Make It Work: Handling a Hard Conversation One of the toughest things we clinicians do is break bad news to clients. These tips can help ease the pain—for you and for them. Make It Work
Make It Work  |   June 01, 2013
Make It Work: Handling a Hard Conversation
Author Notes
  • Judy Stone-Goldman, PhD, CCC-SLP a senior lecturer emeritus with the Department of Speech and Hearing Sciences at the University of Washington, is also a licensed mental health counselor who coaches professionals. This column is adapted from posts on her blog, "The Reflective Writer" (
Article Information
Normal Language Processing / Make It Work
Make It Work   |   June 01, 2013
Make It Work: Handling a Hard Conversation
The ASHA Leader, June 2013, Vol. 18, 26-27. doi:10.1044/leader.MIW.18062013.26
The ASHA Leader, June 2013, Vol. 18, 26-27. doi:10.1044/leader.MIW.18062013.26
Sarah has been feeling nervous all morning. She is scheduled to meet with parents of a young child recently evaluated for speech and language delays. She worries that the conference will be difficult, that her information will be painful for the family to hear. The parents were so optimistic about their child's development at the intake. Surely the results of a significant delay will be a shock to them. Will they respond with guilt about what they "should" have been doing as parents or with fear that their child won't be successful in school? What if their sudden emotions translate into anger, distrust or denial? Sarah rehearses in her mind what to say, but nothing seems right. She remembers with unease another recent conference that was tense and dissatisfying. It shook her confidence and left her uncomfortable and irritable.
Our work as speech-language pathologists and audiologists requires us to communicate with families who are grappling with life-changing news, ongoing stressors and hard realities. How do we prepare ourselves for potentially challenging conversations so that we can best serve our clients?
We often gear up for a difficult conversation by trying to figure out what to say. We imagine that if we prepare the right words ahead of time, we will be better able to provide support and avoid conflict. But as useful as well-chosen words can be, those words are not the place to begin our preparation. Rather, we should start by examining ourselves.
We need to examine what we are bringing to the conversation because our emotional and mental states will affect its mood, direction and meaning. We want to reduce the likelihood of hindering the communication with our own ego, fears or impatience, as well as to increase the chances of bringing an authentic "best self" to the interaction.
One of the best ways to prepare is to ask ourselves questions and reflect on our responses. Through this process (aided by writing out our responses), we can explore possible issues before they catch us by surprise in a conference.
  • What makes you fearful or nervous about this conversation? What are you most worried about?

  • What personal issues or memories are evoked as you anticipate this conversation?

  • What "hot topics" or loaded comments come to mind around this conversation?

  • When have you handled a difficult conversation well? Poorly? How might your attitude, affect or behavior have played a role in these circumstances?

  • What would you most like to happen in this upcoming conversation? What might you do that would contribute to this happening? What might you do that would impede it?

We ask ourselves questions to uncover our feelings, beliefs and associations toward the anticipated exchange. We remember experiences that we can draw upon for encouragement and caution. As we do this, we firm up our boundaries, becoming clear on our own concerns and feelings, separate from those of the family. We identify what we have to offer the family and how we may help. We become alert to our strengths as well as our vulnerabilities.
Once we have done our "inner homework" to increase our awareness of ourselves, we may wish to think through or rehearse possible conversations. The goal is not to create an exact script but to explore different ways the interaction may unfold. Every different turn in the conversation offers us a chance for more readiness-both to offer appropriate help to the client and to stay alert to our own reactions and attitudes.
Of course, even with the best preparation we may still be surprised by emotion, discomfort or insecurity during the conversation itself. Here are tips to keep in mind for difficult or destabilizing moments:
  • Breathe and observe your body language. Lower your shoulders and uncross your arms! If you notice anxious thoughts, breathe more deeply.

  • Listen with respect and patience. Strive to understand, to appreciate what the client is going through, and to find something to connect with for further discussion.

  • Know that the client's emotional experience may feel uncomfortable to you. Instead of trying to escape (through excess words or cutting yourself off emotionally), sit still and imagine the emotions are a wave that will flow over you safely. The wave does not have to knock you over.

  • Remember that when people are distressed, information is of less use than quiet support. Your tone of voice, calm presence and emotional availability are key. Do not deny information if it is requested—some people find it a comfort even if they don't remember it—but offer it gently and simply. Avoid persuading, convincing or arguing, which will only block connection and resolution.

  • Be willing to acknowledge incompletes, to yourself and the family. "I imagine we are not done with this conversation" or "This has been a good first step. I know there is more to come."

When we quiet our own anxieties through reflective preparation, we remember that most situations are imperfect, and that even uncomfortable exchanges hold positive potential. We then are better prepared to listen to the client without trying to impose our agenda or push away uncomfortable feelings. Finally, keep in mind that any conversation is but one slice in the client's experience. We may never know its impact or what comes after. Our job is to make this conversation the best it can be, and to trust its place in an evolving life story.
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June 2013
Volume 18, Issue 6