Communication Problems

Communication refers to a process in which information is exchanged between people. This can be verbal, nonverbal, or a combination of the two.

Good communication:

• Helps people grow closer to each other.
• Helps people manage life’s challenges.
• Supports emotional self-regulation.
• Expresses feelings in a positive and respectful way.
• Involves respecting the rights of others to express themselves.
• Involves respecting your own right to express yourself.
• Includes both talking and listening.

Verbal communication is the use of words to convey a message, whether in writing, by phone, or in person.

Nonverbal communication, which happens in many ways, accounts for the majority of our communication. It includes anything other than words that conveys a message from one person to another. Examples of nonverbal communication include:

• Eye contact.
• Proximity, or how physically close you are to the person you are communicating with.
• Tone and volume of voice.
• Body posture.
• Facial expression.
• Gestures.

Sometimes, our nonverbal and verbal communication do not send the same message. This is sometimes called a mixed message. In this situation, the listener is more likely to believe the nonverbal message.

Styles of Communication

Westerntheories of communication recognizefour main styles, which demonstrate varying degrees of respect when people communicate with each other. Communication styles may vary depending on a person's cultural background.

• Aggressive communicators do not respect the rights of others.
  • They believe that the only important thing is what they want.
  • They are rude, demanding, and controlling.
  • They cause others to feel humiliated and hurt.
  • They are often seen as angry individuals.
• Passive communicators do not respect their own right to be heard.
  • They believe that others are always more important than them.
  • They allow others to make decisions for them.
  • They often feel anxious, helpless, and ignored, but do not express these feelings.
  • They have poor boundaries and can be seen as “weak.”
• Passive-aggressive communicators appear from the outside to passively accept the rights of others over their own. However, they assert their views in manipulative or deceitful ways and do not respect others’ right to be heard.
  • They manipulate others to get their way instead of being direct.
  • They consistently send mixed messages.
  • If they do not get their way, they will often make sarcastic comments, make others feel guilty, or try to get others to feel sorry for them.
• Assertive communicators respect both their own right to be heard and others’ right to be heard.
  • They make their own decisions and are clear, direct, and appropriate.
  • They are polite, open, and willing to compromise.
  • They value what others have to say.

Of the four styles, assertive communication is the healthiest. It is an empowering, peaceful way to approach communication.

We are always communicating, whether we are conscious of it or not. Our body language, eye contact, and choice of seating all communicate things to the people around us. However, healthy communication requires time and attention. People need to make a conscious choice to listen to, talk with, and spend time with each other in order to solve problems and have healthy relationships.

• Encourage your clients to use assertive communication to talk, listen, and respond to others. Help clients learn assertive communication skills by practicing with them during a session through Role Playing.
• Some clients may need help understanding that other people have a right to their own feelings and thoughts.

Personal and historical trauma influence communication. People often have difficulty talking about their trauma, and forcing them to talk about things that are difficult is not beneficial to them or the relationship.

When working with families, remember that each stage of childhood brings new challenges for both children and parents. See: Parenting for more information.

Children, in particular, learn how to communicate by watching others, especially their caregivers. If a child is having difficulty communicating:

• Evaluate the caregivers' communication skills to learn how the child learned to communicate.
• Consider the child’s living environment. Children are affected by their parents' lifestyles and what happens at home, even if they do not understand them.

Effective and assertive communication is one of the most important skills a healthy family can use. If a family has difficulty with communication, help them explore the factors that can impact communication in households.

• There might be different languages spoken in the home. Communication barriers may impact the family's communication.
• Empower your clients to use their native language and learn to communicate effectively in their preferred language.
• Children will be strongly affected by the quality and the amount of time they spend with parents and caregivers. Parents can help their children by listening to them with genuine interest and attention.
• The use of electronics can negatively impact communication if people are watching TV, using their phones, or on social media instead of communicating with those around them. Consider helping clients establish limits around screen time.

Communication problems may be a sign of larger problems or co-occuring condition. If you suspect any of the following, see the appropriate chapter:

• Abuse or neglect. See Chapter D-3: Abuse and Neglect.
• Learning or cognitive disorders. See Chapter D-11: Learning and Cognitive Disorders.
• Developmental disorders, see chapter D-12: Developmental Disorders.
• Substance use or abuse. See Chapter D-2: Substance Use and Abuse.
• Domestic violence in the household. See Chapter B-5: Mandatory Reporting and Duty to Warn.
• A medical condition that may affect the client's ability to hear or speak. Refer the client to a medical professional or local CHA/P.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history as it relates to his family situation or behavior patterns.

Treatment plan, including a history of presenting problem and recommended course of treatment.

Communication history for the client and culture.

Communication patterns

• Feels frustrated or angry when talking to the other
• Frequently yells or has explosive outbursts
• Interrupts others or frequently tries to control the conversation
• Is withdrawn
• Is unwilling to communicate
• Uses manipulation as the primary means of getting what they want (instead of asking directly)

Personal history

• Has a learning or cognitive disorder
• Has been diagnosed with an intellectual disability
• Has a developmental delay or intellectual disability
• Experienced significant or traumatic event(s)
• Recently moved or relocated

General concerns

• How would you describe your family’s communication style?
• Do you feel that you communicate respectfully?
• Do you feel that your family members listen to you?
• How do you usually feel when you talk to others? Do you feel frustrated or angry a lot of the time?
• Do you feel you can be honest with your family members?
• How much do you trust your family members?
• Are you ever afraid to talk to your family members?
• How much time do you spend with your parents or family members?
• Is there a recent change in the family or family roles?
• How well are you able to communicate with your spouse or significant other?
• Do you generally feel heard by your spouse or significant other?
• Do you let your spouse or significant other talk, and do you listen well?
• How do you think you could improve in your communication?
• What situations tend to leave you feeling misunderstood?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, you may consider developing skills like DBT-based Interpersonal Effectiveness. Assertiveness training and teaching clients how and when to use "I-Statements" can be very effective. Other strategies include helping clients enhance their self-esteem through goal setting and intentionally engaging in pro-social behaviors, encouraging journaling to help them organize and articulate their ideas, and practicing scripted role-plays in counseling sessions. This can seem awkward for the client (and provider, sometimes), but can be very helpful.

Family counseling can be helpful for families with communication problems. They can learn communication skills and practice them in a safe setting.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.