lation of skills that contrib in the health care environment and acting on health ca LOW literacy is associated with poor understanding of write S, such medical advice affecting health and is prevalent in certain gron socis the less educated, those of lower cognitive ability, persOns and ethnic groups, and the elderly.' Communication skills are learned. One's speaking, lis ability to understand verbal and nonverbal messages "ciouse developing. Putting the principles into practice requires repeated atempts, and many trials. With practice, in a eia

care information.

or spoken

Such as

f certain socdl

nd the

continue

cious effor ely short tin practice requires co

2/COMMUNICATION 27

ill notice a difference in the way others respond to you. Honing the

skills, however, is an ongoing process and begins with an understanding of

the many clements included in the interpersonal communication exchange.

Interpersonal Communication Model

Complicated processes are easier to grasp when they can be visualized in

a model. The model is a graphic illustration to aid one's understanding

Studying the communication model to understand the role of each com-

poncnt is essential for professionals who are intent on expanding and improving their OWn communication repertoire.

Components of the Communication Model

The elements included in the communication model are the following: sender, receiver, the message itself, both verbal and nonverbal, feedback, and barriers. They are depicted graphically in Figure 2-1.

Sender Senders of the message originate the thought or emotion, encode it into

words, and speak first.

Receiver

Receivers or listeners attempt to decode or make sense of the message and

usually interpret and transmit simultaneously. They may be listening to

what is being said, filtering the message through their past experiences,

=MESSSAGE/FEEDBACK

LOOP R=RECEIVER

S 8ENDER

BARRIERS

Figure 2-1 Communication model.

28 1/COMMUNICATION SKILLS

are going tO say when values, or biases, while thinking aboul what they are goino

ble for receivers the sender stops talking. Even when silent, Il is impossible fo

in a two-way communication transaction not to communicate. Th

be reacting nonverbally with a flushed face or bored look, for example, ceivers' appearance and demeanor and adjust subsequent communica

hey may iepending on their inferences from the message. Senders internraple

accordingy. Thus, the two parties are sending and receiving simulta.

ously, Message

The message is the information that is communicated to another The receiver interprets two messages, the actual verbal message and the non verbal message inferred from the sender and the environment. Nonvetbal inferences arise from the perceived emotional tone of the senders voiro facial expression, dress, gestures, tone of voice, choice of words, diction and pronunciation, as well as from the communication environment 1on,

Feedback

Since the communication process can be fraught with error, misunder standing, or misinterpreted by the recipient, feedback is helpful. The tem "feedback" refers to both verbal and nonverbal responses to messages. It insures that the message is understood and that the communication is suc cessful. In face-to-face communication, the sender is talking while looking at the other person. The other person's verbal and nonverbal reactions to the senders message, whether agreement, surprise, boredom, or hostility are examples of feedback. After the first few seconds, face-to-face communication becomes a Simultaneous two-way sending-and-receiving process. While senders are talking, they are receiving nonverbal reactions from receivers. Based on these reactions, they may change their tone, speak louder, use simpler language, or in some other way adjust their communication. One can ex pect that feedback will vary with a person's experience, education, genue

and cultural group." In many non-Western cultures, it can be subtie a Circuitous, while the sender may prefer a more direct acknowledgmen In written communication, writers cannot clarify the content Ote ders Decause they do not see them. Even when writers carefully select words for the benefit of their intended readers, written communication is geneia

less effective than one-on-one verbal communication because o in-ability to adjust written language in response to the feedback trom redue Barriers

Barriers, sometimes called noise or interference, ca tion, and interfere with the understanding of the message. Tnes include the unique attributes inherent in senders and rece

r factos

the physiologic state of each communicator at the moment.

can distort commu

as

nent. Other factor

2/COMMUNICATION 29

ins itlude the 10om Size, shape, color, temperature, and furniture arrange- 1 7intciference can result from a ringing telephone or a television set.

N fwO people are exactly alike. Feelings of anxiety, fear, or apprehen- sion imay distort the message. Because no one has shared in the exact life

eDcricnces of another, no two people understand language in precisely

the same way. The sophisticated communicator needs to understand these

dynamics and compensate or safeguard accordingly, so that the intended

message is the one received.

Bcar in mind that individuals have a limited capacity for processing in- formation. When it exceeds our ability, the result is information overload. People may select, ignore, or forget, resulting in less effective communication"

Words mean different things to different people, and misinterpretation of

the message may result. Meanings are in people, not in words. Today's clients and employees, more than ever, originate from a wide variety

of ultural and ethnic backgrounds. People froma different group increase the likelihood ofa miscommunication in a verbal exchange. Words imply different things in different languages and people have different values, experiences, perceptions, and frames of reterence." Distortions can stem from psycholog- ical interference as well, including bias, prejudice, and dosed-mindedness.

Psychological interference in healthcare patients may be due to fear of

illness and its consequences. The job of senders is to generate in receivers

those meanings for language that are closest to the senders own. Because

meanings are not universal, they can be affected by both external and in-

ternal influences. The communication environment, cultural differences,

the distance between speakers, lighting, temperature, and colors are a

few of the variables that can affect meanings ascribed to a message. These

variables can be barriers and account for the difficulty in generating in

others the meanings a person intends.

Interpersonal Communication

When focused on relationship-centered care, effective interpersonal com

munication should lead to better health outcomes for patients and clients.

Improving patient knowledge and understanding, responding to emotions,

and encouraging patient self-management are helpful. Communication

outcomes may be affected by many factors, such as health literacy, pro

Vider communication, personal preferences, level of education, income,

mployment, occupation, neighborhood, culture, and urban or rural

Ocation. These shape interpersonal communication and health. How a

person deals with illness influences health behavior change.

While behavior change theories focus on actual behavioral change,

Interpersonal communication theories are based on the relationship

etween patient and provider. This may include family members and

nends who can influence a person's health and illness may be included."

dionships can affect goals and tasks associated with health behavior

30 1/COMMUNICATION SKILLS

disclosure and change is openness in comnunication and affects how health beha losur

life, healu

change. A relationship with trust and rapport promotes

negotiated by the parties.

The patient or client is an expert on his or her own life h, expe.

riences, and relationships. Shared decisior on-making, negotiatede

removal o dialog with the patient, development of empathy, and respect and ren

judgments allow for trust and openness.0 Relationship-centered care assumes that the provider and natio

ient have relationship characterized by respect, mutual trust, and gement After the patient's feelings are understood and satisfied, one comm

goals and plans for treatment.

Patient-provider communication is important in affecting health . out comes. Interpersonal communication develops in a relationshin het

the provider and the patient or client in influencing health he change. Healing relationships respond to the person as well as the tasko

exchanging health information and providing patient self-managemen information. Helping and supporting people in managing their own health

avior

promotes self-management.

CASE ANALYSIS IS1

What are the barriers to communication in the case challenge?

Verbal and Nonverbal Communication We use two languages daily, our verbal language and our nonverbal or

body language. Although both verbal and nonverbal communication o Simultaneously during interactions, they are discussed separately here the context of their influence on the communication process.

Verbal Communication 1o keep the communication channel open between the client or emp

and the professional, one needs to know how to create a supportive c

loyee

A supportive climate is one in which as one person speaks, the other listens

attending to the messag rather than to his or her own internal thought

and feelings. This creates a climate of trust, caring, and acceptanc tance. A delen

1o

sive climate, which occurs when the other person : is feeling threatened Wher

upset, creates the opposite effect, with the listener "shutting down al

this happens, there is little point in continuing the interaction the message is no longer penetrating. Maintaining a suppo her becomes especially crucial when the professional is attempting

Dportive

e

climae

Vieved

io resolve ditt co and defuse

an Tbal guidelines

forcting a support- Sg ie o77 n7iniCation

dimate are (1) to be

a1are f Onc s choice Families communicate at meal time.

of wor1S and discuss Source: Plitteri A. Maternal & Child Health Nursing., 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003. problems descriptively

rather than evaluativcly; 2) deseribe situations with a problem orientation in interpreting messages

rather than in a manipulative way: (3) offer alternatives provisionally rather than dogmatically; (4) treat people as equals listening thoughtfully; and (5) be empathic rather than neutral or self-centered responding sensitively

Descriptive Rather Than Evaluative

Ordinarily when approaching topics that tend to provoke defensiveness in clients, such as weight gain, professionals should think through the discussion before engaging the client, so that the problem area is exposed descriptively rather than evaluatively. Whenever people feel as if others are judging their attitudes, behavior, or the quality of their work, they show an increased tendency to become defensive. Such comments as "You don't seem to be trying." or "You don't care about cooperating" are based on inferences rather than facts. So when the other's response is "I do care,

or "I am too trying," the framework for an argument is set, with no way

of proving who is right or wrong. Instead of making judgments regarding another's behavior or attitudes,

the safest and least offensive way of dealing with a touchy issue is to describe

the facts as objectively as possible. For example, when the professional lells a client that his or her continuing to eat ice cream and potato chips Several times each day is discouraging to her as the client's counselor, she

s Confronting the problem without being evaluative. The client can then

address the topic rather than argue about the professional's evaluation ot

poor adherence. In a work-related situation, accusing an employee who has arrived

ate several mornings of being "irresponsible" and "uncaring" is likely

O provoke a hostile response or cold silence. The employee may believe

that being late does not warrant a reprimand. There may, in tact, be a

Teasonable explanation about which the manager should inquire. De-

SCribing how being late is causing problems for coworkers and causing

Work to back up is honest and descriptive and allows for nondefensive

dialogue. 31

32 1/COMMUNICATiON SKILLS

Problem-Oriented Rather Than Manipulative

Orienting people to a problem rather than manipulating thens

supportive communication climate. Frequently, when peonleOmote people want other to appreciate their point of view, they lead them through a series nt of othe que

manipulation and provokes defensiveness as soon as respondents Tt form tions until the other reaches the "appropriate" insight. This is e

realiz they are being channeled to share the other's vision

"Several weeks ago, you agreed that you were going

to stop eating ice cream and potato chips; however, each week you acknowledge eating them. About a month ago, you agreed to switch to

EXAMPLE

to fresh fruit as a snack, but that has not occurred."

A discussion with the client would be more productive if the counselo took a direct problem-oriented approach.

EXAMPLE "In the past 6 weeks, you have gained 3 lb. With the

dietary changes we planned, we anticipated a 4to-5-lb weight loss.

There seems to be a discrepancy here. Let's discuss what might

explain the weight gain."

Employees and clients respect the professional when they believe the individual is being straightforward.

After the professional plans opening remarks descriptively rather tnau evaluatively, one should allow for collaborative problem solving without preplanned solutions. Creative, superior, and long-lasting solutions d more likely to occur when each person hears out the other fully, is hearu in return, and when the client initiates the solution.

In the previous examples, the counselor's subsequent remarks depenu On how the person responds to the directive to explain the problem. n professional needs to give the person time to think; this often means w Tor an answer. The practitioner needs to learn the discipline of sitting tn

the tension of silence supportively until the client or employee rer Frequently, the first explanations are those that people believe will

Donds

be upset or shock the counselor. The "real" reasons, however, nhack revealed until the client or staff member feels secure enough to risk s In ing the professional without fear of being humiliated or embarta d other words, after the first explanations are offered, professio do best simply to repeat in their own words or parapnrd able enou

wou

sed. In

understood. Only when the clients or employees are comio will they be able to express their authentic reactions, questio

e enough

Swers

2/COMMUNICATION 33

ther ihan Dogmatic Provisional Rath

when otlering adviCe to cilenls or helping them to solve problems, coun-

selo lsshould give advice provisionally rather than dogmatically. "Provi-

SiOn. antimplies the pOSsibility of the practitioner changing the options, prov Ouied that additional facts emerge. It keeps the door open for clients ation. A dogmatic prescription might be, "1 know this is the to adei nlormatio

a tO Solve your problem. A provisional prescription might be, "Here r SevCral alternatives you might consider, or "There may be other ways af handling this problem; perhaps you have some ideas too, but here are

things you might consider."

Equal Rather Than Superior

In discussing issues, the two parties should regard each other as equals and work collaboratively. Whenever the possibility of defensiveness exists, even between persons of equal rank, any verbal or nonverbal behavior that the other interprets as superiority generates a defensive response.

In the relationship between professionals and clients, or managers and employees, the professional's tendencies to emphasize status or rank may arise unconsciously from a desire to convince the other to accept his or her recommendations. Comments such as the following may cause the other to feel inferior or angry: "As a consumer, you may find this difficult to understand. Just do what I recommend; 1've been doing this for 10 years." Certainly, there is nothing wrong with professionals letting clients know that they are educated and competent. However, the manner in which it is done is crucial. A more effective and subtle way is to make it clear that you don't have all the answers and to say, "I have studied this problem and dealt with other clients who have similar situations. I am interested, however, in incorporating your own thoughts and plans into the solution. You must be satisfied and willing to try new eating habits."

An employee making a recommendation to a manager that the manager had tried unsuccessfully in the past might be told, "If I were in your shoes, Twould think the same thing. Someday when you are more experienced, you'll know why it won't work." The subtle underscoring of the inferior relative status of the subordinate could be enough to cause a defensive Dattle. The professional could have succeeded with a comment, such as can understand why you say that. I have thought the same myself, but

wnen I tried, it was not successful." Showing respect for the client's and employee's intelligence and life experiences and recognizing their human dignity facilitates cooperation.

In conflict resolution, problem solving, and the discussion of any issues that may be threatening to the other person, collaboration is far more effec- an trying to persuade the person to act according to the professional's commendations. Collaboration has other virtues as well. People feel more

an obligation to uphold solutions that they themselves have participated designing. If clients are trying the professional's solution, they may feel

34 1/COMMUNICATION SKILLS

ight; however, if the solutio little satisfaction in proving that he or she was right; however

nuine satisfact is one that was arrived at through collaboration, there is genuineolu

xperience, in proving its validity. Two people sharing insights, knowledge, ex

and feelings can generate creative thought processes in each othe ner, which in tun generates other ideas that otherwise would not have emerge.

Empathic Rather Than "Neutral"

Empathy is "an emotional reaction that is similar to the reaction being experienced by another person."" We feel what the other person feels Ask eng

yourself: "Am I able to understand the other person's experiences as if were experiencing them?" The skill of empathy is especially imnoOa ortant when there is bias in healthcare, such as may Occur with obese peonle Empathy is mentioned frequently in the skill of listening and is di

cussed later in the chapter. Empathy conveys that the professional is fulle present and actively engaged in the interaction. Lacking empathv ma leave patients, clients, and staff feeling misunderstood.

To be effective in working with clients and employees, professionals must be able to demonstrate in some way their desire to understand the other's feelings. This "demonstration" might be an empathic response to comments, where the listener tells the other that he or she is attempting to understand both the speaker's content and feelings. For example, a client might say, "For my entire life I have eaten salty foods; they are a part of my culture. I don't know what my life will be like without them. The professional might then respond, "You seem to be worried that the

quality of your life will change because of the dietary recommendations If the professional is accurate in the empathic remarks, the client wll

acknowledge it and probably go on talking, assured that the person liste If the professional is wrong, however, the client will clarify the judgmentanu continue to talk. Thus, the counselor need not be accurate in inferring other's feelings as long as he or she is trying to understand them. In addu empathic responses allow the professional to respond without giving au focusing instead on the individual's need to talk and to express con Before clients or staff can listen to the professional, they must expres etafa concerns; otherwise, while the practitioner is talking the clientso thinking about what they will say when the . individual stops talking weekend

aff ae

to attend An employee

a family who

gathering has asked

might to

receive be released

the following from work

neutral

on a busy respons

weeko nse:

kend

No

offense, but a rule is a rule. If I make an except it too." The employee would still feel sad about working antagonistic toward the supervisor, with the following empat

ption for you, others will e expeca

realize how badly you feel about not being able to attend empathic response

to lety

1

have the day off." The supervisor, by letting the subordinate know

mpathetic that

ng but would feel les

ily party

I feel sory myself having to refuse your request, but I canta an't afford to let yo t he o

she understands the subordinate's underlying feelings and i ent. athetic, us

the most effective means of defusing the person's disappoin

CASE

ia dhe orofessional respond to Mr. Jones? What should be the next steps? How should

Paraphrasing, a Critical Skill

Paraphrasing is restating in your own words what the other person has said

and it is oftcn done with empathy." Most people have not incorporated

he skill of paraphrasing into their communication repertoire. Even after

neople realize hoW Vital this step is and begin to practice it in interactions,

thev may feel uncomfortable, self-conscious, or fear others may think

thev are "'showing off." A hint for the professional feeling awkward about

asking clients and staff to paraphrase would be to ask for the paraphrase

by acknowledging one's own need to verify that what was heard is what

the other intended. For example: "To be sure I understand your concern,

vou seem to be saying. .."

EXAMPLE "l know that I don't always explain as well as I should, and

that frequently, people have questions. Just to be sure I clearly covered

the information, would you mind explaining in your own words how you

will plan your meals?

Of course, it takes less time to ask, "Do you understand?" However,

asking this question is less effective. Because of the perceived status dis-

tinction between the helper and the person being helped, the latter may

be ashamed to admit that he or she does not understand. When persons

oI perceived higher status ask others if they "understand," almost always

the answer is, "yes." This phenomenon is likely when working with somne

ethnic clients. Another possibility is that the client or staff member honestly believes

nat he or she understands, and for that reason answered, "yes." The

understanding, however, may include some alteration of the original

essage, in the form of substitution, distortion, or addition. The skill1

paraphrasing needs to become second nature and automatic for

proressionals to verify important instructions, feelings, and significant

client or staff disclosures. Because of the anxiety attached to being in the presence of another of

ETceived higher status, the client or staff member may be less articulate

dn usual when describing symptoms or explaining a problem. The

PIOTessional should paraphrase to verify that he or she understarnds the

me: cSSage as the "sender" intends. One should try to avoid sounding too

clinical with such comments

as "What T hear you saying is

comment such as 36

1/COMMUNICATION SKILLS

5. nstead,

keep the language clear, simple,

and natural. A comment such as ad

to make sure I understand

this; let me repeat what you are savino :D

own words" is more

natural.

"I wanm are saying in my

Two points need to be emphasIZed regarding paraphrasing: (D:

everything the other person says needs paraphrasing. It would her

come n is

centered on critical information

that must be understood. (2) Da..

phrasing often leads to additional disclosure and theretore providos

further information

People are so accustomed to being with others who do not really lict

that when they are with someone who proves that he or she has been Dav.

ing attention by repeating the content ot what has been said, they usually

want to talk more. For the professional, this additional information can

be valuable. Another benefit is that after the dient or staff member ha

expressed all questions and concerns and has cleared his or her mental

agenda, he or she is psychologically ready to sit back and listen or to solve

problems.

By talking too much or too soon, the professional may not be able to

convey all of the message to the other, who may be using the difference

in time between how fast the professional speaks and how fast the clients

own mind processes information to rehearse what he is going to say next"

The human mind operates 4 to 10 times faster than human speech.

a distraction. Paraphrasing is essential only when the discussion Para-

listen

can

CASE ANALYSIS 3

What did Mr. Jones' verbal statements tell you about his attitudes toward his heai

problem?

SELF-ASSESSMENT 1

Directions: Paraphrase the following:

1. Client: "I've been overweight most of my life. I've tried many different diets. a few pounds, and gain it all back."

lose

2. Employee: "1 don't know why you want to keep changing things around nerc.

old manager was satisfied with our procedures."

Our

Nonverba

Communi

Image Mla ement

and

Coninicatio that

CTCatesmcaning lor

pcople bul is not

verbal or wrilten, is

called "nonverbal. "

Of the two messages Be aware of the person's nonverbal behaviors.

Source: Springhouse. Lippincott's Visual Encyclopedia of Cinical Skills. Philadelph ia. PA: Wolters Kluwer Health: 2009.

received simultane-

ously by receivers,

verbal and nonverbal, the nonverbal is the larger component and more influential and believable. As receivers of mess.ages, people learn to tnist their interpretations of nonverbal behaviors more than the word choices

Consciously selected by the sender. Intuitively, they kno that control of

nonverbal behavior is genCrally unconscious, whereas control of verbal

messages is usually planned and deliber.ate. Nonveral mess.f{s ommunicat our teelings tow.rd others and are

critical to Ielationshis TTowevei, itIs import.nt to develop awareness in

using nonVeibals ) nei.le tionsas wellas to rrognize them in others."

Our noveibil nness.ages c mote beluv.able than our verbal ones.

A pictue is worth.athous.nd words Wh.at is your picture like? Even

belore we speak, we m.ay be jnudgrd by our clothing and appear.ance."l"Dress

lnd appence.ac consciously seleeted and are nonverlbal communication

Vehicles. A1.akeup, hairstyle, dothing and accessories represent who you

re and your selt-inm.age. P'rofessional image is difficult to define, bu it is

n impression on creales at the tirst meeting and most people recognize

It. Personal appearance, including clothing, hairstyle, and accessories, are

mong tlhe most important elements of the image.

Simple well-tailored clothes in neutral colors, such as a skirt or slacks

WIth a blouse or sweater are examples for women. A shirt, tic, slacks,

nd dress shoes are examples for men as the goal is to look professional

dnd conservative.i One should avoid clothes that are too tight, short,

Or trendy, piercings, flip flops, sweats, excessive jewelry, chipped nail

Poish, and uncovered body art. Clients who are unable to relate to your

"PPearance may have trouble relating to your message and question your

Competence."" meeing new people, we begin making judgments immediately, based

OVCrbals, such as noticing eye contact, appearance, and whether or

Ot the handshake is strong or limp.' Chiet nonverbal vehicles inherent

Speakers are facial expression, tonc of voce, eye contcl, gesturEs, pos-

tu and touch, with meanings varying among cultures." The receivers of

nication notice nonverbal behavior in dusters.

37

3 8

1

/C O

M M

U N

IC A

T IO

N

S K

IL L

S

shifting he

clienn p

a p

e rs

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d lo

o k

in g

a t

a c o

m p

u le

r s c re

e n

w ith

a

b o

re d

lo o

sh

ifi

the other nonverbal

If th e professional

is listening to

a

client, for example, but red look,

w ill n

o t b

eliev e th

e p e rso

n is in

te re

ste d

. Ordinarily, people do n lie

p o

stu re

, ey e c

o n

ta c t, o

r facial e x

p re

ssio n

1 S

O lated

fro m

th e o

th e r n

o " tie

verbal ch

an n

els. F o

r th is re

a s o

n , professionals

n e e d

to

m onitor all

nor

with c o

m m

u n

ic a tio

n vehicles

s o

th at together th

e clusters are congruent bal o

n e an

o th

er a s w

ell a s w

ith th

e v erb

al m essages.

each N

onverbal behaviors v ary

w idely am

o n

g d

ifferen t groups w

ith having its

o w

n body language. A

lthough sim ilarities exist, the

m a

o f behaviors differ am

o n

g groups,

a s th

e w

ay people behave is lear "is

earned early in

life. O u

r o w

n history influences o

u r ideas o

f w hat

a person o

r "should be." T

hese variations m ay

require professionals to adant thd.

nonverbal behaviors. If th e client sh

o w

s an y

sign o f resisting o

r objectina

to th

e professional's eye co n

tact o r touch, fo

r exam ple, the professional

should c e a se

im m

ediately. C om

m unication com

petence requires "the ability

to adapt one's behavior tow

ards an o

th er p

erso n

in w

ays that are na

appropriate to

th e o

th er person's culture o

r ethnic group."4

C A

S E

A N

A L

Y S

IS

4

W hat d

o you notice ab

o u

t M r. Jo

n es's nonverbal behaviors?

F acial expression is usually th

e first nonverbal trait noticed. "Sm ile

an d

th e w

o rld

sm iles w

ith you." W

h at d

o y

o u

lo o

k like w

hen you are

happy? O

r w h

en y

o u

a r e b

o red

o r w

orried? A relaxed face w

ith pleasant sm

ile indicates a friendly, approachable clim

ate an d

m akes

a good tit im

pression. A

supportive to

n e o

f voice is o

n e th

at is calm , controlied

energetic, and enthusiastic. Eye c

o n

ta c t includes gazing in

a w

a y

th at allow

s th e communicator

e n

c o

u n

te r th

e o

th er visually-to th

e e x

te n

t of being able to

notice other's facial an

d bodily m

essages. B esides being a

n excellent vehicle o

reedback, eye c o

n ta

c t m

akes th e p

erso n

feel visible and en su

res th e ou

person o f th

e professional's interest an d

desire to com

m unicate. t

1 s b

e st w

h en

leaning som ew

hat tow ard, rather th

an aw

ay from , the

S o

n . Large expansive gestures m

ay b

e interpreted a s

a show o

r pow generally should b

e avoided. T

ouch isa vehicle for feedback that c a n

w ork positively. Through a 8

tu re

a n

d

touch, a

pat, o

r

a squeeze o f the hand,

o n

e c

a n

com m

unicate instan

g e n

tle

a desire to solve

a problem w

ithout offending. T ouch

c a n

com

ted c a le

ssages can be gener. affection, concern, and interest faster than these messa verbally. Although

a n

individual m

a y

look calm , controlled,

a n

u t o

t a l l y

a t ease,

a touch m nay reveal nervousness and insecurity.

2/COMMUNICATION 39

a s M

ust B e A

lert to N

onverbal Signals from O

thers P

ro t

D sidc%

the professional s c o

n c e rn

s w ith

the environm ent and his

o r her

h a l and nonverbal behavior in creating a trusting clim

ate, one m ust

slso be sensitive to

n o

n v

erb al c

u e s in others. Even though the practitioner

is heigopen, caring, a n

d attending to his o

r her o

w n

behavior, the internal v

ict Confusion, nervousness, o

r fear in people m

ay be causing them

t0 misunderstand.

w o

requirem ents for effective interpersonal

c o

m m

u -

ication a re

to observe th

e nonverbal c

u e s in others and then respond to

them

in an alfirm ing w

ay." If the client

o r em

ployee is nodding the head to suggest understanding, for

Cxample. but looks puzzled, the professional needs to verify understanding

by having th e person paraphrase o

r sum

m arize im

portant instructions o r

dietary recom m

endations. If the client is flushed, has trem bling hands,

o r

tcars rolling dow n th

e cheeks, the professional m ay need

to deal directly

w ith relieving anxiety. U

ntil the individual is relaxed enough to

concentrate, optimal tw

o-w ay com

m unication is unlikely.

After talking w ith o

n e another for only

a few m

inutes, both the profes- sional and the client c

a n

s e n

s e the "w

arm ness"

o r "coldness" of the other,

as w ell

a s the degree o

f the other's co n

cern . If the speaker has

a pleasant expression, and looks directly into the eyes of the listener w

hile talking, he

o r she m

ight b e generating interences in the listener o

f being a caring

person. A fter th

e initial positive im pression has been created, the im

pres sion tends to

spread in to

o th

er a re

a s n

o t directly related to

the behavior originally observed.

T he process

c a n

w ork in

re v

e rse

a s w

ell. If the professional does n

o t

look a t the client w

hile talking o r touches the client to

o firm

ly and has a n

unpleasant facial expression, the inferences being created m

ay be negative arrogance, lack of co

n cern

, indifference, and "coldness." E ven though these

initial reactions, both positive and negative, m ay be inaccurate, faulty first

im pressions

a re

c o

m m

o n

. T he professional m

ight n o

t be given a second

chance to w

in the client's tru

st an d

cooperation. Positive A

ffect M u

st B e C

onsistent Seeing clients

o r em

ployees regularly gives practitioners an d

m anagers

a n

opportunity to reinforce o

r alter th

e perceptions th e other p

erso n

has o

f them . A

p erso

n w

ho is cold, aloof, and uncaring o

n a daily basis,

a n

d

Suddenly, because it is tim e to conduct a m

eeting, acts differently, the in- dividual w

ill n o

t be believed. Practitioners need to be consistent in adding

pO sitive inferences to

th e im

p ressio

n s o

f th eir staff an

d clients.

N o

t only is it im portant to

generate c o

n c e rn

through y o

u r o

w n

n o

n -

verbal b eh

av io

r a n

d d

isp o

sitio n

, it is also essen

tial to co

n tro

l, w h

en ev

er

possible, the com m

unication environm ent so that it, too, leads to positive

nferences w hile elim

inating barriers. A ttractive offices, pastel-colored

0O m

s, soft lighting, com fortable an

d private space for counseling, and

c o

m f o

r t a b

l e f

u r n

i t u

r e a

ll c a n

a d

d t

o t

h e l

i e n

t 's

o

r c e a .

w ith privacy and

4 0

1

/ c O

M M

U N

I C

A T

I O

N S

K I L

L S

ember s ol

s o

m u

c h

c o

u n

s e lin

g ta

k e s p

la c e in

a c lin

ic a l s

e ttin

g

successful

desk, a ringing m

obile phone, at al setting,

m o

re ttention m

tiv e p

e r c e p

t i o

n . P

ile s o

f p

a p

e r s o

n

a d

e s k

c o

n s t a n

t i n

t e r r u

p t i o

n s m

u s t b

e r

e p

la c e d

w i t h

p riv

a c y

b e given to

c re

a tin

g a

n in

v itin

g a

t m

o s p

h e r e .

2ctive a n

d

A m

o n

g th

e r e q

u i r e m

e n

t s fo

r e l t e c t i v

e a

n d

s u

c c e s s f i u

l

al to

send verbal nterperso

and non c o

m m

u n

i c a t i o

n is th

e n

e e d

fo r th

e p

r o

f e s s io

n a l

to s

e n

d vo

Perso

'm co

n cern

ed about

v erb

al m

e s s a g

e s th

a t

a r e c

o n

g r u

e n

t w

ith o

n e a

n o

th e r. A

c l i our n

d heal n

an d

th e possible

r e c u

r r e n

c e o

f y o

u r h

e a rt p

ro b

le m

a s a result of

choices." But if the client sees the practitioner taking notes and check

of im patience w

ill b e m

o re in

ten se th

a n

th e sta

te d

m essag

e o f conce cern.

professional m ay have said all th

e "right" w o

rd s, b

u t is judged as insince

a p

ra c titio

n e r say

, "T w

a n

t to

h elp

y o

u ; l'm

c o

n c e r n

e d

a h

o ..

M ay

our h foo

messap w

atch rath er th

a n

looking a t th

e c

lie n

t, th e co

n trad

icto ry

seco n

ak n

onking H

elping professionals an d

m an

ag ers w

h o

d o

n o

t g en

u in

ely like w

o l

w ith

people a r e ultim

ately d e stin

e d

to fail.

Diversity In re

c e n

t years, th e U

S population h as b

eco m

e m o

r e racially and ethnicall

diverse14 W ith the increasing diversity, professionals need knowledg=

and skills related to cultural com

petence in com

m unication. T

he Unites States is becom

ing a m

ulti-racial country d u

e to

shifts in demographi m

akeup resulting from im

m igration an

d fertility

ra te

s w ith the number

of babies born here increasing. In 2011,

m o

re m

inority babies w ere bom

than W hite babies.

M ore children

a re

m em

bers o f m

inorities, tnat

- Black, Hispanic, A

sian, and other non-W hite races.

A s th

e baby boom ers grow

older an d

there is a lack of W hite immg

tion, the W hite population is expected to

decline. Population prou based o

n the 2010 cen

su s show

that W hite people w

ill becom e

a m

in the 2040s.

It is predicted that there w ill b

e n

o racial m

ajorly U

nited States after 2046.13

Cctions inonly

in the

Communicating health and nutrition education is affected n sle

c u

ltu rd

influences. People from other cultures have their o

w n

commuerstandi- languages, practices, beliefs, values, custom

s, and foods. Culturai and competence

are needed to communicate effectively

w

s takesu

cultural, and linguistically diverse groups.4 Developing hese a different from

oneself should be based o n

m utual

a re

culturally respect, and

i n

g u

i s t i c a l l

ndine the person

as well a s exchanging information w

ith simpomm o

n d

in g

ta k

e s tin

e

be influential. Interactions w ith people w

ho are culturaluy at,m p

tolerance, genuine interest, and nonjudgm ental response

wOrds empathy

a te

effectively w ith racial,

e th

n e

Cultural practices, health beliefs, dealing w ith illness alinguisto

ng w ith

illness, an d

litera

nutual respect, trust,

dietary practices in a supportive environment enhances

tion relationship. tion w

ith sim ple w

o rd

s abo

enhances the C

o m

m u

n i d

C O

M M

U N

:C A

T IO

N

4 O

n e n

e e d

s

eed s to

b e aw

are o f o

n e s o

w n

it af

v a lu

e s, assium

ptions, a n

d

h eliefs, b

u t

h a v

e t

h e a

b ility

t o

a n

d c

u l t u

r a l

a c k

g r o

u n

d s . ' i

1 n

c tio

n w

ilh p

e o

p le

fro m

d

iv e rse

e th

n ic

5

P r i n

t e d

m

a t e r i a l s in

th

e p

e r s o

n 's

c u

ltu r e a

n d

a v

a ila

b le

o n

th

e h

te r

o t h

e r r e s o

u r c e s

th e l a r g

e s t m

i n

in

o rity

g r o

u p

fo llo

w e d

by A sia

n s. O

v erall, H

ispanics a r e less

B l a c k

s w

e r e th

e largest m

inority u n

til 2

0 0

0 . C

urrently, H ispanics

a r e

13 A s th

e c

o u

n t r y

b ec e c o

m e s m

o r e racially diverse,

th is

is affecting

B e c a u

s e t h

e r e is a

ris k

in se

lf-d isc

lo su

re , e

th n

ic g

ro u

p S

v a ry

in h

o w

m u

ic h

th ey

d is

c lo

s e a

n d

t o

w

h o

m .

W o

m e n

te

n d

to

d isc

lo se

m

o r e th

a n

m

e n

.

e d

u c a t e d

t h

a n

th

e to

ta l p

o p

opulation a

n d

ra n

k lo

w er

o n

E nglish language

u s a g

e

educational, m

e d

i c a l , a

n d

o th

e r in

s titu

tio n

s .

A m

ericans m a y

d isclo

se a w

id e r ra

n g

e o

f in f o

r m

a tio

n in

clu d

in g

p erso

n al

A m

erican s m

a y

d is

i n

f o

r m

a t i o

n th

a n

Ja p

a n

e se

, C

h in

e se

, a n

d A

sia n

s. P eople in

c o

lle c tiv

is t

su ch

a s C

h in

a a

n d

Jap an

, fo llo

w c

u ltu

ra l n

o r m

s , d

isc lo

se less, a

n d

c u

ltu r e s , s

u c h

a s

w ork for th

e g

o o

d o

f th e group. S

elt-d isclo

su re is a

ffe c te

d by c

o m

p e te

n c e ,

in v

o lv

e m

e n

t, a n

d p

e rc

e iv

e d

s im

ila rity

to o

n e s e lf. In

c o

lle c tiv

is t c

u ltu

re s,

s e n

te n

c e s a

r e ra

re ly

b e g

u n

W ith

"T

° a n

d p

e o

p le

a v

o id

calling a tte

n tio

n to

th e m

s e lv

e s , w

h ile

A m

e r i c a n

s a

r e m

o r e d

ire c t.1

3

N o

n v

e rb

a l

b e h

a v

io r s s h

o u

l d

r e f le

c t

o p

e n

n e s s , re

sp e c t,

c o

n c e r n

, a

n d

in te

re s t by liste

n in

g a

c tiv

e ly

a n

d m

o d

e ra

tin g

c u

ltu r a l v

a ria

b le

s , s

u c h

a s

touch, ey e c

o n

t a c t , f

a c ia

l e x

p re

s s io

n , p

h y

sic a l sp

a c e , a

n d

u s e of gestures. D

o

y o

u m

a k

e e

y e c

o n

t a c t a

s y

o u

m e e t s

o m

e o

n e ? L

e v

e ls

o f p

e rso

n a l s

p a c e a

r e

d e te

r m

in e d

by o n

e 's

c u

ltu r a l b

a c k

g ro

u n

d . P

r e f e r e n

c e s fo

r sp atial d

is ta

n c e

vary, fo r e

x a m

p le

, a n

d s o

m e s

ta n

d c

lo s e r w

h e n

talk in

g . V

o c a l q

u alities,

su c h

a s p

itch , v

o lu

m e ,

ra te

, to

n e , a

n d

r e s o

n a n

c e w

ill d iffe

r. O

u r v

e rb

a l

b e h

a v

io rs

s h

o u

ld i n

d i c a t e re

s p

e c t, e

m p

a th

y , a

n d

n o

n j u

d g

m e n

t a l c

o n

c e r n

,

n v

i t e q

u e s tio

n s , a

n d

in te

g ra

te th

e p

e rso

n 's e

th n

ic v

a lu

e s a

n d

b e lie

fs .

A p

a t i e n

t - c e n

t e r e d

a p

p ro

a c h

to c o

m m

u n

i c a t i o

n c

o m

p e t e n

c y

m a y

c o

n -

S IS

t o f a

sse ssin

g c

r o

s s - c u

l t u

r a l is

s u

e s ; e

x p

lo rin

g th

e m

e a n

in g

o f th

e illn

e s s ;

u irin

g a

b o

u t th

e s

o c ia

l c o

n t e x

t of living; a

n d

en g

ag in

g in

c o

lla b

o ra

tiv e

E g

O ia

tio n

. In th

e h

e a l t h

c a r e in

d u

s try

, a s m

a n

y a

s 2

0 d

i f f e r e n

t la

n g

u a g

e s

D e e

n c o

u n

t e r e d

a m

o n

g p

a tie

n ts

a n

d sta

ff. It is im p

o s s ib

le to

le a r n

a ll

O th

em , b

u t w

e s

h o

u ld

le a rn

th o

s e u

se d

m o

s t o

f te

n .

Listening Skills

in p

ie S

o m

e o

n e is p

r o

b a b

ly th

e m

o s t a

n c i e n

t of h

e a lth

c a r e s k

ills . L

i s t e n

-

Listening tos to

verbal an d

nonverbal m

e s s a g

e s . " " M

o s t o

f u s a

r e e

g o

c e n

t r i c o

r f o

c u

s e d

o n

to ing is "the p

ro c e s s of re

c e iv

in g

, c o

n s t r u

c t i n

g m

e a n

in g

f r o

m , a

n d

r e s p

o n

d i n

g

h at does

m a y

h a v

e d

iffic u

lty fo

c u

s in

g o

n

c o

m m

u n

i c a t i o

n f

r o

m o

t h

e r s

alio n

f o

r e e

d ir

e c tly

t o

u s .

W e l l - d

e v

e l o

p e d

l i s t e n

i n

g s k

ills a

r e a

f o

u n

that does not

O V

id e rs w

n

t e r p

e r s o

n a l

r e l a t i o

n s h

i p

s a

n d

q u

a lity

c a r e o

t h

e a l t h

c a r e

dation for effective interper

p e o

p l e

e r w

o r k

in g

w ith

i n

d i v

i d

u a l s o

r g

r o

u p

s , m

o r e t

h a n

a n

y t h

i n

g

providers. W hether

else, peopl

Ourselves and ectly t

o u

s .

W e l l - d

e v

e l o

p e d

lis te

n in

g s k

ills a

r e a

f o

u n

-

p e r s o

n a l r e l a t i o

n s h

i p

s a

n d

q u

a lity

c a r e of h

e a l t h

c a r e

t o

b e l i s t e n

e d

t o

a n

d la

c k

o f l i s t e n

i n

g lead

s to d

i s s a t i s f a c t i o

n . "

A n individual wirih aerag

e inteila c a n

process intO rm

ation1 m entali

t spee that

a re

taster th a n

h

u m

an

speerh people speak 1

2 5

w ordsper m

inute s o

m e people

c A

n

liste n

u p

to

o 0

ts

wh

to si w

ords per m in

u te

s a result people ha

tim e

to b

e thinking

ab o

u t other thin ig

sim

ultancously. T

w o d.a

later most u

s rem

em ber

o n

ly ^

5 s

to i

o f

w ku

w e heard.

T his

18 t n

c o

t b o

th chcnts a

em plovces. Thus. w

h ile

n u

titio n

pra titio

n es

a re

listenng to

theiu clients o

r staft m

em bers talk. thev

have tinm

e to thinking ab

o u

t o th

e i things

C lients p

ticn ts

a n

d st.att

im u

st b e le

v e that they at

h eard

an d

u n

d eisto

d an

d thau the lisener

Ig en

u u

n ely

m

teiested n

t e ness.age 1

p e r n

c n

te ie

d .tu

n d

e bisedon enmpath

c o

n g

u e n

e

u n

l u

n c o

n d

in o

n .l

positive T

ry

s h

e lp

tu l

L isten

in g

is an c

sse n

tia l

k ill

S o

u rce: C

D C

/A m

an d

u M

il.

Iis te

n y

to a »

|"a k

e r.a

d le

in g

the m nd

w a n

d e r to

o th

e r to

p u

s l to

m th

r v p

e a k

e 1

lo th

rs , sh

o es, jew

ely , dioton,

n d

sp e e h

p attcin

s p

eo p

k n1.ay

trn d

to till in det.ails and develop

c la

b o

ra te

s c e n

a io

w h

ile listenng

Ih e p

ro ro

f good listening nvolves le

a rn

in g

to h

a n

e s s v

o u

r a tte

n tio

n o

th a t y

o u

e alble to

c o

n e n

ta e o

tally o

n th

e sp

e a k

e r's m

e ssa

g e . b

o th

v e rb

a l a

n d

n o

V e rb

a l. D

ev eo

p n

en t

o f

th e se

sk ills

is n

o t ditticult,

b u

t it d

o e s require

a c o

n sC

1 O

U s ellot

p e rse

v e ra

n c e .

L istening ability can be en

rich ed

o n

ly w

h en

the person desires fol

e n

ric h

m e n

t an d

is w illing to follow

th e train

in g

w ith practice. The

lo w

in g

is a list o f fiv

e o f th

e m

o st c

o m

m o

n issu

e s a

n d

b arriets Tetu

e d

o

poor listening':

1 .

M o

st people h av

e a

lim ited

a n

d undeveloped a

tte n

tio n

span 2

. P

e o

p le

te n

d to

s to

p liste

n in

g w

h e n

th e y

h a v

e d

e c id

e d

th a t th

e m

ds i s u

n i n

t e r e s t i n

g a n

d t e n

d t o

p

a y

a t t e n

t i o

n o

n l y

t o

m

a t e r i a l t h

e y

"

i k

e

o f

s e e a n

im m

ed iate b

en efit in know

ing. C

r e d

i b

i l i t y

t h

a n

3

. L

iste n

e rs te

n d

to tru

s t th

e ir in

tu itio

n regarding th

e speaker s ci

b a sin

g th

eir ju d

g m

e n

ts m o

re o n

th e sp

e a k

e r's n

o n

v erb

al b e n

a v

o

n th

e c

o n

te n

t o f th

e m

essag e.

4 . Listeners te

n d

to a

tta c h

to o

m u

c h

credibility to m

e ssa

g e s nedc forth

e le

c tr

o n

ic m

e d

ia , s

u c h

a s t

h e in

te r n

e t, te

le v

is io

n ,

m o

v ie

s , a

r d

5 . C

om m

unication is in h

ib ited

by judging, b ias. prejudice, Bving a

providing so lu

tio n

s, an d

ignoring th e co

n cern

s o f th

e p e rsO

.

8 I v

i n

g a d

v i c e ,

42

5 C

A S

E A

N A

L Y

S I S

sav about M

r. Jo n

es's listening skills? W

h a t w

o u

l d

A ctive listening is

a learned skill an d

requires focusing o

n w

hat another .in

g ., Listening c

a n

b e im

proved w ith

practice. It is n o

t a new skill, but a rt

1 0

elim inate

th e things

th at interfere w

ith listening. T he

m o

st m

nortant step in sS

u ch

m provem

ent 1s resolving to listen

m o

re actively and

a n

efficie iontly.

T he follow

ing a re

specific suggestions for im proving listening:

m e m

b e r to

listen carefully w hile rem

aining silent. G ive your undivided

attention and rem ind yourself o

f th e intent to

listen carefully. Sum m

arize th

e m

ajor facts, ta k

e n

o tes, o

r m ak

e a n

outline o f m

ajor points. N ote

w h

e n

v o

u r m

ind d rifts o

ff to your o

w n

c o

n c e rn

s an d

avoid distractions. ,

R e o

b iectiv

e. T h

e c o

m m

u n

ic a tio

n situ

atio n

sh o

u ld

b e ap

p ro

ach ed

w ith

th e a

ttitu d

e o

f o b

jectiv ity

, W ith an

o p

en m

ind, an d

w ith a spirit of inquiry.

Try rep eatin

g th

e m

e ssa

g e m

en tally

a s it is said

. D o n

o t form

ulate your

r e s p

o n

s e .

W atch fo

r c lu

e s fro

m th

e sp

e a k

e r. Ju

st a s o

n e u

se s bold ty

p e an

d italics

in w ritin

g , sp

e a k

e rs u

s e p

h y

sical arran g

em en

t, p ro

g ram

o u

tlin es, voice

in flectio

n , ra

te , e

m p

h a s is

, v o

ic e q

u ality

, a n

d b

o d

ily actio

n s a

s a

help th e liste

n e r d

e te

rm in

e th

e m

eaning o f w

h at is being sa

id a

n d

its

im p

o rtan

ce. T

ake y o

u r tim

e. L

iste n

e rs n

e e d

to m

a k

e u

se o

f th e th

in k

in g

-sp eak

in g

tim e d

iffe re

n c e a

n d

to re

m in

d th

e m

s e lv

e s to

c o

n c e n

tra te

o n

th e speak-

er's m e ssa

g e . T

hey m u

s t u

s e th

e e

x tra

tim e to

th in

k critically a

b o

u t th

e

m e ssa

g e , s

e a rc

h fo

r m e a n

in g

a n

d u

n d

e rsta

n d

in g

, to re

la te

it to w

h a t

they already know , to

c o

n s id

e r th

e logic o

f th e arg

u m

en ts, a

n d

to n

o tic

e

th e a

c c o

m p

a n

y in

g n

o n

v e r b

a l b

e h

a v

io r - a ll sim

u lta

n e o

u sly

.

F in

d th

e re

a l m

e a n

in g

. L

is te

n e r s n

e e d

to lo

o k

beyond th e a

c tu

a l w

o rd

s to

a e te

r m

in e w

h a t th

e s

p e a k

e r m

e a n

s , a

n d

to d

e te

r m

in e w

h e th

e r th

e c

lu s

S O

r a c C

o m

p a n

y in

g n

o n

v e r b

a l b

e h

a v

io r a

r e c

o n

g ru

e n

t w ith

th e v

e rb

a l

m essag

e. P a ra

p h

ra se

th e in

fo rm

a tio

n .

E S

p o

n d

to c

o n

f ir

m y

o u

r u

n d

e r s t a n

d i n

g . L

is te

n e r s n

e e d

to p

ro v

id e fe

e d

-

C K

to th

e s

p e a k

e r, e

ith e r in

d ire

c tly

th ro

u g

h n

o n

v e rb

a l r

e a c tio

n s o

r

t h

r o

u g

h p

a r a p

h r a s i n

g , re

fle c tin

g , re

s ta

tin g

, o r su

m m

a riz

in g

, to

y th

a t w

h a t is b

e in

g u

n d

e r s t o

o d

by th e lis

te n

e r is w

h a t th

e s

p e a k

e r

d s A

n o

d o

f th e h

e a d

o r "

u n

h u

h " i n

d i c a t e s y

o u

a r e lis

te n

in g

.

in w hich people feel free to

c o

m m

u n

i c a t e o

p e n

ly w

i t h

o u

t fear. U

ltim a te

ly

the m ost v

a lu

a b

le w

ay to

im p

ro v

e lis

te n

in g

s k

ills is o

n g

o in

g p

ra c tic

e , p

u t-

ting ones eself in d

i f f i c u

l t lis

te n

in g

s i t u

a t i o

n s , a

n d

c o

n c e n

t r a t i n

g

a c c u

r a te

f e e d

b a c k

is th e b

e s t w

a y

to p

ro v

e th

a t an

o th

er p erso

n 's

in ssage has b een

h

e a r d

a n

d u

n d

e r s t o

o d

. " It c

r e a t e s a

n a

t m

o s p

h e r e o f trust