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TRANSCRIPT
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Crucial Conversations in Supervision
Linda R. Sealey, Ph.D., CCC‐SLP
Elaine Martindale, M.S., CCC‐SLP
Disclosures
Elaine L. Martindale, M.S., CCC‐SLP
• Mrs. Martindale has worked at the University of Central Oklahoma since 2010 and served as the Clinical Coordinator since 2014.She received her M.S. in Speech‐Language Pathology from the University of Central Oklahoma (UCO) in 2001 and her B.S. in Speech‐Language Pathology with a minor in Vocal Music Education from UCO in 1999.
• Portions of this presentation were developed as part of paid employment at UCO.
• As a speaker she was able to register for this conference at a reduced rate and her employer paid the registration fee.
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Linda R. Sealey, Ph.D., CCC‐SLP
• Dr. Linda Sealey‐Holtz is Associate Professor and Program Director of the Speech‐Language Pathology (SLP) program at the University of Central Oklahoma (UCO).
• Portions of this presentation were developed as part of paid employment at UCO.
• As a speaker and OSHA Executive Committee member she was able to register for this conference at a reduced rate.
Learner Outcomes
• Describe the signs of a crucial conversation
• List techniques for creating a safe space for a crucial conversation
• Discuss techniques and methods of providing feedback and guidance in supervision while maintaining professional boundaries and relationships and promoting self‐reflection to learn and improve skills.
Setting the Stage
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Communication
• Crucial Conversations: Tools for Talking When Stakes Are High (2012) • K. Patterson, J. Grenny, R. McMillan, & A. Switzler, NY: McGraw‐Hill
• Universal
Talking Everyday
• Home
• Church
• Groups
• Work• Boss
• Peers
• Other Professionals
•SLP• Application to three groups:
• SLPA CF Graduate Student
SLPA• Provide meaningful mentoring and feedback to the clinical fellow.
• Assist the clinical fellow in developing independent clinical skills.
• The main purpose of the Clinical Fellowship is to improve the clinical effectiveness of the clinical fellow.
• 3 segments. approx. 3 months ea. of 40hr/wk work
• 6 hours direct supervision per segment
• 6 hours indirect monitoring activities per segment
GR Student• 1st 90 days: 30% per week, 20% direct, 10% indirect
• After 90 days: 10% direct, 20% indirect
• Meetings for feedback or conferences as determined by need and the results of observations.
• 25% for all therapy and evaluation provided
• Meetings, feedback, and conferences as determined by the program.
CF
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Mentoring & Feedback
• Mentor must provide performance feedback throughout CF.
• Feedback & goal setting requires two‐way communication.
• Identify strengths and weakness, discussion & goal‐setting, assist in developing required skills.
• Maintain written records of all contacts & conferences
Crucial Conversations
What makes a conversation crucial?
• Opposing Opinions
• Strong Emotions
• High Stakes
High Stakes
Crucial Conversations
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3 options for handling a crucial conversation
• Avoid them
• Face them and handle poorly
• Face them and handle well
The perception of a crucial conversation
Watch the following video clips and determine if the conversations are crucial
• Scheduling
• Late for meeting
• Billing 7‐minute rule
• Caseload management
Scheduling Is this a crucial conversation?
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Meeting SLP/CFIs this a crucial conversation?
BillingIs this a crucial conversation?
Caseload ManagementIs this a crucial conversation?
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Creating SafetyWhen a conversation fails, was the safety lost?
Learn to spot a crucial conversation
Watch for conditions
• Physical‐ stomach tight, sick feeling
• Emotional‐ scared, hurt, angry
• Behavioral‐ raise voice, pointing finger or become very quiet.
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Other considerations
• Timing
• Mood
• Additional external factors
Creating a safe conversational environment
Learn to spot safety problems
• Dual‐processing‐ content and conditions
• Dialogue ends when you don't feel safe
• Fight or flight
• Withdrawal, hiding, defensive
• All motivated by fear
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• People rarely become defensive simply because of what you're saying (content). They become defensive when they no longer feel safe (condition).
• The problem is not the content of the message, but the condition.
Video – meeting S1 & S2
Making it safe
• Create Mutual Purpose
• Create Mutual Respect
Mutual Purpose
• Working toward a common outcome
• Not forcing your own opinion
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Questions to determine if Mutual Purpose is at risk:
• Do others believe I care about their goals in this conversation?
• Do they trust my motives?
Mutual Respect
• If people perceive disrespect, the conversation becomes unsafe.
• Mutual respect is the continuance condition of dialogue
How to spot if people feel disrespected
• Emotions become highly charged
• Fear turns to anger
• Resort to pouting, name‐calling, yelling and making threats
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Can you respect people you don't respect?
YES!
• Find a way to honor and regard basic humanity
• Don't dwell on how others are different from ourselves
• Without excusing behaviors, try to sympathize, even empathize with them.
What do you do if Mutual Purpose or Respect is at risk?
• Apologize
• Contrast
• Create a mutual purpose
Apologize
• Offer a sincere apology when appropriate
• Check your motives
• Admit when you have made a mistake that hurt others
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Contrast
• When others misinterpret your purpose or intent, contrast to fix misunderstanding
• Contrasting is a don't/do statement that:
• Addresses others' concern that you don't respect them or have a malicious purpose (don't)
• Confirms the respect or clarifies your real purpose (do)
Examples of Don't/Do statements
"The last thing I wanted to do was communicate that I don't value your work and your contributions to our therapy team. (don't)
I do think you are an incredible therapist and bring so much to our team." (do)
"I don't want you to think I am not satisfied with your quality of work. I really do think you are doing a good job. The issue of punctuality is very important to me and I'd just like you to work on that"
Create a Mutual Purpose
• What do you do if you clearly have different purposes?
• Move towards a compromise
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Commit to seek a Mutual Purpose
• Stay in the conversation until you come up with compromise and create a mutual purpose
• Stop arguing
• Put your belief aside that your way is the best or right way
• Be open to the idea that a third choice is out there
Invent a Mutual Purpose
• Move to more encompassing goals
• Brainstorm new strategies
YOU ME
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Techniques
Techniques
• Start with Heart
• Mastering Your Stories
• STATE
• AMP
This Photo by Unknown Author is licensed under CC BY‐NC‐SAStart with HeartAnd Stay in Dialogue when you’re hurt, angry, or scared.
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The journey to Starting with Heart
• Focus on what you can control – you.
• You are in this session because you want to be better at supervision.
• We each have engrained ways of responding.
• Before we can change those habits, we need to take a good look at ourselves.
• We can’t move into conversations when we have the idea that ‘if we could just ‘fix’ them, all would be okay’.
• First, we need to realize that in every situation, we contribute in some way.
• Change the focus from ‘others’ to our part in the interaction.
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• Coming into a crucial conversation, those who are best at conversations ‘start with heart’, they are clear about their part in the situation and have explored their heart, determining what they want out of the interaction.
A situation:
• You have scheduled a meeting with your fellow, Lauren. One of the items you want to discuss is a complaint from the administration and nursing at her facility that Lauren is typically late for all appointed procedures or meetings. You arrive at the facility and get to the conference room a few minutes before the scheduled meeting time. Twenty minutes after the appointed time, Lauren arrives. At this point you mention to Lauren that she is late for the meeting. She responds indigently that YOU were late for your previous meeting, 3 weeks ago.
‘Old’ ways of responding
• You are at the edge of a crucial conversation
• Typical ways of responding:
• Winning
• Punishing
• Keeping the peace
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Winning
• You might feel like you’ve just been attacked.• Challenged or pointed out inaccuracies
• Trained early to win.
• Instinct to correct the facts, etc.
• Switched to needing to ‘win’.
• Creates a cycle.
Punishing
• Anger moves from needing to ‘win’ to ‘punishing’.
• “You have some nerve. Everyone here knows you can’t be on time if your patient’s life depended on it.”
• “We will be documenting your arrival times”
Video – Meeting S2
Keeping the Peace
• Say nothing.
• Don’t win, don’t punish
• But, don’t have an honest communication.
• Choose personal ‘safety’
Video – Meeting S3
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Tools you can use
• Avoid the fool’s choice; avoid making a choice between two ‘bad’ choices, winning or punishing, or keeping the peace
• Do not choose between candor and kindness
• Do not fall into ‘winning’ or ‘punishing’, or ‘keeping the peace’
• How can you be honest and respectful?
• How do we engage in the crucial conversation?
Start with your Heart
• Stay in dialogue by focusing on what you REALLY want.
• Take a moment.
• Check your motives
• Avoid the chemical/emotional tide
• Make a conscious choice
• What do you really want?
• What do you want for others?
• What do you want for the relationship?
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Back to our meeting…
• You’ve avoided being derailed.
• You’ve clarified what you want.
• Now, clarify what you DON’T want.
• Then, give yourself a more complex problem.
Search for the ‘and’
• Is there a way to talk with you fellow about your real concerns andnot offend, but build a strong relationship?
• Is there a way to talk about being on time and not get into an argument or derail the meeting?
Video – meeting S4
Mastering Your Stories
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Find the space between the ‘event’ and your emotions• ‘That Look’
• Who pushes your buttons – you
• Don’t let your emotions be the ONLY valid response
• ‘she cut me off’
• Don’t just stuff down the emotions – do something different
Behavior
•Action
• Silence
•Winning
• Punishing
Event
•Feelings
Behavior
• Silence
•Winning
• Punishing
Event
• Feelings
Think them out• Act on your emotions by thinking them out.
• Choose your emotions & choose your behaviors
•
ActTell a Story
•Re‐frame
Event
•Feeling
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Stories provide our rationale
• Master the story by:
• Noticing your behavior
• Getting in touch with your feelings
• Analyzing your stories
• Getting back to the facts
Taking charge of your emotions
• You can either allow them to take over or learn how to master them
• Try to suppress –bite your tongue
• Usually come out eventually
• Blow up
• Think them out
• Choose your emotions
Watch for 3 common stories
• Victim Stories– “Its not my fault”• The innocent sufferer
• The other person is ‘wrong’ or ‘bad’ and we are ‘right’ and ‘good’.
• But you’re NOT an innocent victim ‐‐‐ that is rare
• Typically ignoring your role in the problem
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• Villain Stories – “Its all your fault”• Nasty tales that turn others into villains, set out with evil intentions to harm you
Beware the Double Standard• When WE make the mistake, we are the Victim, our motives are innocent and pure.
• When OTHERS hurt or inconvenience us we tell of their terrible motives and flaws
• Helpless Stories – “There’s nothing else I can do”• If I didn’t yell, he wouldn’t hear me
• We convince ourselves that there are no healthy or helpful alternatives for dealing with the situation.
• “If I told the fellow that I’m too busy, he would complain that I’m not providing mentoring”
• We are changing other’s behaviors into fixed and unchangeable traits.
• The control freak fellow
Back to our meeting…
• Victim?
• Villain?
• Helpless?
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The ‘Why’ – We all do it
• Those VVH stories match reality – we really could be an innocent victim
• VVH stories get us off the hook
• VVH stories keep us from acknowledging our own sellouts
• We don’t tell VVH stories until we’ve done something that we need to justify.
• The annoying habit
• The sellouts:• You believe you should help someone, but don’t
• You believe you should apologize, but don’t
• You say ‘yes’ when you should say ‘no’
• You should listen respectfully to feedback, but become defensive instead
• You have information the other could use, but keep it to yourself
• Etc.
The rest of the story
• Turn your victim story into an action• Are you telling your story as if you are the innocent victim? Notice your role in the problem.
• Tell the rest of the story – your part in the story & the important facts
• Turn you villain into a human
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STATEHow to speak persuasively, not abrasively
• We’ve come a long way, learning about
• Spotting the signs of a crucial conversation
• Maintaining safety in a conversation
• Starting with heart ‐ finding the ‘and’ • some bad habits ‐ Winning, Punishing, Keeping the Peace
• Mastering our story • Some common stories ‐ Victims, Villains, the Double Standard, and Helplessness
• Let’s explore another technique, STATE, as a framework for communicating
STATE
• Share your facts
• Tell your story
• Ask for the other’s path
• Talk tentatively
• Encourage testing
Video – SchedulingTiming & attitude to bring into conversation
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Share Your Facts
• Retrace your steps to the facts
• Follow your path
• Hold your tongue
• Get to the objective facts
• Facts are:• Less controversial
• Most persuasive
• Least insulting
ActTell a Story
•Re‐frame
Event
•Feeling
Tell your story
• The facts alone don’t complete the idea
• The conclusion calls for face‐to‐face discussion
• This takes confidence
• Don’t let it simmer, don’t pile on
Ask for Their Path
• Takes confidence and humility
• Confidence to share our facts and stories
• Humility by asking for and listening to their story
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Tips for the Communication – Talk Tentatively
• Throughout STATE – talk tentatively
• Soften the message without manipulating
• A ‘good’ story
Video ‐ Billing
Encourage Testing
• How you ask – makes a difference
• Consider safety, yet VIP to express true opinions
• Invite opposing views = “Do you see it differently?” “Does anyone have a different side to the story?”
• Make sure you REALLY want to hear it
• Play devil’s advocate
• Repeat until they believe in your motives
How did we get like this?
• Know that backing off when we care the most is counterintuitive
• Be ready to check our stories and catch it when we are pushing our ideas on others
• We do NOT have all the knowledge or meaning
• When you find yourself just dying to convince others that your way is the right way, back off. Think about what you really want, for you, for others, and for the relationship.
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AMPPHow to listen when others blow up or clam up
• ASK
• MIRROR
• PARAPRHASE
• PRIME
Ask To Get Things Rolling
• Seek to understand the others' views
• "I'd like to hear your concerns."
• "What's going on?"
• "Please let me know if you see it differently."
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Mirror to Confirm Feelings
• Allow them to feel the way they are feeling (watch your tone)
• Describe what you see
• "You're saying you're okay, but by the tone of your voice, you seem upset."
Paraphrase to Acknowledge the Story
• Paraphrase what you heard in your own words
• Do not simply parrot back what was said
• Remain calm and collected
• Rephrase in a way that suggests you are trying to understand
PrimeWhen You're Getting Nowhere
• Prime (gently push for more information) when you believe the other person has something else to share and might do so with a little more effort.
• Take your best guess at what they may be thinking and feeling
• Don't push too hard
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Move to ActionHow to turn crucial conversations into action and results
Dialogue is not decision‐making
• Realize by talking about something (open dialogue) does not mean that an end decision is made
How are decisions made?
• Command
• Consult
• Vote
• Consensus
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Four important questions in decision‐making
• Who cares?
• Who knows?
• Who must agree?
• How many people is it worth involving?
Put decisions into action
• Who?
• Pass out the assignment for who will do what
• There is no "we"
• "So you will be here 15 minutes before your first patient"
• Does what?
• Be specific and spell out the exact expectations
• To help clarify, use Contrasting (don't/do)
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• By when?
• Give a deadline
• If vague or unspoken, action never takes place
• Goals without deadlines aren't goals; they're merely directions.
• How will you follow‐up?
• Agree on how‐often and by what method you'll follow up.
• Build in an expectation for follow‐up
• "You have until the end of November. Email me when you have completed that part and then we can meet to determine the next step."
• Document your work
• Don't rely on your memory
• Write down details of conclusions, decisions and assignments
• When someone fails to deliver, use STATE skills
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Finish Clearly
• Determine who does what by when
• Make actions crystal clear
• Set a follow‐up time
• Record details, conclusions, decisions and assignments
Example of Student Improvement Plan
• Determine who does what by when
• Setting clear, measurable goals for improvement
• Set a clear deadline for completion
• Set a follow‐up time
• Document progress and completion of plan
Summary:
• Crucial Conversations can occur with opposing opinions, strong emotions and high stakes
• Create safety in the conversation‐ mutual respect/mutual purpose
• Techniques:
• Start with the Heart
• Mastering your Story
• STATE
• AMPP
• Move to action
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Put it into Practice
Groups
1
2
3
4