LoraKim Joyner, DVM, MPVM, MDiv
Abstract: A large part of veterinary medicine includes communicating with a variety of humans. The better we can communicate, the greater the ability to exchange accurate information, convey clarity and motivations for treatment and research plans, provide a context for creative solutions in often emotionally charged situations, resolve conflict, and support others in supporting the animals and one another. Communicating a caring presence further promotes human well being, which in turn augments greater organizational capability and human satisfaction in the work place. Key components to compassion include nonjudgmental observation, active listening, empathy, and clear requests, all of which are found in Nonviolent Communication, a theory and practice of compassionate communication developed by Marshal Rosenberg. This presentation offers background on the importance of compassionate communication and how it might be used in veterinary medicine, most notably in the areas of alleviating Compassion Fatigue and promoting self care.
Key words: communication, empathy, client, One Health, veterinary practice, emotion, social intelligence, compassion, active listening
Studies confirm that caregivers play host to a high level of compassion fatigue. Day in, day out, workers struggle to function in care giving environments that constantly present heart wrenching, emotional challenges. Affecting positive change in society, a mission so vital to those passionate about caring for others, is perceived as elusive, if not impossible. This painful reality, coupled with first-hand knowledge of society’s flagrant disregard for the safety and well being of the feeble and frail, takes its toll on everyone from full time employees to part time volunteers. Eventually, negative attitudes prevail.
Compassion Fatigue symptoms are normal displays of chronic stress resulting from the care giving work we choose to do. Leading traumatologist Eric Gentry suggests that people who are attracted to care giving often enter the field already compassion fatigued. A strong identification with helpless, suffering, or traumatized people or animals is possibly the motive. It is common for such people to hail from a tradition of what Gentry labels: other-directed care giving. Simply put, these are people who were taught at an early age to care for the needs of others before caring for their own needs. Authentic, ongoing self-care practices are absent from their lives.1
Easily recognizable in others and perhaps ourselves, Compassion Fatigue surfaces repeatedly in veterinary medicine. By experiencing compassion, that is, deep awareness of the suffering of another coupled with the wish to relieve it, veterinary team members may find themselves unable to contribute and communicate as efficiently and with as much satisfaction as they would like. By combining compassion and communication as an intentional practice tool in of veterinary medicine, our medical kit becomes like Mary Poppin’s magical bag, a seemingly endless reservoir of methods to attend to the multiple beings in our circles of care, including ourselves.
Beneficial Aspects of Compassion
Effective communication is the cornerstone of quality animal care and leads to positive experiences and outcomes for patients and clients.2
Communicating compassion is one relationship-based communication skill used to supplement the technical skills of veterinary medicine. Compassionate communication emphasizes intrapersonal and interpersonal skills, and encompasses self-awareness, self-care, flexibility, non-judgment, mindfulness and presence, empathy, conflict transformation, social and emotional intelligence, and being a non-anxious presence. Though it may take practice and time, compassionate communication reaps noticeable results. For instance, human physicians experience high rates of burn out and the number of malpractice suits is correlated to impaired communication and shorter patient visits. Spending time with staff and patients decreases the chance for compassion fatigue. Superb leaders in human services are not those with greater knowledge or technical skill, but those with highly developed interpersonal skills like empathy and conflict resolution.3 Medical staffs perform better when they feel they have a secure base to work from, such as an organization that operates with a high level of social intelligence. Social intelligence is the ability to act from understanding our interior lives (intrapersonal skills) and our lives in relationship to others (interpersonal skills).
Social intelligence recruits our reality-based understanding of what it means to be human with all our emotional and cognitive gifts and burdens, and uses these characteristics in an intentional way to improve the quality of life for ourselves and others. We are strongly hardwired for relational learning, emotions, empathy, compassion, kindness, and for care and collaboration as well as competition. The more attentive we can be to the emotions and status of another person or animal, the more likely we are able to respond with greater care, in more ambiguous situations, and more quickly. To be more attentive to another person, we strive to understand them, as well as ourselves.
Social intelligence also contributes to business management, which is a vital aspect of many veterinary practices. Cutting edge business leadership models focus on empathy and deep listening within the organization to improve success. The shift is from producing results to producing the growth of people who produce great results.4 Success depends on both intrapersonal and interpersonal skill development, which grows businesses and relationships. Life giving relationships are the powerful engine of successful organizations, and compassion, and empathy are great tools for increasing power in organizations. Positive emotions make a difference in a work place as do expectations and clarity of how we are to “treat one another” on a day-to-day basis. Practices that produce positive emotional encounters result in individuals with higher commitments to the organization.
Success extends beyond relationships or organizations. Planetary health also depends on skill development. To escape ecological destruction we must overcome our fear of authentic psychological development and attend to social intelligence. Using social intelligence to communicate and become increasingly self-reflective can also lower the high risk of addiction, suicide, and stress persistent in veterinary medicine.
“Being” is another way of describing critical self-reflection, presence, or “mindfulness.” It is to be a nonanxious observer of the behaviors and internal experiences of ourselves clients, veterinary team members, and of the nonhuman animals. Ronald W. Epstein, a physician notes that the “goals of mindful practice are to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognize bias and judgments, and thereby act with principles and compassion. Mindfulness involves a sense of unfinished curiousity.5″ This flexibility contributes to the conversational needs of the present moment, and “also increases the client’s experience of the veterinarian as present and compassionate in the conversational interactions,” writes Elizabeth Strand Director, Veterinary Social Work, Social Worker at the University of Tennessee College of Veterinary Meidicine.6
Strand encourages another slightly different understanding of mindfulness in veterinary practice which supports non-anxious presence, as well as compassion in conversation, action, and self-care. This mindfulness, defined by Jon Kabat-Zinn as “moment to moment non-judgmental awareness” calls “practitioners to begin to observe the internal experiences of emotional, cognitive, and physical occurrences without trying to change them.” A Mindfulness-Based Stress Reduction (MBSR) program has been used in human medical patients, medical students, pre-medical students, and nursing students. Using this program reduces levels of depression, anxiety, fatigue, confusion and increases levels of empathy and self-confidence.7 Using this program, much like practicing compassionate communication increases our chances to stay engaged peacefully and fruitfully with other humans.
Background and Theory
Compassionate Communication, based on Marshal Rosenberg’s Nonviolent Communication theory, emphasizes honesty and empathy in interpersonal and intrapersonal relationships.8 Through practice it leads to shifts in thinking and emotional responses. It is based on the understanding that human beings operate best in social groups when they receive empathy. Greater connection and rapport between individuals, so paramount in social discourse, happens if language used and even deeper consciousness reflected in body language, is founded upon the idea of universal needs and not on judgment, blame, or domination to get needs met. Instead empathy through deep listening, authentic sharing of needs and feelings, and clear requests suggest the best strategy for people to come up with creative solutions where everyone is heard and has their needs considered, as well as the needs of nonhuman animals. Turner develops this theory by developing concrete ways that people can transact through the medium of needs to produce positive emotions and commitment.9
Empathy and listening:
Full listening helps us attune to others and their internal states. By stilling the cognitive loops and chatter that go on inside of us, we come to attentive recognition of what another is feeling, and have a greater chance to understand them and offer empathy. When another person feels heard and receives empathy, they in turn are in a better place to listen to you, as well as to recognize their own emotional state without it being overridden by concerns of threat from without.
Self-empathy: attuning to your feelings and needs:
A core concept for having compassion and empathy for others, is to have it for yourself. When you attend to your own feelings and needs, it offers you a sense of connectedness to humanity because all humans universally share basic needs.10 Furthermore, knowing your actual needs and not some “should stories” inherited from family and culture, orients you to what might satisfy you. In this spaciousness, you can then listen and open to the needs of others, without judging yourself or them. In addition, even though you may not meet your specific needs in the way hoped for, by self-reflecting and attuning to your feelings and needs, you give yourself choices on which actions might actually better meet the needs that arise in you instead of reverting to strategies that repeatedly fall short of bringing results and satisfaction in your communication and relationships.
Basics of Nonviolent Communication in Compassionate Communication
Nonviolent Communication is a social construct, one of many cognitive frameworks for growing interpersonal and intrapersonal understanding and skills. With practice, nonviolent communication shifts our thinking and rewires our cognitive loops so that our orientation increasingly embraces compassion towards ourselves and others. Words need not even be spoken, as our consciousness demonstrates in paraverbal and nonverbal cues that we have empathy for others. Therefore the four components of this relational tool are not to be taken literally or to be seen as a cure all for all relational ills and situations. They are a guide that can alter our negative cognitive loops and bring mindfulness and satisfaction to our lives. The following description and example are but one drop in the ocean of a life-long practice.
Four Components of Nonviolent Communication
- We observe and speak based on factual, observable phenomena such as what a video camera might record
- Observations are differentiated from evaluations or judgment
- We express feelings when we can, which are differentiated from thoughts
- Our feelings are not caused by others, but by a met or unmet need
- Our specific needs are differentiated from strategies, which are the practices we employ to meet our needs.
- Our needs are universal, whereas strategies are specific to the person and place
- Having a met or unmet need stimulates our feelings
- Persistent feelings are stimulated by thought and cognitive loops, and likely don’t have much to do with current needs
- Our needs connect us to our shared humanity (and to other life through evolutionary connections)
- Requests are differentiated from demands and have no conditions
- Requests are more likely to be heard and less likely to be resisted by others
- They are framed to be positive, concrete, and doable in the moment
- We make requests that strive to attend to the needs of all involved (human and non human)
- Underlying our requests is a search for connection and understanding
Using all four components together:
When I see or hear…
Because I need…
Would you be willing to…
Connection: tell me how you are feeling about what I said?
tell me what you heard from what I said?
Action: (concrete, positive, doable) do….
In this example, the veterinarian has been encouraging a client to pursue diagnostics and treatment in a curable condition. The client declines further service with the comment, “you veterinarians just charge too much!” Instead of arguing, further persuading, rationalizing, or defending, the veterinarian might do this:
Empathize with self:
No wonder I am so irritated, I really long for ease and also desire the well-being of this bird.
Empathize with client:
I’m guessing that you really value your bird’s health, and are afraid that you don’t have the resources to take care of you bird?
After the client feels heard and empathized with, you say:
When I hear you say that you are unable to use my services, I feel sad because I would like to help you and your bird without causing too much stress on your family. Would you be willing to tell me what comes up for you when I say this? (or..Would you be willing to talk with me further to see how we might provide for your bird?)
Reality suggests that such a conversation may not “fix” the problem and add any more ease or support for yourself, the client, or the bird . Attempting to empathize with yourself, the client, and the bird, however, does open up the possibility for the greatest compassion and creativity to come forward in our complex inner and outer worlds.
Compassionate Communication in Practice
To incorporate, grow, or further investigate compassionate communication:
- Schedule weekly case reports or review of conversations and relationships
- During this time discuss, support, and practice communication skills
- Offer empathy
- Pursue further training and learning (Center for Nonviolent Communication. Available at: http://www.cnvc.org. Accessed February 24, 2010)
- Involve yourself and support others on the veterinary medical team in individual or group practices in mindfulness (such as meditation, journaling, nature walks, etc)
In my own life I am committed to compassionate communication as a learning and practice tool to grow my compassion. Much of my passion for this comes from my experience as a veterinarian where I have seen how important it is to support veterinary team members as they strive to heal animals and bring health to our world. My dream is that we find ways together to be more compassionate, empathetic, and understanding of one another and that you will join me in this cause.
1. What is compassion fatigue? Compassion Fatigue Awareness Project: Where healing beings. Available at: http://www.compassionfatigue.org/pages/compassionfatigue.html. Accessed February 24, 2010.
2. In Practice: Tools for Practice Success: Caring, Compassion, Confidence, and Communication. Bonvicini K. Available at: http://www.vetlearn.com/ArticleDetails/tabid/106/ArticleId/4424/Default.aspx. Accessed February 26, 2010.
3. Senge P, Scharmer CO, Jaworski J, Flowers BS. Presence: An Exploration of Profound Change in People, Organizations, and Society. NY, NY: Doubleday; 2004.
4. Joyner L. The socioscientific arts of avian medicine. Proc Annu Conf Assoc Avian Vet.
5. Epstein RW. Mindful practice. J Am Med Assoc. 1999; 282:833-839.
6. Strand E. Enhanced communication by developing a non-anxious presence: A key attribute for the successful veterinarian. J Vet Med Educ.2006; 33(1):65-70.
7. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998;1:93-98.
8. Rosenberg M. Nonviolent communication: a language of life. Encinitas, California:Puddledancer Press; 2003.
9. Turner JH. Face to Face: Toward a Sociological Theory of Interpersonal Behavior. Standford, CA: Standford University Press; 2002.
10. Maslow AH. A theory of human motivation. Psych Rev. 1943;50(4):370-96.