Portal de Periódicos da CAPES

Nonviolent Communication

2021; Elsevier BV; Volume: 22; Issue: 3 Linguagem: Inglês

10.1016/j.carage.2021.03.002

2377-066X

Paige Hector,

Peace and Human Rights Education

Perhaps the title of this article caught your eye. Was your initial response something like, “Are you kidding? I do not use violence to communicate!” If so, you are not alone. This was my reaction as well when I was discussing a care plan with a colleague who informed me that its language was violent. In the moment, I was puzzled and, if I’m truthful, offended. I reread the care plan thinking I had missed something, that staff had written offensive or inappropriate words. My colleague went on the clarify that nonviolent communication supports connection, a universal human need, yet elements of this care plan were punitive and fostered disconnection. My curiosity was piqued, and I began studying this way of thinking and communicating. In 1984, Marshall Rosenberg, PhD, a psychologist, mediator, author, and teacher, created the nonviolent communication (NVC) process, based on the work of the psychologist Carl Rogers. Dr. Rosenberg founded the Center for Nonviolent Communication, which now has hundreds of certified trainers worldwide. In Nonviolent Communication: A Language of Life (3rd ed., PuddleDancer Press, 2015), Dr. Rosenberg writes, “Nonviolent Communication shows us a way of being very honest, without any criticism, insults, or put-downs, and without any intellectual diagnosis implying wrongness.” He goes on to say, “NVC is founded on language and communication skills that strengthen our ability to remain human, even under trying conditions. While we may not consider the way we talk to be ‘violent,’ words often lead to hurt and pain, whether for others or ourselves.” Imagine a situation in which you are trying to express your point of view and do not feel heard. Perhaps you try to explain yourself again and again, only to experience more frustration and maybe even anger. Our instinct (which is also what many of us were taught and what is reinforced by society) is to approach situations in which we disagree with others with the goal to convince them that our position is “right.” We shower them with opinions, knowledge, and facts with the intent to prove them wrong or convince them that their position doesn’t have merit or makes no sense. When we interact in this way, it is like a tennis match, each person volleying the next response over the net. Each person is listening to respond, instead of listening to understand. The NVC process has four components: observations, feelings, needs, and requests. Dr. Rosenberg describes the process as “the concrete actions we observe that affect our well-being. How we feel in relation to what we observe. The needs, values, desires, etc. that create our feelings. The concrete actions we request in order to enrich our lives.” Identifying how we feel and what need is not met — then forming a specific request to meet that need — is anything but simple. Truly, NVC is like learning a new language, one that allows us to engage with ourselves and each other with authenticity, empathy, and compassion, instead of criticism and blame. The NVC process offers a way to engage in dialogue with compassion and empathy. NVC elevates our emotional intelligence competency by increasing our emotional language vocabulary. With an expanded vocabulary, we are then more equipped to connect emotions and feelings directly to a need. For example, if I’m feeling hopeless, I may have an unmet need for safety or balance. If I’m feeling resentful, I may have an unmet need for understanding or appreciation. When my need for compassion is met, I may feel grateful or engaged. Feelings and needs are directly related to one another, and once we become more adept at thinking and speaking this language, our connections with each other and our relationships improve. Identifying our needs in relation to our feelings is difficult. Dr. Rosenberg writes, “Not only have we never been educated about our needs, we are often exposed to cultural training that actively blocks our consciousness of them.” There are universal human needs, and no matter our age, race, culture, gender identity, or any other difference the needs are the same. Just a few examples include food, sleep, relaxation, stability, dignity, humor, understanding, connection, acceptance, respect, integrity, choice, and passion. Consider a recent time when you felt angry or frightened. What need of yours was not being met in that moment? Alternatively, recall a recent time when you felt grateful or excited. What need was being met in that moment? Becoming skilled in identifying our needs — met and unmet — is paramount to communicating with authenticity, empathy, and compassion. The algorithm for employing the four NPC components — observations, feelings, needs, and a request — goes like this: “When a, I feel b, because I am needing c. Therefore, I would now like d.” The NVC method is not an answer but rather a method to communicate about feelings and needs, our own and those of others. Let’s look at some examples of conversations with staff members. Becoming skilled in identifying our needs is paramount to communicating with authenticity, empathy, and compassion.The nonviolent communication method helps us talk about feelings and needs, our own and those of others. A staff member at your facility tells you, “That resident is awful.” How do you respond? Using NVC language, I could say, “When I hear you describe the new resident as awful (a: my observation), I feel concerned (b: my feeling) because I value compassion (c: my value or need). I would like you to be specific and describe what happened with the new resident that you find difficult (d: my request).” Alternatively, I could choose to focus on the feelings and needs of the staff member and say, “Are you frustrated (b: a feeling) because of something that happened with the new resident (a: a general observation) that made it difficult for you to complete your admission assessment (c: a need)?” In this example, I focus on that person’s needs and feelings without including a request at this time. Using NVC language, I make an educated guess as to what the other person might be feeling (based on an unmet need), and I check it out. It’s not important to name the feeling and need correctly. What is important is the connection I’m making with the other person, trying to understand that person’s feelings and needs, which is the essence of empathy. If what I say doesn’t fit someone’s perception or experience, he or she can correct me, which allows us both to better understand each other and the situation. Next, let’s consider another scenario on the important topic of COVID-19 vaccination. A staff member at your facility says, “I won’t get the vaccine because I don’t trust the government.” How do you respond? You could respond with disbelief, frustration, or an attempt to evoke shame, guilt, or a sense of duty to get vaccinated for the safety of your residents. Or you could accept her position and write her off as “refused.” Or you could choose to say nothing and judge her silently. None of these three options meet the needs of either person. Here’s why. The decision around vaccination is not just a decision based in logic; it has an emotional component as well. Unless the emotions are acknowledged, we will not reach the degree of vaccine acceptance that is necessary to achieve the safety (the need) to re-engage in society (another need). Feelings are based on perceptions. Perceptions are not necessarily right or wrong — they just are. Many factors contribute to a perception such as life experiences, education and training, family history, and culture. If people perceive the government as not trustworthy, they have a right to their perception. It is not our responsibility to prove or disprove that perception, nor will arguing and debating about the importance and safety of the vaccine move these feelings. Criticizing, analyzing, or blaming will likely just anger or alienate others. Instead, our job is to seek understanding of that person’s perception by naming the feeling and the unmet need — in other words, to empathize. How could we engage with this person using nonviolent communication? Let’s explore a possible dialogue between the staff member and her supervisor using NVC. Staff Member: I won’t get the vaccine because I don’t trust the government. Immediately, the supervisor is listening for the feeling and what unmet need might be contributing to the feeling. Supervisor: Are you feeling upset because you want to make sure you have a choice of whether or not to get the vaccine? Staff Member: Of course! It’s my right to choose, and no one is going to make me do anything I don’t want to. Supervisor: Being in charge of decisions that affect your health is important. Are you uncertain that the government has people’s best interests in mind? Staff Member: Just read the reports. This thing was rushed ... they even called it Operation Warp Speed. No way can it be safe. I’m not going to be a test subject. Supervisor: Are you worried that steps were skipped to develop the vaccine? This is an important part of the conversation. The supervisor continues to stay present, empathize, and inquire about the staff member’s feelings. She started off expressing that she was upset, which transitioned to uncertainty, and now the feeling is worry. Regarding needs, the supervisor was able to learn that the staff member has needs for choice, empowerment, and safety. Staff Member: I’m worried that if I get the vaccine and get sick, I won’t be able to take care of my son. Supervisor: Am I remembering correctly that your son is a third-grader? My son is in high school now, and sometimes I feel so vulnerable when I think about his safety. Do you feel vulnerable as a parent, too? Staff Member: How could I not? Everything is such a mess ... I worry about school, paying bills, not getting this damned virus, my mom’s health — I haven’t seen her in months, and when I talk to her on the phone, she cries. I just want things to go back to the way they were. At this point in the conversation, there is a shift. The supervisor has uncovered the deeper feelings and needs around the staff member’s hesitancy to get vaccinated. The staff member feels vulnerable and needs stability regarding her ability to care for her son. Often when a person feels “heard” to their satisfaction, the shift can be seen in their body — a softening of the face, a deep breath, a relaxing of the shoulders, a new sense of settling and perhaps even quiet. The person has said what she needs to say about her pain, she was received with empathy, and she feels understood. At this point, sometimes individuals can even be ready to hear the other person’s feelings and needs. Notice that there was no “debate” about vaccine safety or the intentions of the government in the second scenario. There was no guilt-tripping or shaming of the employee in an attempt to change her mind. What occurred was deeper listening and the identification of feelings and unmet needs. The supervisor understood the feelings and needs behind the staff member’s statements and even shared them herself as a mother. They connected, which is the essence of NVC. The supervisor may still want to express her views on vaccine safety; because the tone of the conversation is no longer adversarial, the staff member will be more likely to receive this information. Now might be an opportunity for the supervisor to invite the employee to see the connection between her need to care for her son (to protect him) and how she can better meet her need by getting vaccinated. Now may also be a good time to use the motivational interviewing technique “Ask-Tell-Ask” to share information about vaccine safety. NVC communication upholds the trauma-informed care principles of safety, trust and transparency, collaboration, empowerment, and choice. To trust that people can share their opinion (point of view, perspective, fear) and not be judged but validated is what cultivates the safe space to connect with each other with compassion and empathy. Ms. Hector is a clinical educator and public speaker specializing in clinical operations for the interdisciplinary team, process improvement and statistical theory, risk management and end-of-life care, and palliative care, among other topics. She is a member of the Editorial Advisory Board for Caring for the Ages. She is passionate about nursing homes and supporting staff to care for the most vulnerable people in their communities.Try Nonviolent Communication: A Case ScenarioA daughter calls the post-acute and long-term care medical provider regarding her father, who was discharged from the facility a week ago. Upon discharge, along with his remaining medication prescribed in the facility, her father received a prescription for pain medication. The family did not fill the prescription, and it has now expired. Her father has had a follow-up visit with his oncologist since discharge, but the oncologist would not call in the prescription for the pain medication. He has an appointment with his primary care physician next week. The daughter is demanding that the PALTC provider renew her father’s prescription now. During this conversation, the daughter’s voice is raised, she interrupts the PALTC provider repeatedly, and she accuses the provider of “not caring.”How might you respond using NVC? Begin by considering what the daughter might be feeling and insert it into the phrase, “Are you feeling ... ?” Then consider her unmet need, and continue your statement with “Because you need ... ?” Please jot down your ideas before reading the continuation of this case on p.19.Try Nonviolent Communication: ContinuationFor the description of this case, see the text box on page 17.It is important to acknowledge how distressing these types of situations can be. When we are faced with someone’s anger — especially when it seems to be directed at us — it can be incredibly difficult to remain neutral. It can also be challenging to respond in a way that does not accept responsibility for the other person’s feelings but instead offers an empathic response to connect with the individual.Anger is indicative of a deeper pain and usually points to some kind of struggle. When people are “in struggle,” they will resort to habitual responses (think: fight–flight–freeze), and they may demand, blame, or criticize. When we are on the receiving end in situations like these, our own habitual communication patterns are likely to be triggered: we may argue, defend, or criticize in turn rather than listen deeply to what is alive in the other person and respond to those feelings and needs.As the PALTC provider in this scenario, if you choose to hear blame and criticism, you may respond similarly, which serves neither of you. You may feel angry, which could elicit a defensive response when you’re accused of not caring. You may also try to explain why the prescription must be renewed by the primary care physician. These responses are understandable, but none of them address the underlying feelings or needs of the daughter or yourself.Using NVC places the emphasis on identifying feelings, which are directly related to a need. Here are suggestions for how you could respond to the daughter using the NVC process: “Are you feeling ... ?”and “Because you need ... ?”•“Are you concerned (feeling) about your dad and need reassurance (need) that his pain will be addressed?”•“Are you angry (feeling) because you need to be understood (need)?”•“Are you upset (feeling) because you need more information (need)?”It’s not important that you get it “right.” The point is to make your best guess based on the situation and the information you have. Offer it in the form of a question, and see if your comment resonates with the daughter. If not, she’ll likely tell you! That’s great because then you have more information and can try again. The value in this exchange is the effort that you are making to connect with her, to hear her feelings and unmet need. Ultimately, the resolution may not be what she expects, but it is more likely that she will feel heard and validated, even if her demands cannot be met.If the daughter continues to criticize you and not demonstrate willingness to work together, you may choose to say something like, “Maria, when I hear you call me uncaring (observation), I am frustrated (upset, disturbed, uncomfortable) (feeling) because it’s important to me that I connect (need) with you in order to discuss your dad’s situation.” A daughter calls the post-acute and long-term care medical provider regarding her father, who was discharged from the facility a week ago. Upon discharge, along with his remaining medication prescribed in the facility, her father received a prescription for pain medication. The family did not fill the prescription, and it has now expired. Her father has had a follow-up visit with his oncologist since discharge, but the oncologist would not call in the prescription for the pain medication. He has an appointment with his primary care physician next week. The daughter is demanding that the PALTC provider renew her father’s prescription now. During this conversation, the daughter’s voice is raised, she interrupts the PALTC provider repeatedly, and she accuses the provider of “not caring.” How might you respond using NVC? Begin by considering what the daughter might be feeling and insert it into the phrase, “Are you feeling ... ?” Then consider her unmet need, and continue your statement with “Because you need ... ?” Please jot down your ideas before reading the continuation of this case on p.19. For the description of this case, see the text box on page 17. It is important to acknowledge how distressing these types of situations can be. When we are faced with someone’s anger — especially when it seems to be directed at us — it can be incredibly difficult to remain neutral. It can also be challenging to respond in a way that does not accept responsibility for the other person’s feelings but instead offers an empathic response to connect with the individual. Anger is indicative of a deeper pain and usually points to some kind of struggle. When people are “in struggle,” they will resort to habitual responses (think: fight–flight–freeze), and they may demand, blame, or criticize. When we are on the receiving end in situations like these, our own habitual communication patterns are likely to be triggered: we may argue, defend, or criticize in turn rather than listen deeply to what is alive in the other person and respond to those feelings and needs. As the PALTC provider in this scenario, if you choose to hear blame and criticism, you may respond similarly, which serves neither of you. You may feel angry, which could elicit a defensive response when you’re accused of not caring. You may also try to explain why the prescription must be renewed by the primary care physician. These responses are understandable, but none of them address the underlying feelings or needs of the daughter or yourself. Using NVC places the emphasis on identifying feelings, which are directly related to a need. Here are suggestions for how you could respond to the daughter using the NVC process: “Are you feeling ... ?”and “Because you need ... ?”•“Are you concerned (feeling) about your dad and need reassurance (need) that his pain will be addressed?”•“Are you angry (feeling) because you need to be understood (need)?”•“Are you upset (feeling) because you need more information (need)?” It’s not important that you get it “right.” The point is to make your best guess based on the situation and the information you have. Offer it in the form of a question, and see if your comment resonates with the daughter. If not, she’ll likely tell you! That’s great because then you have more information and can try again. The value in this exchange is the effort that you are making to connect with her, to hear her feelings and unmet need. Ultimately, the resolution may not be what she expects, but it is more likely that she will feel heard and validated, even if her demands cannot be met. If the daughter continues to criticize you and not demonstrate willingness to work together, you may choose to say something like, “Maria, when I hear you call me uncaring (observation), I am frustrated (upset, disturbed, uncomfortable) (feeling) because it’s important to me that I connect (need) with you in order to discuss your dad’s situation.”