1. The Use of Self as a Guide toThe Use of Self as a Guide to
Sensitive and CompassionateSensitive and Compassionate
CommunicationCommunication
Eva MatussekEva Matussek
Chartered Counselling PsychologistChartered Counselling Psychologist
Lelanie SmookLelanie Smook
Counselling Psychologist in TrainingCounselling Psychologist in Training
Clinical Health Psychology DepartmentClinical Health Psychology Department
Cross Street Health CentreCross Street Health Centre
DudleyDudley

2. What we plan to discuss todayWhat we plan to discuss today
• Ideas about compassionIdeas about compassion
• The role of active listeningThe role of active listening
• Stress and how it affects compassionStress and how it affects compassion
• The role of self awarenessThe role of self awareness
• Mindfulness as a tool to practiceMindfulness as a tool to practice
compassion towards self and otherscompassion towards self and others

3. • What is compassion?What is compassion?
• Why is compassion important in healthcare?Why is compassion important in healthcare?
• Can it affect your interactions with patients andCan it affect your interactions with patients and
the outcome of treatment?the outcome of treatment?
• What happens to patients when there isWhat happens to patients when there is
“compassion fatigue”“compassion fatigue”
• How can compassion towards yourself influenceHow can compassion towards yourself influence
your behaviour towards patients?your behaviour towards patients?

4. How do we listenHow do we listen
Lelanie SmookLelanie Smook
Counselling Psychologist in TrainingCounselling Psychologist in Training

5. Aims for this presentationAims for this presentation
• Client process in illnessClient process in illness
• How they receive informationHow they receive information
• How do we react and respond to supportHow do we react and respond to support
clientsclients
• Awareness of our roles in illnessAwareness of our roles in illness
information sharinginformation sharing

6. Word associationsWord associations
• SickSick
• IllIll
• CureCure
• DiagnosisDiagnosis
• PatientPatient

7. Role of diagnosisRole of diagnosis
Diagnosis
Self
Medical
Close relationships

8. ExpectationsExpectations
• What does a diagnosis imply?What does a diagnosis imply?
• Role of medical professionalsRole of medical professionals
• Stages of illness:Stages of illness: crisiscrisis
stabilizationstabilization
resolutionresolution
integrationintegration

9. MessagesMessages
• Receiving diagnosis (crisis/onset)Receiving diagnosis (crisis/onset)

10. ExerciseExercise
• Role play: client and doctorRole play: client and doctor
• FeedbackFeedback

11. How do we respond?How do we respond?
• Client: reject or defend self: rigid responseClient: reject or defend self: rigid response
• Medical professional: healer vs. enemyMedical professional: healer vs. enemy
• EpocheEpoche

12. Active listeningActive listening
• ““Tell me what to doTell me what to do
you are the expert”you are the expert”
Desperate client
Making decisions
Give advice
Encourage

13. What does listening mean?What does listening mean?
• Invest in person’s experienceInvest in person’s experience
• Hold own ideas and interpretationsHold own ideas and interpretations
• ‘You can learn to be a better listener, but
learning it is not like learning a skill that is added
to what we know. It is a peeling away of things
that interfere with listening, our preoccupations,
our fear, of how we might respond to what we
hear’.

14. Reflections on listeningReflections on listening
• What interferes with good listening?What interferes with good listening?

15. What happens when we or ourWhat happens when we or our
patients get stressed?patients get stressed?
STRESS-STRESS-
The Mind – BodyThe Mind – Body
InteractionInteraction

16. What happens in the brain when we get stressed?What happens in the brain when we get stressed?

17. • When a patient receives bad news (or no news!)When a patient receives bad news (or no news!)
or is due to have an operation, threat systemsor is due to have an operation, threat systems
activated.activated.
• Natural, evolved, human state.Natural, evolved, human state.
• However, unable to think or communicate clearlyHowever, unable to think or communicate clearly
at this point.at this point.
• The patient will attempt to use behaviours thatThe patient will attempt to use behaviours that
normally help them regulate their affectnormally help them regulate their affect

18. When met with threat based behaviour (patient’sWhen met with threat based behaviour (patient’s
expression of anger or fear in reaction to difficultexpression of anger or fear in reaction to difficult
medical news), we find also it harder to thinkmedical news), we find also it harder to think
clearly,clearly,
so we react instinctively to the “threat” of an angryso we react instinctively to the “threat” of an angry
or anxious patient with threat based behaviouror anxious patient with threat based behaviour
(“telling patients off” to deal with our own(“telling patients off” to deal with our own
frustration at them not listening to us!)frustration at them not listening to us!)

19. • To prevent these difficult situations fromTo prevent these difficult situations from
escalating it is important that we treatescalating it is important that we treat
both ourselves and the patient withboth ourselves and the patient with
compassion.compassion.
• But how?But how?

20. Awareness!Awareness!
• Awareness of our reactions to others:Awareness of our reactions to others:
We have “Mirror Neurons”We have “Mirror Neurons”
• Awareness of self – MindfulnessAwareness of self – Mindfulness

21. MindfulnessMindfulness
• What is itWhat is it
• What is it notWhat is it not
• Why is it importantWhy is it important
• What it does to our bodies/minds/arousalWhat it does to our bodies/minds/arousal
levelslevels
• A quick mindfulness exerciseA quick mindfulness exercise

22. “Window ofWindow of
Tolerance”Tolerance”
Moderate,Moderate,
regulatedregulated
arousalarousal
Flat affect, numb, “feel dead”, cognitivelyFlat affect, numb, “feel dead”, cognitively
dissociated/slowed/disabled, submissive responsesdissociated/slowed/disabled, submissive responses
Disabled defensesDisabled defenses
Hypoarousal: CollapseHypoarousal: Collapse
Sympathetic ArousalSympathetic Arousal
Hyperarousal:Hyperarousal:
Emotionally reactive, impulsive,Emotionally reactive, impulsive,
hypervigilant,hypervigilant,
hyperdefensive, intrusivehyperdefensive, intrusive
images and affects,images and affects,
obsessive or racing thoughtsobsessive or racing thoughts

23. Mindfulness as a way of practicingMindfulness as a way of practicing
loving-kindnessloving-kindness
• How to put this into practice – find ways ofHow to put this into practice – find ways of
getting within “window of tolerance”getting within “window of tolerance”
• Some examples: “Un-mirroring”, awareness ofSome examples: “Un-mirroring”, awareness of
own thoughts, emotions, physiology, behaviourown thoughts, emotions, physiology, behaviour

24. Be your ideal carer!Be your ideal carer!
• Imagine a person with following qualities:Imagine a person with following qualities:
WisdomWisdom
StrengthStrength
WarmthWarmth
ResponsibilityResponsibility
• When were you treated this way? How did itWhen were you treated this way? How did it
feel?feel?
• When did you want to offer help and support?When did you want to offer help and support?
How did that feel?How did that feel?

25. Why compassion?Why compassion?
• Kindness to self and othersKindness to self and others
• We are here, not always a choice in whatWe are here, not always a choice in what
happenshappens
• Understanding and acceptanceUnderstanding and acceptance
• Small daily practiceSmall daily practice

26. Questions or comments?Questions or comments?
• What will you take away from today’s workshop?What will you take away from today’s workshop?
• Feedback questionnairesFeedback questionnaires
• How to contact us:How to contact us:
Clinical Health PsychologyClinical Health Psychology
Cross Street Health CentreCross Street Health Centre
Cross StreetCross Street
DudleyDudley
DY1 1RNDY1 1RN
Tel: 01384 366 249Tel: 01384 366 249
Email Eva: eva.matussek@bcpft.nhs.ukEmail Eva: eva.matussek@bcpft.nhs.uk
Email Lelanie: lelanie.smook@bcpft.nhs.ukEmail Lelanie: lelanie.smook@bcpft.nhs.uk

27. ReferencesReferences
• Degrees of active listening retrieved fromDegrees of active listening retrieved from
http://upload.wikimedia.org/wikipedia/commons/thumb/8/82/Active-http://upload.wikimedia.org/wikipedia/commons/thumb/8/82/Active-
listening-chart.png/400px-Active-listening-chart.pnglistening-chart.png/400px-Active-listening-chart.png
• Diagrams developed using principles of sensorimotorDiagrams developed using principles of sensorimotor
psychotherapy: www.sensorimotorpsychotherapy.orgpsychotherapy: www.sensorimotorpsychotherapy.org
• Gilbert, P. (2010). An introduction to the Theory and Practice ofGilbert, P. (2010). An introduction to the Theory and Practice of
Compassion Focused Therapy and Compassionate Mind TrainingCompassion Focused Therapy and Compassionate Mind Training
for Shame Based Difficulties retrieved fromfor Shame Based Difficulties retrieved from
www.compassionatemind.co.ukwww.compassionatemind.co.uk
• Rogers, C.R. and Farson, R.E. (1987). Active listening. In R.G.Rogers, C.R. and Farson, R.E. (1987). Active listening. In R.G.
Newman, M.A. Danzinger and M. Cohen (Eds). Communicating inNewman, M.A. Danzinger and M. Cohen (Eds). Communicating in
Business Today. Lexington, USA: D.C. Heath.Business Today. Lexington, USA: D.C. Heath.
• Robertson, K. (2005). Active listening. More than just payingRobertson, K. (2005). Active listening. More than just paying
attention.attention. Australian family physicianAustralian family physician , Vol. 34 No. 12, 1053-1055., Vol. 34 No. 12, 1053-1055.