by Paul Micallef BA DClinPsych CPsychol(UK)

Chartered Clinical Psychologist &

Consultant/Advisor for Staff Training and Retraining

Communication skills are prescribed with such frequency as the key to successful solutions that with time many professionals tended to view them somewhat skeptically.  Towards the end of the 20th century, communication skills seemed to become a panacea for numerous problems, be it personal or professional, making an ever increasing number of us weary of them.  Now, we are witnessing a revival of their potential and need.


In my first two letters published in the previous two issues of TheSynapse magazine I wrote to you about how initially, effective communication has to start with ‘me’, on an intra-personal level.  If I cannot communicate effectively with myself at an intra-personal level then I am bound to have problems communicating with others, be it at an inter-personal or family / team / organizational level.


In this issue I promised to write about assertive communication, the most coveted of the three communication styles.  Assertive communication is in constant competition with passive or aggressive communication.  Assertive communication focuses on everything there is to know about what you want to say, why you want to say it, how to say it in the best way, when to say it, which non-verbal and verbal skills to use, whom to involve in the process and where to say it in order to achieve maximum output.


On using these skills in combination with your technical expertise, I recommend that you also consider how realistic, reasonable, fair and honest you are. In the end, this is what makes communication complex and why many people end up taking ‘short cuts’ in providing a holistic quality service.  Unfortunately, when we do this we end up paying a hefty price because we undermine ourselves and the quality service we aim to provide.  Moreover, with medico-legal litigation becoming increasingly frequent we cannot afford to cut corners where communication is concerned, be it verbal or non-verbal.


As we approach the end of the first decade in this 21st century the pressures on us as health care professionals are constantly growing.  These pressures are not only linked with keeping updated on the advances being made in our respective fields of practice but are also directly linked to the ever increasing and evolving human and organizational expectations, patient rights, I.C.T. and the fact that both public and private health care sectors are focusing on adding greater value to the holistic prevention, treatment and care achievement processes.


Assertive communication requires an open and positive personal attitude towards self and others.  This attitude needs to actively reflect the very self respect and trust that are fundamental to effective communication.  Therefore a closed, defensive or negative attitude that is strongly linked to the mental programming outlined in the second letter is a definite foe of successful communication.


Another core component in communication is flexibility.  Many people believe that if they allow themselves to be flexible or adaptable, then they are going to reflect a personal or professional weakness and vulnerability normally associated with passiveness.  This is completely false and misleading because flexibility has nothing to do with being passive.  In fact, a lack of flexibility and adaptability in dealing with others reflects a strong tendency towards aggressive communication.


Assertive communication is also based on a two-way open communication channel that allows for mutual active listening, precise understanding, continuous feedback and the ability to negotiate with the other person / party so that a decision benefiting both sides is taken and acted upon.  Assertiveness is based on the following 5 key principles:


  1. Equality: the ability to recognize that everyone, you and the other person, has the right to express their thoughts and feelings;
  2. Planning: the ability to plan a realistic agenda that strategically outlines what one wants in a mutually respectful manner;
  3. Expression: the ability to use both verbal and non-verbal communication to state what is wanted in an open, honest and clear way;
  4. Persistence: the ability to persist and not give up on one’s realistic agenda until it is given a fair and reasonable hearing;
  5. Decision making: the ability to make a decision given the factual evidence and information available at that point in time, in the best interest of all parties concerned, whilst prioritizing. To prioritize, one needs to appreciate the difference between what is urgent and important.


The art of finding a mutually acceptable solution encourages people to continue working and / or living together harmoniously and over time.  Assertive communication differs from aggressive communication because aggression is about getting your own way.  Aggressive communication involves little or no respect for others.  It frequently ends up with people shying away from the aggressive person therefore jeopardizing the listening, understanding and feedback process that are crucial in effective communications.  In the health services, the person who tends to suffer most when aggressive communication is involved is the patient.  This is truly contradictory and destructive to the holistic prevention, treatment and care process because the person on whom we are supposedly channeling our energies on is the same person who ends up suffering or losing.  If the aggressive communication persists, everyone ends up losing because colleagues too pull back and avoid the aggressive person.  If there is no patient involved and the aggressive communication is taking place in the context of a family or team, then normally the more vulnerable or emotionally distressed person ends up suffering the most leading to a loss of valuable input and an unhealthy balance in team dynamics.


Aggressive people tend to bully and harass others, often capitalizing on the lack of time as an excuse.  Bullying and harassment are unfortunately very popular where pressure to perform is high, due to numerous factors including competition, expectations, private practice and the ever growing waiting lists in the public sector.


At the other end of the communications continuum is passive / submissive communication. The objective of a passive person is not to cause any disruption or attract any attention towards him/herself.  This is normally linked to a low self-esteem or confidence.  Passive communication often triggers frustration in both parties and has the tendency of eventually trigger an explosive combination of the two undesirable communication styles, i.e. passive-aggressive.  This is a dangerous way to communicate because when one passively bottles up thoughts and emotions over time, eventually they tend to suddenly and unreasonably explode in a highly destructive and painful manner to all concerned.


The whole purpose of this series of letters is for you to improve self care and achieve a healthier work-life balance.  The way in which today’s letter contributes to this is by helping you take some time and space to actively reflect on your preferred communication style and where necessary consider enhancing it.  Sit back and consider these questions:


  • When someone talks to you, do you actively listen to them and then take time to give them feedback on what you understood to reflect that you really listened and understood them?
  • When you talk to someone important to you, like a family member or a patient, do you calmly ask them to tell you what they understood after you finish talking to them?
  • When you want to say something important, do you consciously stop and think why, how, when, where and which skills to use and what you actually want to say, before you go ahead and speak to the other person?
  • Do you genuinely believe that what you have to say is as important as what the other person has to say to you?
  • When you want to deliver an important message to someone else, how empathic are you of that person’s situation including emotions and personal biases?
  • Do you negotiate with another person and come to a mutually acceptable decision that you then go on to respect and follow-up?


If your honest answers to the above 6 questions are predominantly negative, then you are the aggressive type.  Take note and if you would like to do something about it, simply follow the instructions indirectly outlined in the questions themselves.


If you answer “yes” to the following 2 questions, then it tends to indicate a tendency towards passiveness.


  • Do you often give up saying something you personally believe in because the other person shows little or no interest in you or what you have to say?
  • Do you find it hard to consider creative and innovative ways to deliver your message in a different way, or to a different person, be it verbally and non-verbally?


Assertive communication is about respecting and trusting yourself to such a degree that you strategically decide to manage this complex communication process in the most competent and successful manner.  It is about using your mind and your complementary multiple intelligences to enhance the potential for effective listening, understanding, giving feedback and taking decisions which are actively followed-up over time.


Time to communicate effectively is extremely important.  I therefore suggest that we all seriously invest in competent communication skills and afford them the same trust and respect we look for in someone helping us invest our personal finances or addressing a serious personal problem.


Thank you and I hope you enjoy a peaceful and serene Christmas.


I will be back early in the New Year in the next edition of TheSynapse magazine with my last letter in this series focusing on self care.  Next time, I plan to write about adjusting to major changes and life transitions.




Paul Micallef