Module 2 – Communication, Active Listening and other soft skills needed to work with people with disabilities

Communication, Active Listening and other soft skills needed to work with people with disabilities

This module has the aim of giving clear definitions of specific terms related to communication abilities, such as active listening, self-care, empathy, etc., Additionally, the learner will able to bring these terms to practice and will be presented with a list of resources like practical examples, videos, etc.

The objective of this module is for the learner to further develop their communication skills and their empathy to be able to better approach people with disabilities.

The module is divided into a first theorical output explaining the main terms, practical exercises and some resources like examples, videos, questionnaires and bibliographical sources for the reader who would like to learn more on active listening, the humanistic approach, self-care and empathy.

Introduction

Many people with disabilities report having a hard time when trying to express their needs to others, apart from dealing with stereotypes and prejudice. One of the main obstacles they find both for social and for labour inclusion is an important lack of understanding of their personal situation from the rest of society. This lack of understanding, fuelled by prejudice and stereotypes, is the cause of many difficult interpersonal situations that people with disabilities have to go through and have a major role in the exclusion of many people from work or from other areas of social life. This module aims at giving the reader some useful communication tools to be able to get to a clearer and more exact understanding of the personality, skills and needs of the people they work with so that they are able to positively affect the person with disabilities’ way of life.

The term active listening was coined back in 1957 in an article by Carl Rogers (founder of Humanistic Psychology) and Dr Richard Farson. Though it is originally a key skill within face-to-face psychotherapy and counselling with the objective of gaining a deep understanding of what a person is trying to express to build a better person-centred relation towards them, it has since been used and misused many times within positive psychology and coaching as a kind of “method for everything” or it has been transferred from the care sector to the business sector with quite a different aim than improving a person’s quality of life.

Active listening can be generally described as “a basic communication skill which involves giving free and undivided attention to the speaker, understanding free attention as: ‘… placing all of one’s attention and awareness at the disposal of another person, listening with interest and appreciating without interrupting’” (Robertson, 2005).

In the following points we hope to give the reader a deeper and more complete definition of this skill, some practical examples and explain how it can effectively be used.

There are many important benefits of practicing active listening when talking face to face to a client, a familiar or a contact. These benefits affect both parties and not only the person that is speaking. The active listener will also experience a series of benefits regarding their relation to the other. The following list mentions some of the main advantages:

• Building of a relation of trust 
• Empowerment for the speaker to get to their own conclusions and solutions
• Materialisation of thought
• Enhancement of self-esteem through acceptance and non-judgement
• Validation of emotions
• Better understanding of the person
• Creating empathy
• Learning about the person

Until we can demonstrate a spirit which genuinely respects the potential worth of the individual, which considers his sights and trusts his capacity for sell-direction, we cannot begin to be effective listeners.

Carl R. Rogers and Richard E. Farson (1987)

In A Text Book of Family Medicine, McWhinney quotes the same author of the above defining active listening as “giving one’s total and undivided attention to the other person and telling the other that we are interested and concerned. Listening is difficult work that we will not undertake unless we have deep respect and care for the other… we listen not only with our ears, but with our eyes, mind, heart and imagination, as well. We listen to what is going on within ourselves, as well as to what is taking place in the person we are hearing. We listen to the words of the other, but we also listen to the messages buried in the words. We listen to the voice, the appearance, and the body language of the other… We simply try to absorb everything the speaker is saying verbally and nonverbally without adding, subtracting, or amending.

Active listening is more than just listening to someone in a passive way or paying attention to someone. It is a listening style that involves full concentration, attention, interest and curiosity towards another person as a living being and the message they are trying to transmit. The active listener does not only listen to what the person says, but is also mindful of what the person doesn’t say: what the person does, their movements, their tone of voice, their eyes, their body posture and, in general, the non-verbal part of their message.

Moreover, an active listener doesn’t just listen carefully to the other person. They also give some sort of constant feedback to the speaker as proof of listening. This feedback can take on a non-verbal form (eye contact, body posture, movements of the head) or a verbal form (saying “yes”, “I understand” or simply “Mm-hm”; or paraphrasing what the other person has said). For the person who is delivering the message, these signals are interpreted as symbols of recognition and validation and will reinforce the continuity of their information exchange.

In relation to the information received by the listener, it goes far beyond the direct spoken message. The active listener understands the speaker’s feelings and attitudes that are expressed within the direct verbal message and also delivers feedback on these facts (e.g. “I think that, when speaking about your plans, you sound frightened”).

As mentioned above, the active listener provides feedback in the form of small verbal and non-verbal signals and can also provide short summaries so that the speaker knows that they have been understood. For example, if someone explains that they have a conflict at work that they have no idea how to solve, delivering a full explanation, the active listener can answer with something like: “I understand you currently have a problem with your superior and your goal is to somehow solve it”. It is enough by showing understanding, acceptance and validation regarding the information received, without trying to give the other person advice or solutions.

The following sub-unit aims at describing the main steps to practice effective active listening when in any kind of formal or non-formal conversation. Also, a short list of attitudes and behaviours that must be avoided will be listed below. To finish, a short practical exercise can be carried out to put into use what has been explained up to now.

Generally speaking, when trying to answer the question of how we can practice active listening, we can start by listing a few key features. Imagine the last time someone listened to you, and you really felt understood. What was it that the other person did that made you feel this way?

When listening to someone in an active way, one has to bear in mind and display the following points:

• Let the person direct the conversation. Active listening is non-directive, so the speaker should in all case choose what to talk about and how. 
• Concentrate on the person who is speaking. Try to centre your attention on the person and leave all other topics on pause for now.
• Try to make eye contact with the person during the conversation.
• Be conscious of the non-verbal communication of the speaker. Watch them and ask yourself: what are they doing? How is their posture? Are they talking high or low? Is the person moving a lot or still? Are they making eye contact? Etc.
• Give small and continuous feedbacks (nod your head, answer “yes”, “ok”, “I understand” or “mm-hmm”).
• Paraphrase and summarize: give them a short summary of what has being said in your own words. If you have doubts (questions, things you haven’t understand), ask the person directly.
• If the person decides not to speak about something or stay silent, try to be respectful and patient. 
• Be mindful of your body posture: try to sit forward, directing your body towards the speaker. 
• Be mindful of your own judgements. We will always make judgements, no matter how hard we try not to. 
• Be mindful of your own feelings. How does the person make you feel? Are you uncomfortable? Are you feeling stressed listening? Do you feel identified? Be conscious of what is happening in your mind and your body during the conversation.
• Be sincere and ask questions. For example, if you believe the person likes being with a family member, don’t say “you love being with them”. Say “By listening to what you are saying, I have the impression that you appreciate being with them very much. Am I correct? Is this something important to you?”
• Be honest and authentic at all times with your own feelings and behaviour. 

Psychologist Carl Rogers is interviewing another person, enquiring about a current issue. The client is trying to explain the issue while Rogers displays an active listening attitude throughout the video.

• How would you define the attitude of an active listener?
• Which of the behaviours of active listening can you see in the video?

What is self-care?

According to the World Health Organisation self-care is defined as the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.

Küchenhoff (1999), agrees with this by defining the concept of self-care as the ability to consider own needs, to reduce stress, not to overtax oneself, to deal well with and to protect oneself. Self-care can therefore also be understood as the ability to recognise at an early stage a possible own (illness) process that endangers the maintenance of mental health and to recognise when demands become excessive.

The concept of self-care includes the aspects of mindfulness, empowerment, coping, resilience, and positive psychology. Küchenhoff (1999) goes on to say that self-care is linked to self-esteem and the ability to give loving attention to oneself. It is shaped by the most emotionally significant relationship experiences in one’s own life, which are strongly internalised, especially in early years, but also later .  In this way, how we care for ourselves becomes a mirror of the way we care for others.

Professionals who work with vulnerable populations are skilled to help clients in managing stress and responding to societal issues or dealing with anxiety in difficult life situations. Combined with frequently heavy caseloads and exposure to stories of traumatic experiences, stressful workplace climates, having concerns for safety, can make them vulnerable to stress. In their daily work they often ignore their own needs, neglecting to engage in habits that can help them maintain their physical and mental health, which may lead to emotional and energy depletion, which can affect the capability to actively problem-solve and impact the quality of service provision (Ohio University, 2020). Kate Jackson explains in Social Work Today (2014), that some of the obstacles standing in the way of self-care, are a lack of energy, too many responsibilities, and the fear of appearing weak or vulnerable.

These obstacles need to be overcome, not only for professionals, but for everyone who acts as a caregiver, as self-care is important and necessary for people for their own effectiveness and success in honouring their professional and personal commitments. The NASW Code of Ethics also requires social workers to take action if their work or the work of their colleagues could be adversely affected. The goal behind that is to make practicing self-care not just an idea but a professional and ethical obligation for professionals working in with vulnerable groups (Blackmon et al. 2020).

As mentioned, self-care can be defined as the ability to promote health, prevent disease, maintain health, and to cope with illness and disability. There are many suggestions, good practices and examples of things one can do to practice self-care and to enhance their own health or simply to improve their tolerance for problems that could always be present. Some are quite straightforward, such as regular physical activity, eating healthy, staying connected to people you love, reach out to people when you need support, etc. 

Another, less straightforward, but good example of a method to practice self-care is Mindfulness. Mindfulness was founded in 1979 by doctor Jon Kabat-Zinn in Massachusetts to treat chronically ill patients that didn’t respond positively to the traditional treatments used for their specific pathologies. Since then, it has been applied within different areas like psychotherapy, coaching or labour guidance, and applied to many issues ranging from psychological disorders, stress, decision-making, teambuilding or simply wellbeing. It can be defined as “a state of active, open attention to the present. This state is described as observing one’s thoughts and feelings without judging them as good or bad” (Psychology Today). The American Psychology Association defines mindfulness as “a psychological state of awareness, the practices that promote this awareness, a mode of processing information and a character trait” (American Psychology Association). Research has shown many advantages of using mindfulness on a regular basis, such as stress reduction, focus, boosts to working memory. Less emotional reactivity, etc. So why not give it a try?

When it comes down to self-care, it is important to realise that everyone needs to find out for themselves what it means to them, and what the best ways are for them to take care of themselves.

Now take a moment to think about your own self-care. What is it that you need in order to stay resilient for set-backs or to keep on giving to other people? Does it have a place in your life right now? If not, how do you think you could improve your self-care, and what keeps you from doing so?

When communicating with people with a disability of any kind, many people are confronted with doubts and insecurities regarding if they are doing something right or wrong. Some people continuously doubt if they are being offensive are creating misunderstanding because of not having enough knowledge regarding the persons issue, while other people are strongly guided by stereotypes and believe that there is a specific way of dealing with people with specific conditions. This problem not only affects people on an informal level, but many professionals from different areas like labour guidance, social work or counselling can experience this kind of difficulty, which can affect the relationship in a negative way.

The National Disability Coordination Officer Program of the Australian Government listed the following general tips to follow when communicating with people with disabilities:

• Relax – People with disability are just people
• Speak to people with disability as a person first
• Speak to adults with disability as adults 
• Don’t make assumptions about a person’s disability: e.g. don’t assume a person using a wheelchair is paralysed
• Don’t make assumptions about what a person with disability can or can’t do
• If a person has one disability don’t assume they have another e.g. don’t yell at a person who has a vision impairment; or e.g. don’t assume a person with a speech impairment has an intellectual disability.
• Ask before you help and respect a person’s right to refuse your help. People with a disability have their own way of doing things.
• Take the time to listen to people with a disability – you may learn a lot. If you can’t understand what a person is saying, don’t pretend – just ask them again.
• Always speak directly to the person with a disability. If the person is with a carer or interpreter do not direct your conversation at them.

Tips for communicating with people with learning disabilities

Use short, clear and direct sentences 

• Rephrase information if it is not understood, or present it differently 
• Consider using visual aids like diagrams or pictures 
• Always provide opportunity to answer any questions 

Tips for communicating with people with autism spectrum disorders 

• Avoid using humour, sarcasm, figures of speech or colloquialisms
• Use simple and short sentences and closed questions 
• Be aware that body language may not be understood 
• Use words that are flexible – “we may” NOT “we will” 

Tips for communicating with people with a physical disability 

• Do not shout, speak more slowly or over exaggerate 
• Make eye contact and speak directly to the person with a disability. Where possible, sit down to speak with a person using a wheelchair so that you are at the same eye level 
• Don’t hang onto a person’s wheelchair or tray – the chair is part of their personal space 
• If a person also has a speech impairment: 

1. Don’t assume they can’t understand your speech 
2. Be patient, don’t try to finish their sentences 
3. Ask questions that only require short answers 
4. Ask them to repeat themselves if you don’t understand 
5. Don’t pretend to understand 

Tips for communicating with people with chronic medical conditions

• Often you may not know a person has a medical condition and won’t need to communicate any differently 
• If a person is showing signs of distress or being unwell:  Remain calm and keep your voice tone unhurried  Ask the person if you can do anything to help  Help the person access support and tell them what you are doing

Tips for communicating with people with a mental illness 

• Often you may not even know a person has a mental illness and won’t need to communicate any differently 
• If a person is showing signs of agitation, anxiety, panic, fear, disorientation or aggressiveness: 

1.  Remain calm and keep your voice tone unhurried 
2.  Make time and allow the person to talk 
3.  Show empathy without necessarily agreeing with what is being said e.g. “I understand that you are feeling frightened by your experiences…” 
4.  Accept that hallucinations and delusions are real for the person with disability – but do not pretend they are real to you. 
5.  Use clearer, short sentences Help the person access support and tell them what you are doing 

Tips for communicating with people with an intellectual disability 

• Use your natural volume and tone and speak clearly using standard language 
• Check understanding by asking the person to repeat what you have said in their own words Rephrase information if it is not understood, or present it differently 
• Ask short questions to gather information 
• Make instructions clear and brief and try not to get frustrated if you have to repeat yourself 

Tips for communicating with people with vision impairment 

• Introduce yourself by name, even if you already know the person 
• Use your natural voice – don’t shout or over-exaggerate 
• Tell the person when you are leaving the room 
• Be specific with any verbal directions or instructions e.g. “slightly to your right” not “over there” 
• Don’t presume that the person can’t see anything – if appropriate it’s ok to ask them what they can see 
• Don’t be embarrassed if you use phrases like “see you later” or “did you see…” 
• Don’t pat a guide dog in its harness as you may distract it from working 

Tips for communicating with people with hearing impairment 

• Place yourself where they can see you to gain attention, or lightly touch their shoulder 
• Position yourself to ensure maximum light on your face 
• Always face the person – do not turn away or cover your mouth 
• Don’t provide unnecessary detail – keep sentences short 
• If necessary, use a pen and paper to communicate 
• Be flexible – if a person doesn’t understand something you say, reword it instead of repeating it 
• Don’t be embarrassed if you use phrases like “did you hear about…”

Nonverbal communication (from now on NVC), also known as body language refers to the ways in which beings convey information about their emotions, needs, intentions, attitudes, and thoughts without the use of verbal language (Hall, 2001). It can also be understood simply by the process of sending messaged to other people without only the use of words.

There are many kinds of NVC, like facial expressions (of anger, happiness, sadness, etc) movements (the way you stand, the speed of your walk), gestures (like moving your hands when explaining something), eye contact (communicating trust or even hostility), touch (for example, a hand shake), space (standing closer or further away from someone) and tone of voice (as we saw in our point on active listening: what we say, what we don’t say and our way of saying it means everything).

It is popularly said that 93% of our communication is non-verbal. Even if this information remains untrue and is said due to data misinterpretation, it remains clear that a huge part of the information transmitted and received by others is non-verbal, part of which remains unconscious. As necessary as NVC is, it is also a form of communication that can easily lead to confusions and misinterpretations.

Assertiveness means to communicate and express our thoughts, feelings and opinions in an open, clear and direct way to others, without disrespecting the way they feel. Assertive communication can be very helpful to reduce conflicts, manage our own emotions, meet our own needs and have more positive relationships with friends, family or co-workers.

Assertive communication is a style that can keep us more connected to others through communication and is one of the key points to the creation of a respectful environment. This is the main reason assertive communication could be so important in a diverse environment where different personalities from different backgrounds find themselves and come together.

The University of Kentucky states the following behaviours of assertive communication:

Assertive communicators will

• state needs and wants clearly, appropriately, and respectfully
• express feelings clearly, appropriately, and respectfully
• use “I” statements
• communicate respect for other
• listen well without interrupting
• feel in control of self
• have good eye contact
• speak in a calm and clear tone of voice
• have a relaxed body posture
• feel connected to others
• feel competent and in control
• not allow others to abuse or manipulate them
• stand up for their rights

In this Module, we have explored active listening as an interpersonal tool, talked about self-care and its relevance and mentioned some main communication strategies. Active listening is highly functional communication skill that can create observable effects on someone, including their emotional expression, their self-esteem, their trust in themselves or others; self-care means to consider one’s own needs, to reduce stress, to deal well with issues and to protect oneself; assertive communication means to express oneself in a open and clear way while respecting other people’s rights. These three key skills are considered tools that can be used to build better healthier relationships with other people and, in this way, enhance one’s social life through the improvement of one’s empathy and communication skills. Regarding people with disabilities and people that usually have contact with them, like professionals or family members, enhancing these skills could improve their empathy, their understanding, their quality of life and their ability to communicate with others.

A step-to-step guide on how to practice active listening (Lifehack)

The video gives a short and clear description of the main points of practicing active listening formally and non-formally

Active Listening”, by Carl. R. Rogers and Richard E. Farson

An elaborate text on active listening written by two important authors on the matter. It gives a more in depth definition and analysis of active listening, for those who would like to learn more.

What do we mean by self-care?

A short description of self-care by the World Health Organization

Taking Care: A short guide on self-care

Read this article on how to improve self-care. What do you already do to care for yourself? Which of the strategies mentioned would you consider applying for yourself?