Communication Is More Than Just The Words Coming Out Of Your Mouth
Communication is more than just the words coming out of your mouth
By David W. Hart, Ph.D.
Most of us think about communication as a process of sending verbal messages back and forth, between two individuals or groups of people. Generally the information we share is semantic (facts and figures), episodic (time and place), or process oriented (stories and meaning-making). If you haven’t noticed, our culture particularly excels at the latter.
Communication, in all its forms, is more than simply speaking words. Communication is about conveying an emotional message. The stories that pull our heart strings or make the hair at the back of our necks stand at attention are often the most meaningful, and subsequently memorable. As the old adage says, it’s not so much what we say it’s how we say it. This simple lesson in communication can be a primer for communicating with loved ones who are experiencing cognitive decline due to Alzheimer’s disease or a related dementia.
Family caregivers who attend my support group or other workshops are frequently at a loss for how to communicate with loved ones in the moderate to later stages of dementia; patients who seldom seem to understand the content of spoken and written communication. The frontal temporal lobe of the brain, responsible for comprehension, language, judgement, and rationality, is generally the first part of the cerebral cortex impaired by Alzheimer’s disease. Returning to my earlier explanation of communication, once the frontal lobe is damaged, semantic (facts and figures) and episodic (time and place) communications will progress from confused to total lack of comprehension. The ability to make a rational argument will become non-existent and emotional reactivity on the part of both caregiver and patient will likely take the place of coherent, strategic dialogue – to the chagrin of both parties.
The prescription to a communicative stalemate is to try and connect on an emotional level. As Alzheimer’s disease ravages the rational part of the brain, the inner structure of the organ that regulates emotions and behavior – known as the limbic system – can be communicated with vis-à-vis the language of feelings. Again, it’s not so much what you say, it’s how you say it.
Let’s examine a real life example. Imagine for a moment that your loved one is in the middle stage of Alzheimer’s disease and she has returned home from the hospital after a fall, which fractured her hip. The care plan requires that she remain mostly bedbound for the first week post discharge. Your loved one is agitated and wants to stand up and move about, primarily to find her beloved mother, who has been deceased for over twenty years. Likely, the family caregiver will first communicate semantic (e.g., you need to stay in bed on doctor’s orders) or episodic (e.g., you mom passed away over 20 years ago) information. Although the caregiver’s intention is good, the patient’s response may be less than positive.
What if we tried a different communication strategy that focused on the feelings inherent in this patient’s behavior? Could we cultivate a more positive response that will ultimately support her safety and well-being? Let’s try a simple and mostly effective redirection strategy outlined below:
- Validate: Mom, it looks like you’re worried. I imagine that you want your mom to help you feel better. Note: I encourage you to meet the patient in her reality, not to reorient her to this time and place.
- Join: I’m waiting for your mom to come too, she’s such a wonderful woman. Note: Imagine how joining this patient in her experience will likely lessen the anxiety and agitation.
- Distract: Tell me about what makes your mom so special. Note: This is storytelling at its best and will likely mitigate the anxiety.
- Redirect: While you’re talking, move the discussion to another activity that has meaning to the patient. Maybe playing music, turning on the television, engaging a meaningful activity, bringing in a pet, or lighting a candle with her favorite scent.
The redirection strategy is not guaranteed to work all of the time but a local study on this behavioral intervention in a hospital setting demonstrated a significant rate of success. It’s worth noting to remember the basics of good communication: gentle eye contact and tone of voice, empathic facial expressions, muted gesturing, and a mostly peaceful environment. Lastly, just because your loved one with cognitive impairment doesn’t make sense to you, it doesn’t mean that they don’t want to be understood. The more you can move from content based communication to addressing the underlying feeling, the more successful your communication will be. For more information on dementia specific emotional communication, join me at my next Caregiving Essentials course on Saturday, August 17th from 9a – 12p. You can email me for more information.