Training Report: Nonverbal Communication
Mary Phelps, Case Manager

Communication-- Just a word meaning "a need of human existence that can be defined as the transfer or exchange of information between entities; the art of being able to structure or transmit a message in a way that another can understand." Wow! Place that in a box relating with Baddour Center residents, families, staff, supporters, and the general public! This was the topic of our first quarter inservice, Communicating With Residents Who Have Limited Verbal Skills, led by Manager of Alternative Vocational Services Beth Crowell. Although we were focusing on communicating with our residents, I viewed the inservice through the eyes of a 42-year-old mother, wife, daughter, sister, niece, best friend, and social worker. I found applications to all of those life roles.

After attending the inservice, I found myself pondering all of the styles of communication I must exhibit in my everyday life. Whoever said, "just be yourself" must live in a cave. You have to also match your style to the needs of your communication partner. We have many forms of communication from which to choose. Verbally, we can select oral or written formats. Nonverbally, we communicate through our facial expressions, behaviors, and body language. Those non-verbal forms of communication are actually far more powerful than verbal styles.



Staff evaluation results indicated this training program to be excellent! Median ratings in all categories were "4," our highest score. Comments included phrases such as, "this really applies to my relationships with the residents," and "this session made me stop and think about how I spend my time." 53% of staff members indicated they'd like to learn more on this topic. Recommendations for future sessions included using role play sessions and im-proving communication between staff and departments.

Think about it; how often do we say things we don't really mean? The nonverbal cues allow the listener to tell we are kidding, being sarcastic, or just plain lying!

The purpose of the inservice was to improve our ability to communicate with residents whose verbal skills are less defined. Much of the work I do is with residents who live in the apartments and transitional homes. On the surface, this inservice might appear to apply less to me than to some of the case managers who work with residents who live and work in the pre-vocational homes and work areas. Actually, though, with one or two exceptions, all of the residents I work with have communication deficits. Even if they are highly articulate, when something is troubling them they often seem to shut down and I have to work extremely hard to extract the pertinent information from them. It is not at all unlike trying to communicate with my children. I have many stories about those trials and tribulations; they are both comical and difficult. My son is a talk-a-holic; when something is troubling him, he becomes quiet as a church mouse and vigorously rubs the nape of his neck. My daughter talks less than my son in daily life, but she never reserves an opinion. When something bothers her she raises her voice and expells a harsh tone that would intimidate Satan himself! If I just stuck to my preferred form of communication when my kids were upset, I'd probably hurt my son's feelings and engage my daughter in battle. I have to respond to their needs, individually, just like I have to respond to the needs of the residents as individuals. I feel so fortunate to work in a situation that helps me develop these skills.

When I first began working at The Baddour Center, I worked with a few less verbal residents. Behaviors such as refusing chores, work, meals, etc., would surface when they could not express how they were feeling. My job was to look past the behavior to see what was driving it. Many times, they just needed someone to listen, care, and give feedback. Giving feedback can be a tricky deal. It involves clarifying -- re-stating what the person is telling you (verbally or nonverbally) so that you both know you are understanding one another. It also includes interpreting your observations. Is their behavior out of sync with their normal routine? We must beware of passing our own judgements, too. If our feedback consists of offering advice, we must ensure that we know the person and their situation well enough. Otherwise, it might look like criticism rather than assistance. Sometimes it is hard to tell whether your personal opinion should be entered into the equation. The person has to be ready to hear it and you have to be ready for their reaction to it.

Communication Barriers

Although the information from this inservice could be applied to communicating with anyone, there are particular barriers we should watch out for when dealing with our residents. For example, we must be careful to choose the right type of communication. They don't always tell us when we are using words they don't under-stand. We have to watch for other cues. Also, The Baddour Center residents come from all around the country, with different family back-grounds. There are cultural differences among us, and that can cause misunderstanding some-times. Language differences exist, too. People with less developed verbal skills, for example, may still spend a great deal of time talking. It is up to us to learn to understand that "whe' chi?" means "where is Melissa today?"

One big avoidable barrier is disinterest. Staff members are busy, and often times residents have predictable repertoires of conversation. We are guilty of "going through the motions" without paying much attention. We should be careful of this, though, because today may be the day that you miss the chance to hear something important. On a related note, we are often communicating with one another without having all of the information we need. We should get all sides of a story before jumping to any conclusions. On the flip side, we often assume everyone in the conversation has all the information they need. With the residents, we either think they've heard it elsewhere, they've absorbed it just by being here, or that the reasons for our actions and decisions are too complex to explain. Lack of information, though, can really cripple communication and lead to problems we don't want. This is related to another communication barrier -- fear. We are sometimes afraid to know what has happened so we just don't try to find out. If someone has a problem you're afraid to deal with, though, imagine how they feel!

Unfortunately, sometimes residents don't communicate important things about their lives be-cause they don't fully trust us. The best thing a communication partner can do is create a sense of safety and trust. We can do this by monitoring our nonverbal communication skills. We generally start with eye contact, but you have to know about the resident's use of eye contact as well. Some people will let you know that there is a problem by not making eye contact. Others have difficulty with eye contact in general, so that is not a good way to judge their needs. We can also create trust by standing at the appropriate distance for the occasion. When upset, some people don't like to be crowded. Others want the sense of intimacy that comes from being close. Likewise, we choose to touch or not to touch. For an angry person, being touched might be the trigger for aggression. For a sad person, a hug might be just the thing! However, you also have to know about the person's general preferences. Some of us are very big huggers and others are stand-offish. Watching for differences in this can often signal that something is up. Finally, we can create trust by showing good listening skills; leaning toward the person who is speaking, nodding to indicate you are still listening; supplementing your words with gestures; maintaining an open and positive facial expression; and speaking in a warm and accepting tone.

As a last note, the presentation ended with several quotes from our staff experts -- those who interact with residents everyday. My favorite was from Goodworks Complex II Supervisor Paula May, "Stop, listen. You are the one the person has chosen to trust and talk to, because you might be the one to hear them. The person might not tell it to everyone else, and they might not come back again." This statement is so true. They might not have chosen us because we are their case manager, DSP, or nurse; it might be because they know we care about them.

Thanks to Beth Crowell for some wonderful and helpful information to help and improve the lives of the residents we serve, as well as our own!