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Communicating in the Treatment Room
Anger in Code: Understanding and Responding to Attack and Blame
Part One

By Anita Simon and Ben E. Benjamin

This is the second in a series of articles based on the SAVI® (System for Analyzing Verbal Interaction) communication  system¹. Our goal in these articles is to provide massage therapists with the knowledge and tools they need to make conversations work better.

SAVI identifies all the different behaviors people use to express themselves verbally² (Complaint, Opinion, Paraphrase, Proposal, and so on) and explains how they are likely to affect communication. In studying SAVI, you come to understand why some conversations work well and others end in frustration and misunderstanding. You also learn strategies for successfully communicating your ideas and responding more effectively to the communication of others.

In the first article, “The Anatomy of Communication,” (published in two parts, in February/March 2007, page 110, and April/May 2007, page 122), we provided a general introduction to SAVI—discussing its underlying principles, the nuts and bolts of the SAVI Grid, and some of the ways we can use SAVI to get unproductive conversations back on track. Here we’ll narrow the focus to look closely at one behavior that has a toxic effect on communication, with the potential to turn any discussion into an argument. In SAVI, this behavior is known as “Attack/Blame” (see Figure 1).


In massage therapy, as in other helping professions, some of our most difficult work is in areas that are not the focus of our professional training. Many of us can relate to the old saying, “My work would be so easy if only I didn’t have to talk with clients!” The people part of massage therapy can be very challenging, particularly when clients are angry or disappointed or when we are annoyed at them. Who hasn’t experienced tension, irritation, or worse when hearing a client say, in an aggrieved voice, something like:

• You’re raising your fee? You’ll make it impossible for me to get treatment!”
  
• All of my friends are getting this new treatment. Shouldn’t you be doing that with me?”
  
• You don’t pay attention to me during my treatments. You talk too much about yourself.”
  

Attack/Blame: Fighting with Words
A conversation filled with Attack/Blame sounds like a fight. Whenever we hear an Attack statement, whether or not it’s directed at us (and even if it’s coming from us), we can feel it in our gut. An Attack has a hostile or threatening quality. It may include cursing, name-calling, or threats, and is usually delivered in an angry tone—the voice may not be loud, but there’s an edge to it. Note that how you speak can be just as important as what you say. The same words can be an Attack or not, depending on the voice tone. (For example, “How much did you spend for your shirt?” is a real question if asked with genuine curiosity and an Attack if said with hostility or a demeaning tone).

Blame is a close relative of Attack. When we Blame, we assign responsibility to someone else for a specific situation that we don’t like. The edge to our voice says, “It’s your fault—you’re the bad one.” (In this article, we’ll often use “Attack” to refer to both Attack and Blame statements.)

This basic description of Attack/Blame statements is fairly straightforward and generally not surprising or new for people. What is a new insight for many people is the core dynamic at work with this type of behavior. What’s happening is that the speaker is sending out two different messages at the same time. With the tone of their voice, they’re expressing something about themselves: “I’m furious!” or “I’m so frustrated!” But their words say something completely different—not about the speaker’s feelings, but about the listener’s failings: “Here’s what’s wrong with you … !” Consider the example of a client fuming, “Your fees are too high.” Here, the focus seems to be on you and your fees. Yet the main message that comes barreling through is the one encoded in the voice tone: “I’m angry!”

Meanwhile, one of the most critical pieces of information is not expressed at all. While the speaker’s voice tone tells you that he’s upset, and his words give you some idea of what’s upsetting him, there’s no indication of why it is upsetting. For instance, the client who says, “All of my friends are getting this new treatment. Shouldn’t you be doing that with me?” may be frustrated because he expected to be healing more quickly than he has been; he may have heard reports from friends that the other treatment works more quickly. Alternatively, it could be that he feels competitive with those friends and doesn’t want them to be doing something cool that he’s not doing. Or there could be something else bothering him that hasn’t even occurred to you. It’s impossible to know exactly what his reasons are until he tells you, and without that you can’t address the real problem.

This basic dynamic (expressing angry or irritated feelings without talking about those feelings or what’s causing them) is key to understanding what’s going on in every single Attack statement. It makes no difference whether the conversation is happening between a client and therapist, father and child, boss and employee, or two complete strangers. This dynamic is also crucial to understanding why Attacks often lead to interpersonal difficulties. Any communication that expresses angry feelings, but only indirectly, will tend to increase uncertainty about what the speaker is feeling about us. This uncertainty causes a communication problem: all of us like to know what’s going on, and when we don’t, energy gets diverted away from the content of the conversation and onto figuring out what state the speaker is in—particularly to determine if he is mad at us.

Because the person has not directly told us why he’s upset, we may come up with our own (often incorrect) conclusions. For instance, if a client Attacks you when you tell him about your raised fees, you may assume that he’s angry with you because he believes your new fees are too high. However, it’s possible that he’s been angry at you for a while about something different (for instance, because his treatment is taking longer than expected or because you repeatedly keep him waiting for appointments). Or he may not be angry with you at all, but may be upset because his boss just told him he’s getting laid off.
When we communicate anger or irritation through voice tone only, the information about what we’re feeling and why we’re feeling it (our wants and needs that aren’t being fulfilled) gets lost. This emotional and cognitive data, which is needed to resolve the conflict, stays hidden from the listener—and frequently from the speaker as well. In the example given earlier, the client using Attack behavior about your increased fees does not directly access his anger, his worry that his injury might never be healed, his frustration at your keeping him waiting, or whatever else is upsetting him.

Since the speaker’s thoughts and feelings are not explicitly stated, they cannot easily be addressed by the listener. This makes resolution by both parties more difficult than it needs to be, though far from impossible. Later on, we’ll discuss how a skilled responder can use the data hidden in Attack/Blame statements to foster a very productive conversation.

Information Impasse: The Impact of Attack/Blame
Attack/Blame is a potent communication stopper: whenever it’s used in a conversation, information flow tends to come to a screeching halt. Heated words may be exchanged for hours (or years) on end—“How could you?” “It’s your fault.” “You never listen.”—but in terms of understanding or problem solving, a dialogue filled with these Attacks almost always goes nowhere. Frustration and agitation only build as time goes on.

Let’s look deeper inside a dialogue of Attack behaviors. Communication starts to break down whenever one person initiates a verbal fight and another person fights back. Notice that it takes two people (at least) to keep the fight going. It can be tempting to lay all responsibility on the individual who makes the first Attacking remark. However, the listener’s response is just as decisive in determining whether or not a fight will develop. As we’ll see later in this article, while it takes some work, it is possible to respond to Attacks in ways that foster empathy and real understanding.

Typically, the inclination to fight back is extremely strong. This is because the ambiguity in the Attacking comments provokes irritation. As a result, the listener often feels a strong impulse to retaliate. There is a pull to keep the fight going—it’s really hard to stop talking until we get the last word in. It’s as though the anger acts as emotional glue, keeping us stuck in the conversation. And while we’re determined to get the other person to see our point of view, it’s difficult for us to see any value in his point of view. When someone has attacked us, fighting back usually comes much more easily than actively listening to his perspective.

In addition to the negative effects an Attack may have on a listener, this type of communication is generally counterproductive for the speaker as well. The person may gain some sense of emotional release, but, in the long run, will almost always end up dissatisfied, since the underlying source of conflict has not been resolved. Note that Attack and Blame are not inherently bad; they are problematic only if 1) they are chronic and 2) your goal is to communicate information in such a way that the listener can hear it and use it to help solve a problem or meet a need.

Understanding Anger, Rediscovering Choice
At the root of all Attack statements are feelings of frustration or anger. Therefore, learning to understand and effectively deal with these feelings (in ourselves and others) is crucial to finding alternative responses. It is important to differentiate our feelings, which are experienced internally, from our words and actions, which are broadcast externally. When we’re frustrated or angry (a feeling), it often feels good to lash out (a behavior). So the personal desire to retaliate comes into conflict with our rational self that knows that bashing someone verbally does not resolve the problem that generated the feelings in the first place (see Figure 2).

 Wanting to go in these two different directions when we feel irritated or angry is an internal conflict. Recognizing when you’re experiencing this conflict is a first step away from automatically Attacking. The next step is recognizing the many behavioral options you have when you’re angry. As an alternative to Attacking, you could help get information flowing by choosing any behaviors from the Yellow light or Green light rows shown in Figure 1. For example, you can give information (say you’re upset, suggest taking a break, or say you’d like to take time to think about the issue), you can seek information (ask questions), or you can check to see whether you heard correctly what was just said (paraphrase).

While there are many different ways we could behave when we’re angry, each of us has certain deeply ingrained, habitual responses. Early in life, we learned how to express anger from the examples set by those around us, primarily our parents. Their behaviors may have tended toward flight (going away angry and never talking about the issue again), external fight (yelling or worse), or internal fight (getting upset with and yelling at oneself or becoming anxious). In times of stress, we generally respond in the modes that are most familiar to us; these are the procedures that come naturally and feel “right.”

Often, parents do not teach their children the distinction between having an emotion and how that emotion is expressed (indeed, few understand this distinction themselves). Therefore, most of us were never encouraged to notice the behavioral choices we have when we’re feeling strong emotions, and we have little experience to draw upon to teach our own children these skills. Moreover, very few families provide good models of putting feelings into words without Blaming themselves or others. But fortunately, these skills can be learned at any time in life.

Let’s look at a concrete example to see what different behavioral options might sound like in an actual conversation. Think back to the case of the client who’s angry because you raised your rates. Imagine that you’ve been treating this client for a long time, you care about her welfare, and you hope to maintain a positive professional relationship with her. She’s visibly angry, and tells you, “You’re too expensive. You’re making it impossible for me to get the treatment I need.” How do you reply? While there’s no right answer, there are several productive alternatives to Attack/Blame. (Remember that your voice tone is important—a comment or question that may be helpful when spoken with genuine empathy or curiosity is an Attack behavior when spoken hostilely.)

Tell your own feelings. “I felt upset when I heard you say that. I care about your well-being. I’ve felt we have done good work together, and I’m sad to think you may not want to continue.”

Tell your own worries. “Like you, I’m concerned about your being able to get the treatment you need. Are you saying that my new fee puts treatment with me out of reach?”

Ask about the other person’s feelings. “Are you angry because you think I don’t care enough about your health? Are you worried that your injury may not heal properly?”

Join truthfully. “I also remember being very upset when a therapist I was seeing raised her rates. I was worried I wouldn’t be able to continue getting treatment. Is that concerning you, too?” 

Involve the other person in problem solving. “What would make it easier for you to afford treatment? Would it help to set up a payment plan spread out over several months? Are there insurance options you could look into? Would you be willing to see another therapist some of the time?”

Invite the other person into your shoes. “Suppose you found yourself in my position—having decided to raise your rates, and yet wanting to make it possible for your clients to receive treatment. What would you do?”

Most people are surprised to learn just how much power they have to turn a conversation around. In the context of an Attack, the road to constructive dialogue doesn’t have to begin with the person who’s using Attack behavior changing his attitude or admitting he was wrong. By resisting the impulse to retaliate (Attack back) and trying a different response instead, you can shift away from habitual patterns of fighting. The payoff is not just a reduction in conflict, but a greater potential for mutual understanding and more rewarding emotional connection.

In the second part of this article, we’ll discuss some more specific strategies for dealing effectively with Attack/Blame behaviors—both when others use them and when we catch ourselves using them. If you don’t want to wait for the next issue, you can access part two online now.

Anita Simon, EdD, is codeveloper of SAVI with Yvonne Agazarian. She has been writing about SAVI since 1965 and has delivered workshops on this and related topics since 1968. Simon is in private practice as a psychotherapist in Philadelphia, specializing in work with couples, business partners, and individuals. She can be contacted at anitasimon@savi
communications.com. The SAVI website is www.savicommunications.com.

Ben E. Benjamin, PhD, holds a doctorate in education and sports medicine. He is senior vice president of strategic development for Cortiva Education and founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than forty years and has taught communications as a trainer and coach for more than twenty-five years. He teaches extensively across the country on topics including communication, SAVI, ethics, and orthopedic massage, and is the author of Listen to Your Pain, Are You Tense? and Exercise without Injury and coauthor of The Ethics of Touch. He can be contacted at bbenjamin@cortiva.com.

Notes
1. SAVI® is a registered trademark of Anita Simon and Yvonne Agazarian.
2. This article focuses on just one of the communication behaviors categorized by SAVI. The complete system includes a variety of different categories of behavior organized in a grid. Each behavior’s location within the SAVI Grid is based on the type of information it carries and whether it helps, hinders, or is neutral with regard to effective communication. As shown in Figure 1, Attack/Blame falls in Square 1, “Fight,” the intersection of Column 1 (person information) and Row 1 (avoidance). For more information on SAVI, visit www.savicommunications.com.

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