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The Give and Take of Effective Communication

A senior couple having a serious discussion beside a peaceful pond.by Ann S. Williams, PhD, RN, CDE

Whether you have diabetes or not, being able to both express yourself and understand the
people you care about—the give and take of communication—are essential to building satisfying and mutually supportive relationships.

But if you have diabetes complications, communication skills are even more important, as they often stir up strong emotions for everyone involved. This article will discuss three true stories about diabetes complications and communication problems. (The names and a few details have been changed to keep everyone anonymous.)

Each of these stories involves two people who care a lot about each other and need support and help from each other. The people with diabetes are dealing with new complications and their feelings about them. However, they are not talking about these feelings, so they are unable to receive the support and help they need in ways that matter. Effective communication is the strongest way they can begin to change that.

In a process of giving (or talking) and receiving (or listening), you can begin to build a bridge to understanding. The following few paragraphs describe some simple guidelines for talking with and listening to someone you care about. Such guidelines are especially helpful for people who need to communicate about strong emotions, such as the fear and anxiety that often accompany diabetes complications.

Talking about Feelings: Making “I” Statements

An “I” statement is a way to open a conversation by explaining how you feel about something. It has 3 parts:

1. Describing the situation (very briefly)

2. Naming the feeling

3. Explaining the effect on you

Usually, an “I” statement takes the form, “When ( 1 ), I feel ( 2 ) because ( 3 ). Even though this seems like something of a formula, using it will allow you to begin talking openly about emotionally intense subjects.

Consider the following story:

A man and woman sit with their backs to us. The woman has her arm around the man’s back and appears to be comforting him.Lucinda has had type 1 diabetes for 22 of her 23 years. Last year, she graduated from college, got her first professional job, and became engaged to a young man she has known for 5 years. Her ophthalmologist recently told her that she has proliferative retinopathy and has scheduled laser surgery for next week. Lucinda remembers that her grandmother and aunt were both blind from diabetes near the end of their lives and she is afraid she will soon be blind herself. She does not want to worry her fiancé, so although she has mentioned the surgery to him, she called it “no big thing,” and has not discussed her fears.

Lucinda’s situation is an excellent opportunity to use “I” statements to help her communicate. She might say to her fiancé: “Ever since my doctor told me I have to have laser surgery I feel frightened, because I think I might go blind.” By doing this, she opens communication with her fiancé and can gain valuable support from him as she copes with her eye surgery.

Now consider this true story:

Clarence and John have been friends for about 35 years. Both are in their mid-40s now. Clarence has had type 2 diabetes for 14 years, although he has not paid much attention to it. John says he knows a lot about diabetes, since he helped to care for his grandmother, who had diabetes and eventually died of kidney failure. John is worried about his friend because he has noticed that Clarence seems to eat whatever he wants. When Clarence mentioned to John that his doctor had told him that he has some early signs of kidney disease, John decided to give his friend advice about his diet whenever they eat together. Clarence does not like this, and has tried to laugh it off. John has responded by becoming more insistent.

When you make “I” statements, talk about your own feelings but avoid accusations about the other person. For example, if Clarence said to John, “You’re insulting me,” or if John said to Clarence, “You’re being self-destructive,” they will probably respond to each other defensively. That conversation is likely to end in an argument.

Notice the difference when Clarence and John focus on how they feel and use “I” statements. Clarence could say to John, “When you tell me what to eat, I feel put down, because I’m an adult and I can make my own decisions.” In turn, John could say to Clarence, “Since you told me you might have kidney disease, I feel worried. I’m afraid that you could get very sick and need dialysis, like my grandmother.”

Of course, when people are talking about complicated, emotionally intense topics, making “I” statements is only the beginning of the conversation. Take this true story, for example:

Sue and Leonard have been married for 38 years and both have type 2 diabetes. Recently, Leonard has had difficulty achieving an erection. He still feels attracted to Sue and wants to be able to have sex. He feels embarrassed and has stopped approaching Sue sexually.

Sue has mixed feelings about this. While she misses the closeness of sex with her husband, and feels she is to blame for their lack of an active sex life, she also knows she has gained weight and is showing signs of aging. She worries that she is no longer attractive to Leonard. At the same time she is somewhat relieved because for the last several years she has had difficulty feeling sexually aroused. In fact, sex has been occasionally unpleasant and even painful for her. Neither she nor Leonard has spoken to the other about their troubled sex life.

Sue and Leonard have a range of complex feelings about their situation. But if one of them could begin a conversation about their lack of sexual intimacy with an “I” statement, they could help each other to see that they can work on the problem together.

Listening to Feelings: Active Listening

Of course both people must actively participate to have a conversation. While your partner opens with an “I” statement, you can help the communication by using active listening. This is a two-step process: First, listen carefully, giving the speaker your full attention. Do this without thinking of your answer while the other person is speaking. Then let your companion know what you have heard. Acknowledge the emotions you noticed, then re-phrase or summarize the message without judgment. Active listening helps communication in two major ways. First, you confirm that you have understood what someone has told you. Second, the other person learns that you have been listening carefully.

For example, if Leonard began a conversation with Sue by making “I” statements about his difficulty achieving an erection, he might be feeling vulnerable and nervous. But Sue has strong feelings about her own sexual problems, so she might only half-listen while thinking about what she wants to say. If she responds to Leonard with her own point of view or turns her hurt feelings of rejection into an accusation, Leonard will probably respond defensively, even angrily. Then Leonard’s attempt to talk about a difficult subject could easily lead to an argument.

Imagine how different this conversation can be if Sue uses active listening. She knows she will have a chance to express her point of view, so she can lay aside her own feelings and responses while Leonard explains his difficulties and desires. When Leonard pauses, Sue could say something like, “I can see that you feel frustrated about this.” This simple statement would go a long way towards helping Leonard feel understood by his wife. And for Sue, acknowledging Leonard’s feelings will help her see that the problem is not hers alone.

Next, Sue could summarize what Leonard has said to her, for example: “I hear you saying that you are upset that sex is physically difficult for you, but you still want to have sex with me.” By listening carefully and paraphrasing what Leonard said, Sue is learning that her assumptions and fears about her attractiveness to Leonard are not true.

Now that Leonard has spoken and Sue has let him know that she heard what he was saying, Sue might choose to respond by using “I” statements to explain her feelings and experiences. If Leonard uses active listening to let Sue know that he hears both her emotional tone and the content of what she says, they will have a good basis for understanding each other.

“I” statements and active listening will help Sue and Leonard begin to discuss their problem. In fact, “I” statements and active listening would be helpful to Clarence and John, to Lucinda and her fiancé, and to you and your family members and close friends. With strong skills for expressing your concerns and hearing and understanding the concerns of the people you care about—the give and take of communication—you will lay a strong foundation for satisfying, mutually supportive relationships.