‘‘Difficult conversations’ and their value in a psychologically informed environment’…

12.06.2020: As I write this week’s PIE blog as the Lead for Psychologically Informed Environments (PIE) at the UK national youth homeless charity; Centrepoint, I have been reflecting on some of the conversations that I have had across the organisation. This has felt somewhat like a week of difficult conversations, not just those that I have had, but those I have also been hearing about from others. However, as the American columnist Jeanne Phillips has previously remarked; “sometimes the most important conversations are the most difficult to engage in”. Therefore, if a conversation feels like it might be difficult, because it causes discomfort in us when we are talking to another person, this might actually be an indication of the value or need to have that conversation in order to improve a situation, build a relationship or offer support to another.

A ‘difficult conversation’ is any situation where the needs, wants, opinions or perceptions of the those involved are diverse or opposing, and therefore strong emotions may be elicited from the parties involved. Sometimes the reason behind the strong feelings are because the parties involved feel that they have a lot at stake and may fear the consequences of raising issues or concerns (e.g. resulting conflict, being targeted or being ostracised). Sometimes the conversation might also be difficult because of our previous experience of speaking with that person or others in a similar position, or because of already pre-existing difficulties within our relationship with them.

However, being able to have difficult conversations is part of how we manage relationships with others and is therefore a critical part of creating a psychologically informed environment or PIE within homeless services. Specifically, Keats et al (2012) note in their PIE Good Practice Guide (c.f. https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf); “a focus on managing relationships is perhaps at the heart of what makes a psychologically informed environment different” (p.24). Moreover, “in this model, relationships are seen as a principal tool for change, and every interaction between staff and clients is an opportunity for development and learning” (p.24), whether that be a positive or a more difficult conversation. Because of the powerful nature of relationships in a PIE, it therefore follows that difficult conversations are usually less difficult when they occur within the context of pre-existing or supportive relationships.

Consequently, what do psychologists note as helpful when having ‘difficult conversations’? Of course, forming and developing the relationship within which the difficult conversation will be held is critical, and therefore such person centred approaches such as Rogers (1959) give us some pointers. Specifically, when we engage with another person, it is vital to do this in a constructive and empathic manner, using active listening skills, remaining in as non-judgemental stance as possible and offering unconditional positive regard towards the other person. We may not agree with their perspective or opinion, but respecting them as an individual albeit with a differing view, helps form the relationship in which to have a meaningful, if difficult, conversation. Remaining calm or in a ‘wise mind’ set (c.f. Linehan, 2015) is also important, so ‘picking the moment’ of where and when to raise the conversation needs careful thought. Considering what you want to say or how you might say it beforehand is therefore helpful, and thinking about how to remain calm, even if the other person is not, can be valuable preparation.

One thing that I have also learnt after years of working in highly volatile forensic settings, where I often had to deliver unwanted or ‘bad’ news, or have difficult conversations about issues of risk with clients, is to ‘actively listen’ to the other person’s response and validate any emotional response they may be experiencing. For example, it can be very de-escalating to someone who is angry to have his or her frustrations acknowledged rather than them simply being asked to ‘calm down’. Of note, I often found that when I really listened and ‘heard’ the other person, sometimes slowing down the emotional salience of the conversation by reflecting back to them what I had heard them say before formulating my response, resulted in them being more likely to reciprocate and listen to me! In addition, seeking clarification and remaining curious to the perspective of the other person, whilst keeping in mind a ‘solution focused’ (c.f. Pichot & Dolan, 2003) rather than ‘blaming’ approach to the conversation, can allow a difficult conversation to move towards a more positive, hopefully shared solution, learning or outcome. Moreover, sticking to facts and owning their personal impact upon us (e.g. ‘I think’ or ‘I feel’ because of X or Y) can be less confrontational than statements such as ‘you make me feel’, which can increase the other person’s level of defensiveness and reduce their willingness to engage because of guilt or shame. Finally, being aware of our body language is important especially if deescalating strong emotions in the other person (e.g. taking a non-confrontational stance) as well as noticing the other person’s body language (e.g. if they are disengaging, perhaps this isn’t the right time for the discussion?).

Reflecting on the importance of ‘difficult conversations’ has also felt timely as the protests supporting the #BlackLivesMatter movement have continued this week. I am aware of how challenging and emotionally difficult these period has been for some of our staff, but also for some of the homeless young people that we support, who are from a Black, Asian and Minority Ethnic (BAME) background. For the latter, sometimes this has resulted in them joining the protests in our UK cities, with the associated risk from COVID-19 or has manifest in them experiencing negative emotional responses or displaying challenging behaviours as they struggle to articulate their feelings triggered by past traumatic memories of racism. In addition, as an individual from a White background, this week has been challenging at times for me to examine my privilege and to think about how best to respond or to push for action, as well as leading me to have difficult conversations with friends, family, my children or my colleagues about this issue.

However, as Cardemil & Battle (2003) note, it is vitally important to have these conversations about racism because being willing to engage with others on this topic, or just ‘put it on the table’ for the future, with those of a different background to ourselves can build relationships and promote ‘an environment of trust and understanding’ (p.278). I would argue that this is particularly important within our organisation between staff as well as between our staff and the homeless young people we support, in order to build therapeutic engagement and ‘hear their voice’ (especially as they may not have been heard before). Sometimes we can feel we do not know how to initiate these conversations or are reluctant because we feel anxious or we are concerned that we might say something ‘wrong’ or unintentionally offensive, so avoiding the subject is easier.

Of course, whilst we must always respect an individual’s wish not to talk about their experiences of racism, as they may be too painful or not be appropriate in that moment, we must also be willing to shine a light on this issue and create the spaces for these conversations to occur, maybe for the first time. For example, I can recall working with one Black man in a previous NHS Mental Health Service role, and asking him about his background and his experiences of growing up in Brixton, South London following the 1980s riots. It was interesting that he admitted to me that I was the first person that had asked him about this, and the significant impact these events had had on his life such as the subsequent development of mental health issues such as a paranoia, low mood and anxiety. This cultural context not only informed our psychological formulation of his mental health issues and shaped our subsequent intervention, but it also was helpful in building our therapeutic rapport.

Thus, as with any ‘difficult conversation’, conversations about racism are effected by the relationship we have with the other person, and it is critical to be sensitive to this. Whilst there are no ‘rules’ as to how to have the conversation, Carfemil & Battle (2003) have noted some useful pointers, including the importance of suspending our preconceptions or assumptions about the other person’s ethnicity and that of their family, as this may not be obvious (and if we are not sure, why not ask the other person how they define themselves?). They also note that asking more generally about another person’s background can lead to many valuable conversations not just about race, but also religion, culture, class or language that can be an opportunity for our own personal learning and growth as well as building a relationship with them.

Carfemil & Battle (2003) also highlight that racial groups are not homogenous, as income, class and gender can intersect with race to create an individual’s unique experience and the development of their identity. They note that in having these conversations, we might not always ‘get it right’, but acknowledging this, reflecting on and modifying our approach as well as embracing the other person’s experiences as valid is a good place to start. In addition, Sue (1990) also notes the importance of being aware of different communication styles, particularly non-verbal cues such as posture, gesture, facial expression, tone of voice and personal space, which can all vary between cultures and lead to miscommunication if not considered. For example, is the person avoiding eye contact because they are shy or because this is a mark of respect, and is another person presenting as angry or just speaking and gesticulating in a more animated manner than what we might do?

Finally, in order to have meaningful conversations about race, even if difficult, it remains important that we educate ourselves if we are not from a BAME background (e.g. http://www.ywcahbg.org/sites/default/files/manager/10%20Things%20Allies%20Can%20Do.pdf), and not to rely on our BAME colleagues to educate us unless they want to (c.f. https://www.theguardian.com/world/2017/may/30/why-im-no-longer-talking-to-white-people-about-race). Those of us from a White background need to take responsibility for our own understanding, so that we are better placed to have those conversations with our friends, colleagues or the homeless young people that we support. Luckily, there are plenty of resources available for this purpose (e.g. https://padlet.com/nicolethelibrarian/nbasekqoazt336co / https://nmaahc.si.edu/learn/talking-about-race), including books, TED talks and television programmes (e.g. https://parade.com/1046031/breabaker/anti-racist-tv-movies-documentaries-ted-talks-books/amp/?__twitter_impression=true). I was personally quite effected this week watching the documentary ‘13th’ on Netflix, about the role of the criminal justice system in the USA (and to a lessor but still significant degree in the UK) in perpetuating the inequality and ‘enslavement’ of those from a BAME background even up to the present day. Moreover, there are also resources that we can utilise with the homeless young people in our services (as well as our own children) on racism and inequality (e.g. https://www.commonsense.org/education/articles/social-and-cultural-literacy-resources-for-classrooms) as well as to support them to engage in online activism if protesting in person is currently not an option or too risky (e.g. https://www.digitalcivicstoolkit.org/).

In conclusion then, ‘difficult conversations’ on any topic with our colleagues or the homeless young people we support are by their nature challenging and we need to manage our expectations about how successful they might be. However, even if they do not go ‘perfectly’, our willingness to engage in them rather than avoid them can aid the development of relationships, crucial in any psychologically informed environment, and gives space for understanding and solutions to develop. Moreover, difficult conversations are an inevitable part of life, which we need to manage, reflect on and move forward. If we don’t have these difficult conversations, issues are left unaddressed, voices are silenced and positive change in the future is stifled…