Potential Constraints to Effective Communication

It is easy to assume that communication skills are intuitive and universal, but communicating with service users with specific needs and issues requires a high level of professional skill.

Though Section 1 highlighted the importance of effective communication within the context of allied health, there are times when barriers to communication can create conflict or confusion. Communication barriers may be in the form of ‘noise’ which prevents the client from being cognitively and emotionally present. Other communication barriers may occur during the transmission of the message due to factors such as language, client disabilities, or cultural differences.

When there are communication barriers, the client may not disclose his or her feelings and concerns fully enough for the health worker of allied health professional to completely understand what the client is experiencing, and the professional may not respond in ways that the client finds helpful. Additionally, these constraints, or barriers, can occur as an early sign of potential conflict, most often as nonverbal behaviours or existing environmental contexts, and actual/later confrontation, such as verbal messages (words people use) or tones (aggressive tone). These constraints can be controlled or altered to prevent or limit conflict, which will be discussed further later.

The following factors can influence communication or create barriers:

• Jargon, Slang and Acronyms: Jargon, slang and acronyms are words or terms that are specific to your work and that families may not be familiar with.
• Individual Perception: A client may attribute completely different meanings to a situation resulting in a vastly different perception of the situation compared to the worker’s perception of the same situation. It is important not to assume the client thinks in the same way as their worker.
• Language Differences: A communication barrier is likely to occur if a client primarily speaks a language that is different to the workers language.
• Emotional Stress/Trauma: Intense emotions such as those triggered by stress and trauma: These can create a barrier to the communication process by disrupting cognitive functions such as concentration, attention, and memory. Clients who present in this state may find it difficult to concentrate, their attention may be limited. They may find it difficult to both remember key facts and also to process new information. Stress may also affect client verbal communication resulting in a difficulty in self-expression. Clients may speak very quickly or very slowly, and their communication messages may be disjointed and non-linear. Their handwriting may be messy and difficult to read. Non-verbal indications of stress may include flashing or rolling eyes, rapid breathing or holding breath, crossed arms and/or legs, sweating or flushing, staring or avoiding eye contact and excessive fidgeting.
• Environmental Factors: The room or building layout may prove to be a barrier. For example, if the client can hear people nearby – for instance in an open space, room with an open door, or space only separated by a screen – they may not communicate as openly as if they were in a space with walls and a closed door.
• Physical: This may include obstacles such as note taking. Taking notes or records while the client is speaking has the potential to disrupt the communication process by distracting both the worker and client. The worker may miss certain non-verbal cues while looking down at the notes and the client may be more focused on what the worker is writing than his or her communication.
• Cultural issues and Religion: Culture refers to the attitudes and beliefs that come from our personal environment and experience. Two people could receive the same message but interpret it in two entirely different ways. For example, a person from one culture may find eye contact aids rapport, whereas a person from another culture may find direct eye contact to be impolite. Differences in customs and practices, such as greeting rituals, gift-giving, and social etiquette, may also vary across cultures.
• Disability: A client may have an impairment or disability that could prevent them from being clearly understood or expressing themselves.
• Age issues. Some clients look upon younger workers as inexperienced and may not feel comfortable talking to them, whereas a child or adolescent may feel more comfortable with a younger worker due to feeling they are more able to identify with them. This is not always the case, but it is important to take age into consideration.

As you can see, various environmental and individual differences can represent significant communication barriers for both clients and their workers.

Recognising communication barriers is the first step to overcoming them. As a health worker, it will be your job, not the client’s, to be mindful of communication barriers and work to resolve them.

Environmental barriers can be overcome by making changes to the environment to accommodate the client’s needs and eradicate or minimise the barrier. For example, to address the issue of traffic noise, a health worker or allied health professional could ensure a quieter room is used or make use of a water fountain or background music to mask the traffic noise. If the client is distracted by something outside the window, you could ask if they would mind if you closed the blinds. You should always adhere to your organisation’s privacy policies and Workplace Health and Safety guidelines to reduce the likelihood of environmental factors impacting on the client-worker communication process.

If a client’s disability is likely to result in problematic communication, it is important to adapt your communication to accommodate any disability your client may. For example, you could take particular care to sit closer to a client who is hard of hearing and speak slowly and clearly. Where speech or comprehension represent communication barriers, workers should adjust the language they are using and speed of delivery to match individual clients and ‘check-in’ frequently to ensure understanding. You could also address this directly by providing supportive services. For example, a client who has a significant hearing impairment may benefit from the services of an Auslan interpreter who is fluent in sign language. Barriers may also be addressed indirectly. For example, a health worker or allied health professional could minimise the effect of their client’s speech difficulties by utilising attending behaviour and microskills to encourage their client to tell their story rather than finishing off their sentences for them.

If you are unable to speak the client’s language, you will need to consult your organisational guidelines about actions to take in order to reduce the language barrier. This may involve obtaining the services of a translator or referring the client to a service with available translators or allied health workers/professionals who speak the client’s language. With respect to jargon and slang terms, it’s important to ensure people understand what you are saying by regularly checking in.

In the case of age, barriers may sometimes be overcome through discussion with the client. However, in cases when they cannot be, clients may need to be referred to a more appropriate worker within the organisation, or another service. It is also important to remember to use age-appropriate language and body language when communicating with people of specific ages. With age there also exists the possibility for impairments to sensory abilities, i.e., an elderly person may be hard of hearing. In these cases, you should ensure you speak slowly and clearly and are patient with the client.

In the case of cultural barriers, it the responsibility of the worker respect their client’s cultural traditions. For example, avoiding eye contact or sitting beside the client instead of across from them. It is also crucial to consider and evaluate your own personal biases, values, and frame of reference. A health worker should understand their own values and make sure that they do not impose them upon a client.

Health worker should also do their best to understand the client’s point of view and check in regularly rather than relying on their own perception or understanding of the situation. For instance, it may be easy to make an assumption regarding client needs (i.e., that a client with a speech impediment, for instance, needs help) but this may be incorrect and could impact negatively on the client’s practitioner-client relationship or treatment.

As discussed previously, being in a stressed or traumatised state has a significant impact on a client’s ability to both express themselves and take in feedback from others. Workers should remain alert to indications of this and adjust their communication response appropriately. This may involve reducing the complexity and speed at which they provide feedback or information and checking in/clarifying with clients. Empathy is an important tool here (i.e., using responses such as, “it sounds like this is a really frustrating experience for you.”) Additionally, it is important to ensure that non-verbal communication is non-threatening by sitting further away from the client than usual and avoiding sudden movements. As stress and trauma also have a significant impact on the worker’s ability to listen effectively and therefore decode the client’s messages successfully, workers should aim to manage their own stress levels through relaxation strategies and supervision.

Generally, in most instances of communication, it is important to speak slowly and clearly, check for understanding, listen carefully and provide additional assistance in response to specific barriers or influences on communication.

Unresolved conflict in the workplace can create a negative work environment, can lead to absenteeism or turnover, can lead to a breakdown in communication and teamwork, can negatively affect the emotional state of workers leading to stress and/or anxiety, and can lead to legal or professional consequences such as complaints, which can damage the reputation of an organisation or an individual.

As shown above, there are a range of barriers that could influence communication and you have been presented with some strategies for overcoming these. The rest of this section will explore conflict resolution strategies in more detail, from avoiding conflict to defusing and resolving conflict.

Communicating with Respect

Respect is the foundation of effective communication. Respect will help you better understand the clients, parents, carers, and families that you work with. Ensuring communication is always respectful will also help to prevent or avoid conflict situations. This includes respect for every person’s:

• Religious and cultural background, values, beliefs and languages – for example, culturally and linguistically diverse  or Aboriginal and Torres strait Islander  individuals
• Parenting arrangements – for example, blended families, co-parenting families, single-parent families, and LGBTIQ+ families
• Gender diversity – for example, respect for people's gender and preferred pronouns
• Choices – for example, where people live, whether their houses are tidy, or what they are wearing
• Circumstances – for example, people with intellectual disability, parents who are teenagers, and people or families experiencing challenges

Tips for developing culturally competent practice:

• Spend some time getting to know the service user, do not rush meetings and interventions.
• Be continually aware of your professional and personal values and beliefs.
• Remember the service user is the expert of their experience, adopt a position of ‘not knowing’ and be ready to learn.
• Reflect on the power of language. Language empowers and can also leave a person wounded.
• Do not make assumptions about service users because you perceive that they come from a similar background to another service user or someone you know.
• Resist tokenism or simple ‘box ticking’ as a means of evidencing your cultural competence.
• Be flexible, not rigid, particularly when using existing frameworks and tools.

Effective Communication Strategies (Avoiding Confrontation)

Along with communicating with respect, using the 7 C’s of Communication can be useful when communicating to ensure your written and verbal communication is constructed in a well structed manner, ensuring information is clear and easily understood, and to avoid conflict situations.

1. Clear- Be clear in your thoughts and goals and help your client being clear with what is intended.

Tips on how to be clear when communicating:

• Speak using the present tense
• Communicate important facts via presentation or email
• Ensure your message is tailored to the recipient, for example; do you need to use service terminology in your communication

2. Concise- Being concise means keeping to the main points highlighting the key points.

Tips on how to be concise when communicating:

• Include relevant information and key details only
• Don’t repeat yourself
• Ensure the message is easy to understand and clear

3. Concrete- Being concrete means communicating in a specific and focused way to include all of the important details and facts, ensuring all intended recipients understand the message.

Tips to ensure you are being concrete when communicating:

• Provide clear guidelines for when you expect action
• Have a good understanding of the topic and only include information that’s relevant to what you’re saying

4. Courtesy- Show respect. Every individual has inherent dignity and worth and this should be reflected while interacting with client. Also, courtesy is having a good understand of your client and their situation, as well as being considerate of their needs.

Here are some more tips on how to be courteous when communicating:

• Talk in a friendly, open and honest way
• Use eye contact to acknowledge your listeners
• Listen to and engage with feedback

5. Complete- Complete communication means that you convey the entire message and person understands what you are saying.

Tips to ensure you are being about being complete when communicating:

• Be precise when giving information like dates, times, locations and names of places and people
• Ensure you provide accurate information
• Include instructions that are clear if you’re requesting something from your listeners

6. Coherent- You can achieve a coherent message by structuring your message to suit your audience and organise your key messages so that everything flows and has a sequence, which your recipient will understand.

Tips on how to be coherent in your communication:

• Tell a story
• Describe things in chronological order
• Introduce follow-up tasks in the order of importance

7. Correct- Be correct in whatever you convey, including being factually accurate and grammatically correct. Using appropriate verbal and non-verbal language. Let the message conveyed be exact, correct, and well-timed.

Here are some more tips on ensuring correct communication:

• Use a spell checker or a grammar checker, as well as proof reading
• Check that titles and names of people are correct
• Be sure to check that any technical terms you use are suitable for the intended audience

^{(Cutlip, Center, & Broom, 2013)}

Use communication skills to avoid, defuse, and resolve conflict situations

The following steps are inspired by Ringer’s (2022), Step-by-Step Checklist for Difficult Conversations.

• Step 1: Inquiry – Be curious. Try and learn as much as possible about the other side and their point of view. How does the events affect the other person? Be mindful of body language and consider if this is congruent with what they are communicating.
• Step 2: Acknowledgement - Acknowledgment means showing that you’ve heard and understood what the person communicated. Acknowledge whatever you can, including your own defensiveness if it comes up. It’s fine; it just is. You can decide later how to address it. For example, in an argument with a friend, I said: “I notice I’m becoming defensive, and I think it’s because your voice just got louder and sounded angry. I just want to talk about this topic. I’m not trying to persuade you in either direction.” The acknowledgment helped my friend (and me) to re-centre. Acknowledgment can be difficult if we associate it with agreement. Keep them separate. My saying, “this sounds really important to you,” doesn’t mean I’m going to go along with your decision.
• Step 3: Advocacy – When you have heard the other side and allowed the person to express their views and feelings, it will be your turn to share your side, clarifying your position without minimising theirs. For example: “From what you’ve told me, I can see how you came to the conclusion that I’m not a team player. And I think I am. When I introduce problems with a project, I’m thinking about its long-term success. I don’t mean to be a critic, though perhaps I sound like one. Maybe we can talk about how to address these issues so that my intention is clear.”
• Step 4: Problem Solving – The final step is exploring solutions, including brainstorming ideas and continued inquiry if helpful, explore collaboratively what might work to have create a resolution. If the conversation becomes adversarial, consider going back to step one (1) inquiry. Asking for the other’s point of view usually creates safety and encourages them to engage. If you’ve been successful in centring, adjusting your attitude, and engaging with inquiry and useful purpose, building sustainable resolutions with be achieved.

When to seek outside assistance with conflict

Addressing workplace conflicts before they arise, as a preventative measure, or while they are minimally disruptive is the most ideal strategy and outcome. However, there may be times when conflict warrants seeking outside help such as:

• Speaking to a supervisor or manager
• Request mediation (a neutral third party helps to facilitate a discussion and find a mutually agreeable solution).
• Involve HR (especially if the conflict involves issues such as harassment or discrimination)
• Consider seeking external assistance (such as if the conflict is complex or involves legal issues)

This section of the module provided you with an exploration on how to confirm and clarify meaning to ensure effective communication, explores constrains and influences on communication, and provides information pertaining to conflict resolution. This section also highlights the importance of working with diverse clients, including demonstrating culturally competent practice.

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• Beesley, P., Watts, M., & Harrison, M. (2017). Develop your communication skills in social work. UK: SAGE Publications Ltd.
• BetterHealth. (2012). Workplace conflict. https://www.betterhealth.vic.gov.au/health/healthyliving/workplace-conflict#bhc-content
• Cutlip, S. M., Center, A.H., & Broom, G. M. (2013). Effective Public Relations [11th ed]. New York: Pearson Education, Inc.
• Healy, K. (2017). The Skilled Communicator in Social Work: The Art and Science of Communication in Practice. GB: Bloomsbury.
• Schwantes, M. (2019). Here’s Tony Robbins’ Advice on How to Dramatically Improve Your Communication Skills. Inc. Australia. https://www.inc-aus.com/marcel-schwantes/heres-tony-robbins-advice-on-how-to-dramatically-improve-your-communication-skills.html
• SHRM. (2023). Managing Workplace Conflict. https://www.shrm.org/resourcesandtools/tools-and-samples/toolkits/pages/managingworkplaceconflict.aspx
• The Adolescent and Children’s Trust (TACT). (2019). Language that cares: Changing the way professionals talk about Children in Care. https://www.tactcare.org.uk/content/uploads/2019/03/TACT-Language-that-cares-2019_online.pdf
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