What do you say when you know the next thing out of your mouth could strain a caregiver relationship? Having difficult conversations with caregivers is challenging but when handled with care, compassion and professionalism, they’re opportunities for professional growth. Relying on foundational skills will strengthen your ability and confidence in navigating difficult conversations, ensuring the client’s well-being is at the center of these discussions.
Common Barriers in Caregiver Conversations
Difficult conversations with caregivers, such as letting them know you’ve filed a report with CPS, discussing the need to break confidentiality for safety reasons or even having to set boundaries within the helping relationship, often triggers anxiety for helping professionals because we associate difficult conversations with conflict and confrontation. No one—even those of us trained to de-escalate conflict—feels comfortable with initiating conversations that could feel like an argument and potentially rupture the relationship.
We’re also attuned with the emotional needs of our clients and their caregivers and may worry about the impact of hard conversations and the effect it may have on their mental health. This can hinder our ability to communicate clearly and concisely,leading to confusion on the part of the client or caregiver, especially when there are cultural differences. We may be so focused on saying what we need to say, due to our own anxieties, that we aren’t able to hear another perspective or truly understand the cultural differences at play.
A Real-Life Example of Cultural Nuance in Practice
I experienced this early in my career while working with a mother who had immigrated from West Africa. In discussing behavior management for toddlers, she spoke openly about the accepted use of corporal punishment and my initial reaction was to remind her that I was a mandated reporter, which shut the conversation down. Had I been more mindful of the cultural differences at play, I could have engaged in conversation around her own beliefs around discipline and supported her in reflecting on the use of other techniques in managing behavior.
Strategies for Navigating Difficult Conversations with Caregivers
There are several strategies providers can use to support them in navigating these conversations and the great thing about them is they’re foundational skills we already use every day in our practice.
Being Aware of our Non-Verbal Communication
Clients have shared with me that my presence, even over telehealth, can bring them a sense of calm and peace. Having a calm, neutral facial expression and relaxed body sends the message I’m ready to hold space for whatever comes up in our session.
Most people we work with have experienced some type of trauma in their lives and are hyper-aware of how people present themselves as a way to maintain safety. Having an open, relaxed posture when sitting across from someone you’re attempting to have a difficult conversation with, while maintaining appropriate eye contact and a neutral facial expression can help put people at ease rather than making them feel defensive.
Take a Strengths-Based Approach
The goal of having a difficult conversation with a caregiver is to enact positive, helpful, needed change. In order to do that, we need to highlight what’s working in order to turn those strengths into solutions. Taking a strengths-based approach also puts people at ease, making the rest of the conversation feel constructive instead of punitive.
Set Clear Expectations
Being upfront about what needs to be discussed, why it needs to be discussed and what you’re hoping to achieve, in collaboration with the client or caregiver can support them in focusing on the conversation. It also demonstrates genuineness on your part, that this is coming from a place of compassion and concern rather than it feeling like a personal attack on the caregiver.
Active Listening
When we’re nervous about having difficult conversations, taking in what the other person is saying can be a challenge. When we listen to respond, or are even planning what we’d like to say next while the other person is speaking, we miss the non-verbal cues, tone of voice and sometimes, even what they are saying, leading to miscommunication.
By making eye contact, nodding your head, mirroring their body language, listening without interrupting, validating their feelings and then reflecting back what the client or caregiver said, the focus remains on them, allowing them to feel heard and understood.
Maintaining Client-Centered Focus
Using these techniques to guide difficult conversations will help you keep the client’s well-being at the forefront of these discussions. By modeling them for caregivers, we’re supporting them in centering the client’s experience as well. Effective communication between providers and caregivers improves outcomes for our clients and helps caregivers feel aligned with us, allowing us to work together rather than against each other.
When we have these difficult conversations, it’s important to document the details—the initial concern, the content of the conversation, what strategies used, and the outcome. This information can be shared with other members of the team. Tools like Casebook can help streamline documentation, ensure team-wide visibility, and support continuity of care for better long-term outcomes.
