Assertiveness

Ref. COMMUNICATION SKILLS IN PHARMACY

PRACTICE

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 COMMUNICATION ST YLES

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 ASSERTIVENESS

 Assertive communication
demonstrates self-respect and
self-confidence, in addition to
awareness of and respect for
others.

 It begins when you look at the

world from the position that
you are worthwhile and have
rights AND that others are also
worthwhile and have rights.

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 ASSERTIVENESS

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 PASSIVE BEHAVIOR

 Avoid conflict at all cost

 Avoids saying what he/she really think out of fear that
others may not agree
 ‘Hides’ and waits for others to initiate conversation
 Put others’ needs above their own
 May feel secretly angry or resentful towards others
 May see themselves as victims

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 AGGRESSIVE BEHAVIOR

 Aggressive people seek to “win” in conflict situations

by dominating or intimidating others.

 Aggressive persons promote their own interests or

points of view but are indifferent or hostile to the
feelings, thoughts, or needs of others.

 May ‘win’ certain arguments the short term, but their

behavior may lead to long-term negative consequences

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 ASSERTIVE BEHAVIOR

 Assertive behavior is the direct expression of ideas,

opinions, and desires.
 The intent of assertive behavior is to communicate in
an atmosphere of trust.
 Conflicts that arise are faced and solutions of mutual
accord are sought.
 Assertive individuals initiate communication in a way
that conveys their concern and respect for others.
 The goal of communication is to stand up for oneself
and to solve interpersonal problems in ways that do
not damage relationships.
 Assertiveness requires that you respect others as
well as yourself.
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A CRITICAL FACTOR IN BEING ASSERTIVE

 Taking responsibility for our own behavior:

 Is the ability to act in ways that are consistent with the standards
we have for our own behavior. When we tell our selves that other
people “make” us feel or act a cer tain way, we are not taking
responsibility for our own behavior.

 Instead of changing our selves, we tr y (impotently) to get other s to

change. However, the only power we have to ef fect change in any
relationship is to change our own behavior.

 E.g., you may wish that your boss, who tends to be ver y negative
during annual per formance evaluations of staf f, was more
suppor tive of your work. However, just hoping that she would be
more positive in her evaluations will not resolve this issue. You must
take active steps to change how you respond to her criticisms rather
than waiting for her to change her approach.
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 SKILLS FOR ASSERTIVE
COMMUNICATION.

 These include
 initiating and maintaining conversations,
 encouraging assertiveness in others,
 responding appropriately to criticism,
 giving negative feedback acceptably,
 expressing appreciation or pleasure,
 making requests, setting limits or refusing requests,
 conveying confidence both verbally and nonverbally,
 and expressing opinions and feelings appropriately.

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 THEORETICAL FOUNDATIONS
‘IRRATIONAL BELIEFS’

 Behaviorists believe that passive or aggressive

responses have been reinforced or rewarded and thus
strengthened.
 Aggressive behavior often works in the short term
because others feel intimidated and allow aggressive
persons to get what they want.
 Passive behaviors are reinforced when individuals are
able to escape or even avoid conflict in relationships
and thus escape the anxiety that surrounds these
conflicts.

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 BELIEFS THAT INTERFERE WITH ASSERTIVENESS

These beliefs involve

1. Fear of rejection or anger from others and need for
approval (everyone should like me and approve of what
I do)
2. Over concern for the needs and rights of others (I
should always try to help others and be nice to them)
3. Belief that problems with assertiveness are due to
unalterable personality characteristics and are,
therefore, unchangeable (this is just how I am)
4. Perfectionist standards. (I must be perfectly competent.
If I am not, then I am a failure. Others must also be
perfectly competent and deserve to be severely
criticized if they are not.)

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 COGNITIVE RESTRUCTURING
(ASSERTIVENESS TECHNIQUE)

 Te a c h es p eo p l e to i d ent i f y s el f - d e fe a t i ng t ho u g ht s t ha t p r o d u c e a n x i et y
o r i nap p ro p ri a te a ng e r i n d i f f i c u l t s i t u a t i o ns a nd re p l a ce t h em w i th m o r e
r e a s o na b l e t ho u g ht s .

 A s t he s e new t ho u g ht s rep l a c e t he s el f - d efe a t i ng t ho u g h t s , t h ey b e g i n to

b e i nc o rp o ra te d i nto t he p e r s o n’ s b el i ef s y s te m .

 Fo r exa m p l e, a s a p ha rm a c i s t yo u m ay fe e l “ u s e d ” by a b o s s w h o a l way s
c o u nt s o n yo u fo r e m er g enc y cove ra g e. Yo u m i g ht c ur ren t l y s ay to
yo u r s el f , “ I d o n’ t wa nt to c o m e i n to w o rk o n my d ay o f f t h i s w ee k , b u t i f
I s ay ‘ no ’ t he b o s s w i l l g e t m a d , and t ha t w o u l d b e aw f u l . ” B ec a u s e t h i s
c a u s e s yo u a nx i et y a t t he i m a g i ned c a t a s t ro p hi c co ns eq u en c e s o f s ay i n g
“ no , ” yo u r re s p o ns e i s i nhi b i te d .

 A m o re ra t i o na l t ho u g ht p ro c es s w hen f a c ed w i t h s uc h a r eq u e s t w o u l d
b e “ I d o n’ t wa nt to w o rk o n my d ay o f f t hi s w e ek . I t i s my r i g h t to s ay n o .
I a m no t re s p o ns i b l e fo r s o l v i ng a l l t he p ro b l e m s my m a n a g e r h a s i n
f i n d i ng b a c ku p c ove ra g e . ” T hi s t ho u g ht red u c es a nx i et y a n d f r e es yo u to
p r a c t i c e new, m o re a s s er t i ve res p o ns e s to d i f f i c u l t s i t ua t i o n s .
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 ASSERTIVENESS TECHNIQUES

 PROVIDING FEEDBACK
 INVITING FEEDBACK FROM OTHERS
 SETTING LIMITS
 MAKING REQUESTS
 BEING PERSISTENT
 REFRAMING
 IGNORING PROVOCATIONS
 RESPONDING TO CRITICISM

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PROVIDING FEEDBACK

 Letti n g oth e r s k n ow h ow you re s po n d to th e i r be h av i or ca n h e l p to avoi d

mi s un de r s ta n di n g s a n d a l s o h e l p to re s o l ve th e co n fli cts th a t a re i n ev i ta bl e i n
re l a ti on s h i ps .
 Wh e n you c h o os e to convey n e g a ti ve fe e dba c k to oth e r s , us e te c h n i q ue s to
ma ke th e co m m un i ca ti o n l e s s th re a te n i n g .
 Cri te ri a for us e ful fe e dba c k i n cl ude :

1. Fee dba c k focus e s o n a pe r s o n ’s be h av i or ra th e r th a n pe r s o n a l i ty

2. Fee dba c k i s de s cri pti ve ra th e r th a n eva l ua ti ve .
3. Fee dba c k focus e s o n your ow n re a cti on s ra th e r th a n th e o th e r pe r s o n ’s
i n te n ti on s
4. Fee dba c k us e s “ I” s ta te m e n ts th a t ta ke th e form “ Wh e n you [ do or
s ay] _ _ _ _ _ ,I fe e l _ _ _ .” Fo r exa mple, “ When yo u are la te for wo rk , I feel
frus tr ated a nd a ngr y ” is l ess da m aging tha n “ Yo u’re irresp o nsible. Yo u d o n’t
c a re a bo ut t he pa tie nt s who are wa iting a nd t he c o -wo rker s c ove ring for yo u
when yo u ’re la te.”
5. Fee dba c k i s s pe ci fic ra th e r th a n g e n e ra l .
6. Fee dba c k focus e s o n probl e m s ol v i n g .
7. Fee dba c k i s prov i de d i n a pri va te s etti n g .
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INVITING FEEDBACK FROM OTHERS

 We need to invite feedback from others in order to improve our

interpersonal communication skills.
For example,
As a Pharmacist, you should routinely assess patient satisfaction and
invite feedback on your ser vices.
As a manager, you should let employees know that you welcome
suggestions from them on how to improve pharmacy operations.

 Your ability to hear criticism or suggestions without anger, to admit

when you have made a mistake, and to encourage feedback from
others (even when it is negative) encourage people to be honest in
their communications with you.
 They also allow you to identify areas of your professional practice
that may need improvement and promote better relationships with
others.
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 SETTING LIMITS

 Being assertive in setting limits means that you take responsibility

for the decisions you make on how to spend personal resources
without feeling resentful toward others for making requests.

 Being assertive in setting limits does not mean that you stop
saying “yes” to requests. You will no doubt continue to help others,
even though doing so may be an inconvenience, because of the
value system you hold and your desire to help others when they
need help.

 When faced with a request, the first step is to decide how much
you are willing to do in meeting the request.

If you need time to decide, delaying a response is appropriate as

long as you get back to the person within the time frame you specify.
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 MAKING REQUESTS

 Asking for what you want from others in a direct manner is

also necessary in healthy relationships.
 If you are in a management position, clearly communicating
your expectations of others is an important part of carrying
out the goals of the organization.
 In equal relationships, making requests, including asking for
help, is an important part of honest communication.
 We must trust that others will be able to respond to our
requests in an assertive manner, including saying “no.”
 Thus, we must not overreact when someone turns down our
request in an assertive way.

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 BEING PERSISTENT

 One important aspect of being assertive is to be persistent in

assuring that your rights are respected.

 Often when you have set limits or said “no,” people will try to
coax you into changing your mind.

 If you continue to repeat your decision calmly, you can be

assertive without becoming aggressive and without giving in.

 This response of calmly repeating your decision is often called

the “broken record” response (Smith, 1975). It will stop even
the most manipulative person without assigning blame or
escalating the conflict.

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 REFRAMING

Frames are “cognitive shortcuts that people use to help make sense
of complex information” (Kaufman et al, 2003).
TECHNIQUES
 Focus on developing ef fective communication around a set of
limited objectives.
 Examine the potential validity of the other person’s perspectives.
 Establish a common ground. Search for areas of agreement and
focus on desired outcomes with a long-term perspective.
 Identify opportunities to explore solutions not yet pursued and
oppor tunities for “trade-of fs” or compromises. • Finally, identify
dif ferences that cannot be bridged and at the same time explore
conflict reduction actions that can still be taken.

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 IGNORING PROVOCATIONS

 Interpersonal conflict may elicit various ways of trying to

“win” by attempting to humiliate or intimidate others.
 For example, patients who are angry or feeling helpless may
lash out with personal attacks. Pharmacists who feel unfairly
criticized may respond in an aggressive or sarcastic manner.
 Interpersonal conflicts between health professionals are often
marked by struggles for power and autonomy.
 Ignoring the critical comments of others and focusing
exclusively on solving underlying problems can do much to
keep conflict from escalating to the point that relationships
are damaged.

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 RESPONDING TO CRITICISM

 For some of us, criticism is particularly devastating because

we typically hold two common irrational beliefs:
(1) that we must be loved or approved of by virtually everyone
we know, and
(2) that we must be completely competent in everything we do
and never make mistakes.

 Since such perfectionist standards are impossible to achieve,

we are constantly faced with feelings of failure.
 The only way to counteract such feelings and to begin to cope
reasonably with criticism is to begin to challenge the
underlying, irrational beliefs that lead us to fear the
disapproval of others.

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 ASSERTIVENESS SKILLS REQUIRED IN
RELATING TO PATIENTS:

 Willingness to initiate communication

 Encouraging patients to be more assertive with you
 Appropriate response to angry patients
 Empathic response
 Turn criticism into useful feedback
 Ability to set limits without becoming aggressive.

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 ASSERTIVENESS SKILLS REQUIRED IN
RELATING TO PHYSICIANS:

 No need for anger/ or apology

 Always introduce yourself
 Apologizing makes you seem insecure and unassertive
 Do not put the physician ‘on the spot’
 Prepare your recommendation and keep current
references ‘in reserve’
 Do not expect a ‘pat on the back’

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 ASSERTIVENESS WITH
EMPLOYEES

 Talk in private
 Be specific in your approach to the problem
 Broken-record response
 Do not become defensive
 Appropriate feedback techniques
 Positive feedback is as important as negative
feedback (specific praise)

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 ASSERTIVENESS WITH EMPLOYERS

 It is necessar y to be asser tive not only with your employees, but with
your super visor s as well.

 As health professionals, we sometimes work in situations where

super visor s share neither our professional identities nor the ethical
standards we hold for patient care.

 It is necessar y for us, then, to define what the professional standards

for pharmacists are and to be asser tive in insisting that we must meet
those standards whatever our practice environment.

 In addition, we may faced a negative evaluation or criticism of our

per formance by a super visor. Yet the criticisms we receive (and what
we do in response to them) can lead to improved relationships with
other s, if we can avoid some common pitfalls in our responses to
criticism.
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 ASSERTIVENESS WITH EMPLOYERS

Five responses that are helpful in situations of

criticism:
 Getting useful feedback ( U n c o v e r i n g t h e p r o b l e m w i l l p r o v i d e y o u
with specific feedback that may be useful to you in improving your per formance)

 Agreeing with criticism

 Disagreeing with criticism
 Fogging; involves acknowledging the truth or
possible truths in what people tell you about
yourself while ignoring completely any judgments
they might have implied by what they said.
 Delaying a response

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 ASSERTIVENESS WITH COLLEAGUES

The president of your local pharmacy association calls and asks you to
ser ve as chairman of a new committee. You are interested in the committee
but are not sure you have the time to chair it. Which of the following
responses would you choose:

a. “Well, I’d really like to. I don’t know. I guess I could if it doesn’t take
too much time.”

b. “Why don’t you ask Jim? He’d be good. If you can’t find anyone else,
maybe I could do it.”

c. “I’ve given enough time to this organization. Ever yone always comes to
me. Let someone else do some work for a change.”

d. “I’m interested in the committee, but I’m not sure I have time. Let me
think about it tonight and I’ll call you in the morning with my decision.”

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 SUGGESTION

 Let’s now imagine a situation where the president tries to

coax or manipulate you into changing your “no” response to a
“yes” response to his request to chair the committee.

How the Pharmacist should response in that case?

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 CASE STUDY

 Karen's Story
Karen works for a Pharmaceutical company, on a weekly basis
she finds that certain colleagues ask her to do some of their
duties. Karen finds it tremendously difficult to say 'no', she
thinks that it will cause an argument and that she will come
across as rude. She also feels that people are taking advantage
of her, her workload is increasing and this causes her stress
levels to rise, she starts dreading going to work and her self-
esteem and confidence are now being impacted on.

 What if the problem per sists?

 How Karen’s should behave in the above scenario to solve the problem?
 Write down the benefits of your recommended behavior.

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