Conflict Management Practice Notes

Contextualizing Disruptive Behavior in Health Care as a Conflict Management Challenge

Disruptive physician behavior has been defined by the American Medical Association as “personal conduct, whether verbal or physical, that affects or that potentially may affect patient care negatively.” It specifically includes “conduct that interferes with one’s ability to work with other members of the health care team.” Of course, it is not only physicians who exhibit disruptive behavior, and the challenge is to find a way of addressing any disruptive behavior in health care whether by health care workers or patients.

It is assumed that disruptive behavior by health care workers impacts quality of care and patient safety. How best to respond to disruptive behavior is less clear. This article explores the utility in framing disruptive behavior as a conflict management systems challenge.

Health Care as a Complex Adaptive System

I start by exploring the context for the disruptive behavior-health care as a complex adaptive system in which individual agents (physicians, nurses, administrators, medical staff, patients, families, insurers) have certain freedoms to behave in ways that are not always totally predictable, and whose actions are interconnected such that one agent’s actions changes the context for other agents. (Zimmerman BJ, Lindberg C, and Plsek PE. 1998.)

Conflict is an inevitable feature of relationships between agents in a complex adaptive system. Conflict is a sign that there are different perceptions about needs and how they will be met. It may intensify as a behavioral dispute with explicit disagreement. It is certainly a sign that the system has moved away from equilibrium and has reached a bifurcation or change point.

Change occurs both through design (and implementation), and also through self organization. However, the ability to facilitate change in a direct and controlled manner through design is limited. Typically, change occurs through self organization after the system has moved to a more volatile state-what some call conflict, and what some authors have described as the productive edge of chaos. (Milleman, Goya Surfing the Edge of Chaos, 2003)

If change does emerge through self organization it is reflected in the structure, process and pattern of the system. Making a change to a structural element-a new building, a new policy, etc, is relatively easy to achieve using a directive design and implementation approach. Working on processes-the domain of organizational development-such as communication, collaboration and teamwork is harder but can be accomplished through coaching and skills training. However, hardest, is changing the pattern of organization, especially those embedded in the organizational culture through mental models. In the context of health care this includes the beliefs that conflict is by definition a negative experience.

The idea that conflict is a negative is deeply rooted in most people’s mental models. It results in distancing behavior (around 50% of the time) and unproductive fighting for 30%. Only 20% of the time do we use it productively. (Milleman, Goya Surfing the Edge of Chaos, 2003)

Disruptive Behavior as Conflict

I have already shared the ‘in use’ definition of disruptive physician behavior as provided by the American Medical Association. It is explicitly behavioral and links to health care outcomes: negative patient care and interference with teamwork. Does it encompass conflict?

I define conflict as “differences about how expected needs will be met, usually manifesting in emotional tension and relational separation or combative behavior.” As such it encompasses a cognitive, emotional and behavioral dimension. When we think of conflict resolution we are normally thinking about the behavioral aspect. So it is not surprising that that the AMA focus is on the behavioral aspect. And yet, getting to a lasting resolution of a conflict typically requires that in addition to the behavioral dimension, we address both the emotional and cognitive aspects as well.

I also draw a clear distinction between a conflict and a dispute. A dispute is a disagreement after a demand has been made and rejected, in respect of the real or perceived differences.

The AMA does not list what behaviors are disruptive. However, it does encourage documentation of the behaviors in a policy with due process safeguards. Even without a list, this step represents a relatively easy structural change that can be managed and controlled to a high degree. Building on the work of Neff (2000), authors Porta and Lauve list the following as potentially disruptive behaviors:

• Profane or disrespectful language
• Demeaning behavior, such as name calling
• Sexual comments or innuendo
• Inappropriate touching, sexual or otherwise
• Racial or ethnic jokes
• Outbursts of anger
• Throwing instruments, charts, or other objects
• Criticizing other caregivers in front of patients or other staff
• Comments that undermine a patient’s trust in other caregivers or the hospital
• Failure to adequately address safety concerns or patient care needs expressed by another caregiver
• Intimidating behavior that has the effect of suppressing input by other members of the healthcare team
• Deliberate failure to adhere to organizational policies without adequate evidence to support the alternative chosen
• Retaliation against any member of the healthcare team who has reported an instance of violation of the code of conduct or who has participated in the investigation of such incident, regardless or the perceived veracity of the report

(Porto, G, Lauve, R, 2006)Disruptive Clinician Behavior: A Persistent Threat to Safety, July/August 2006, Patient Safety and Quality Healthcare)

For each item on the list there is an implicit expectation about how health care personnel should behave. When there is behavior that contradicts that expectation or when there is a perception to that effect, we have conflict. It is possible to infer that for each item on the list that there were differences about expectations. The Doctor wants to operate now. A nurse has concerns. The nurse asserts her concerns with some anxiety. The doctor responds in anger, and demeans the nurse. Even if it does not rise to the level of a dispute-the nurse demanding and the doctor refusing-it does not seem a stretch to argue that disruptive behavior can be defined as a conflict.

Historic Responses to Disruptive Behavior

Current organizational development efforts to address disruptive conduct still tend to focus on the actual behavior. Good behavior is rewarded. Poor behavior, punished. In contexts where there is a power imbalance between the organization and the disruptive employee, the historical trend has moved from the free use of power, to restraint through right based interventions (laws, policy, contract), and most recently through a collaborative mental model, to a focus on interests, needs and concerns.

In healthcare the relationship between hospitals and nurses typically exhibits a rights based approach: at will employment is subject to basic legal and contractual rights that cover working conditions and workplace behavior. Even where at will employment is in place, disciplinary codes are often progressive and provide some due process rights. In some states Unions play a role in the negotiation of disciplinary standards and procedures. Sporadic adoption of a collaborative approach to relationships with nurses is on the rise.

By contrast, doctors are often not employees and are often viewed as customers by hospitals. As such there is less of a power imbalance than is the case with nurses, and in some instances it can be argued that the doctors have more power.

Some aspects of the relationship between doctors and hospitals is clearly rights based with legal and contractual provisions governing the relationship. A license to practice medicine subjects doctors to specific legal standards and general standards such as the law of tort. Beyond that there are the criminal provisions that deal with behavior that in other contexts would be construed as assault!

It is also collaborative to the extent that mutual and competing interests are addressed through communication. The behavioral aspects of the relationship are not typically governed directly in the relationship with the hospital.

To the extent that disruptive behavior is motivated by a discriminatory intent or has a discriminatory impact it is unlawful under federal law, and most states have augmentary local legislation.

If we accept that disruptive behavior can be considered as conflict, what can the field of conflict management teach us?

Integrated Conflict Management Systems

In their seminal work, “Designing Conflict Management Systems”, Costantino and Merchant (1996) proposed that how organizational conflict is actually experienced should “be viewed as a subsystem within a larger system.” Until that book’s publication, the ways in which organizations dealt with conflict had not been recognized in terms of systems theory or named as discreet systems.

In 2000, the Society for Professionals in Dispute Resolution issued a report on organizational conflict management, titled Guidelines for Designing Integrated Conflict Management Systems. (SPIDR Guidelines) The SPIDR Guidelines advocated an integrated systems approach to the management of all organizational conflict.

An integrated conflict management system (ICMS) is evidenced as an ideal that exists through a coordinated and supportive method for dealing with all types of conflict, through multiple access points, providing a variety of rights and interest-based options, and creating a culture that welcomes dissent and supports collaborative negotiation to resolve conflict at the lowest level of intensity possible.

In an ICMS, the various parts of the system are not operating in isolation or indifference to one another. The tension inherent between the actual structure of the organization (manuals, handbooks, policies, etc.), and the living pattern of relationships (the shadow culture, blame, repeating types of conflict, etc.), is used and integrated through a variety of supportive processes (dialogue, negotiation, mediation, etc.). Most importantly, the tension is integrated in such a way that the emergent properties (such as reduced costs and claims, good morale, organizational learning, and patient safety) are productive.

To resolve conflicts early (before they become full blown disputes) participants need the skills to recognize the fact that there is a conflict, skills to respond respectfully, and skills to resolve the real differences that do sometimes exist. However, it is important to appreciate the different levels at which one chooses to focus. Ultimately, I argue, that focusing on conflict management at a systems level rather than on ad hoc individual situations is key.

Using the criteria of culture, expectations, skills and knowledge, support structures, rewards and consequences, and procedures and options I tease out the various aspects of an integrated conflict management system: Culture: Ideally an organization embraces conflict as a reality and rather than demonizing it, sees conflict as a sign of vitality and an opportunity for new insights and growth. Conflict is not avoided by the organization, and individuals feel comfortable giving feedback and having difficult conversations.

Expectations: Ideally the organization and its individuals know what is expected of them. Conflict management is recognized as a core competency and behaviors that are supportive and productive are incorporated in job descriptions. Employees conflict management roles are described and they have a sense of how their responsibilities mesh with the organizations-through clearly communicated vision, mission and value statements that are both general and conflict management specific.

Skills and Knowledge: Employees need to know how to deal with conflict from a communication skills perspective. They also need to be oriented to their conflict management options, and be able to make informed choices about which option to use and when. Conflict prevention, management and resolution should be recognized as a core competency.

Support Structures: Employees need easy access to support, especially when it comes to handling difficult conversations or challenging situations. Support can be provided in many ways and includes having people to listen, give procedural advice, and intervene to provide direction or to help a solution emerge. An organization that has a senior level conflict management champion is very fortunate indeed.

Rewards and Consequences: It is one thing to say what is expected, another to give employees the skills to reach those expectations, but if no system is in place to monitor performance on an ongoing basis change is unlikely. On the other hand, once a performance review system starts tracking conflict management, the leverage for change is great.

Procedures and Options: A healthy conflict management system provides a variety of procedures for employees to deal with all conflicts. Interest-based options such as discussion, negotiation, and mediation are used most of the time. Rights based options like investigations, arbitration and litigation are used as a back up. Power plays are the last resort. Importantly, procedures and options are provided to employees but also to vendors and clients. The fact that Doctors are not employees does not prevent the negotiation of a dispute resolution procedure.

Integrated Conflict Management for Health Care?

Health care organizations are exploring more interest based approaches to managing employee, but also medical malpractice disputes. As regards the latter, disclosure policies, early resolution, mediation and ombuds programs have started to emerge as adaptive responses both in large health care systems such as Kaiser Permanente, but also in smaller community hospitals.

In the arena of employee or workplace disputes, organizations are revising their policies to introduce progressive disciplinary steps, making in house and at times, external mediation services available both for individuals and teams that are experiencing conflict. Importantly they are providing more and more soft skills training in the areas of communication, negotiation and conflict resolution and team management.

As I have already noted the situation is complicated by the fact that doctors are often not employees. However, that does not mean their relationships with health care organizations exist in a vacuum. In addition to the contractual relationship there are laws that govern their behavior.

As Porto and Fauve note, responses to disruptive behavior is often seen as ineffective because “organizations have not implemented a comprehensive and consistent plan that addresses all the pertinent issues and provides sufficient options for intervention.”

In many ways that is the thrust of an integrated conflict management system. All conflict is welcome. Failure to provide a place to go is considered a fatal error. Saying that we will address certain conflicts but not others sends the wrong message and typically the lack of a forum does not make conflict go away. The other aspect that deserves recognition is the appreciation that a variety of options for intervention must be provided. In organizations with a rights based emphasis this means that the formal investigation will not always be appropriate. Equally, mediation, coaching and other interest based interventions must be available but only used when appropriate.

Organizations that appreciate the value of a different relationship to conflict, that recognize that conflicts are excellent learning opportunities, and that using a combination of avoidance and power plays is not the way to develop a culture of respect, mutual support and learning, will typically start by reviewing all policies and procedures in place that have something to do with conflict management.

Based on the review of their own practices and best practices from Health care and other related industries, a new procedure for managing conflict is drafted with input from as many stakeholders as possible.

Best practices from the field of organizational conflict management offer integration and coordination strategies vital to a program’s success. This article has focused on the elements of an integrated conflict management system as a way of managing disruptive behavior. What differs from organization to organization is the extent to which members are conscious of their conflict management systems. There is a sense that health care is ready to embrace conflict management as an ally for patient safety.

Calming Techniques

In a previous practice note I suggested that there are two ways we can approach our penchant for reactivity when we are triggered. One seeks to address why it is that we are triggered in the first place, the more deep and long term solution. The other focuses on the moment that we are triggered, and seeks to restore short term balance. It is really the symptomatic response-the band aid-that helps the person in conflict calm down, and release the primal grip of the amygdala so that the cortex can come into play. This practice note focuses on techniques for calming down.

The range of these techniques is informed by our understanding of the physiology and neurobiology of stress and relaxation. When a man or a woman is triggered and experiences stress the sympathetic autonomic nervous system is activated and with it a series of typical physiological reactions: dilation of pupils, inhibition of salivation, constriction of blood vessels, acceleration of heart beat, relaxation of airways and inhibition of indigestion. Our bodies prepare for fight or flight. More recent studies of woman under stress have led to an appreciation of gender differences in the stress response and how women will also exhibit ‘tend’ and ‘befriend’ behaviors.

The autonomic nervous system predates the development of the cortex and is essentially driven by the constellation of inner brain structures referred to as the limbic brain, most importantly the amygdala. From a neurological point of view the danger is that when we are triggered and experience a stressful event, our cortex with its capacity for social restraint, alternative analysis and conscious choice is compromised, and we are literally hijacked by the amygdala. We become stuck in a stressful emotional reaction.

An awareness of the early signs of being triggered is vital to being able to calm down before we are swept away by strong emotions. Ideally we are able to self monitor ourselves, but it is not unusual for friends and partners to provide that vital feedback-“you are going red in the face and your lips are tight”; “you are pale and look like you saw a ghost” or even “I notice tears welling up.” Amazingly the person experiencing any of these three physical reactions may be unaware of their anger, fear or sadness at a conscious level.

Assuming that we do gain conscious insight to our physical reaction-whether through self monitoring or through third party feedback, what are techniques that we can employ to calm down?

Breathing

Of all the techniques, probably the most powerful is our capacity for conscious breathing. When we pay attention to our breathing we can shift our physiological reaction and start to calm down.

Breathing is powerful for a number of reasons. Firstly, we can only breathe in the present. So, when we focus on our breathing our capacity to project to the future (as we do in fear) or to the past (as we do with anger) is limited. Secondly, our inhalations stimulate the sympathetic nervous system, and our exhalations stimulate our parasympathetic nervous system. The latter is referred to as the ‘rest and digest’ response. For the most part it produces the opposite physiological reactions to the sympathetic nervous system. So when we breathe deeply into our diaphragm, and make our exhalation longer than our inhalation, we are in affect shifting the balance toward the parasympathetic and a more relaxed state. A third benefit of deep (diaphragmatic or abdomen breathing) rather than shallow (chest) breathing is the amount of oxygen we inhale. When the brain is well oxygenated it functions better. In addition, chest breathing creates shorter, more restless brain waves, while abdominal breathing creates longer, slower brain waves. Longer and slower brain waves are similar to the ones your brain makes when you are relaxed and calm.

People employ a variety of breathing practices to achieve this. Some count their breaths; others focus on their breathing in a manner that ensures that breathing is a continuous loop, while others focus on the movement of their bellies in and out with each deep and purposeful breath.

Mental Visualization

More than anything, our capacity to focus the attention of our mind on something enables us employ a range of techniques that do not require physical exertion. Mental visualization is an example It is a powerful tool that can easily be demonstrated using biofeedback devises that track your heart rate. If at the point you become aware that you have been triggered you imagine a scene in which you feel comfortable, content and at peace your heart rate will drop and you will relax. Your body is reacting to the imagined scenes as if they were real, rather than to the situation that triggered you. The more vivid detail you focus on the better. It helps to identify the scene you plan to use in advance of being triggered. Examples include a tropical beach, a favorite childhood spot, or a quiet wooded glen.

Meditation

Meditation is another useful calming technique that relies on the power of our mind to focus attention. Numerous scientific studies have established the power of mediation to relax the body and reduce the impact of stress. To meditate, sit in a comfortable place, close your eyes, relax your body, and focus your attention on something for a period of time. A limitation is that it is difficult to employ ‘in the heat of the moment.’ However, it has great utility during breaks-even as short as 5 minutes, and certainly at the end of the day.

Distraction

Both mental visualization and meditation could also be described as distraction techniques. In effect you are distracting your attention from that which is causing the stress reaction to something that has the opposite effect. However, it is also helpful to think of the power of distraction all on its own. When a mother waves a teddy bear in front of her crying baby she is a distracting technique. When a police officer asks an angry citizen to remember the factual details of what happened, he or she is using a distracting technique. When you try and count back in multiples of 23 from 1 000 345 678 the next time you are angry you are using a distracting technique.

Progressive Muscle Relaxation

Other calming techniques rely on some form of physical exertion. This makes sense when we consider that the fight and flight response is preparing us for some form of physical action. One of the challenges, especially in the modern office environment, is that our opportunity for exercise while we are being triggered is limited. Often we are in meetings, on the telephone, or behind a counter.

Progressive muscle relaxation is a technique that involves the systematic tensing and relaxing of muscle groups This technique is easy to do, even if you are behind a desk or on the phone. Importantly, it can help you calm down by relaxing the major muscle groups in your body.

Next time someone pushes your buttons in a meeting try tensing and relaxing your feet –one at a time, then your legs-one at a time, then your hands-one at a time. Just that will help. For a full ‘treatment’ you would ideally begin with your facial muscles and work down through the shoulders, arms, chest, legs and feet.

Exercise

Any exercise that you can do, at the time of, or soon after you have been triggered will help. This can be achieved by requesting a break-and then using it to take a walk or doing a few press ups in your office. Sometimes you can invite the person you are having the difficult conversation with to take a walk. Not only will the exercise help you, but also them!

Conclusion

We are all triggered from time to time. Unless we are aware that we are being triggered there is not a lot we can do. Fortunately there are a range of techniques available to us to help us calm down and regain our centered, balanced state. Practicing our technique of choice will go a long way to help out in the most difficult of circumstances.

The Importance of Follow Up

One of the reasons that coaching has become so successful is that we contract out accountability for our goals to another person. That person-the coach-checks in with us on a regular basis to see how things are going without taking responsibility for the accomplishment of the goals themselves.

When we follow up after a mediation that has produced an agreement, we are essentially doing the same thing. We are not taking responsibility for the implementation of the agreement, but we are creating a forum for participants to report back on how things are going and to explain both the successes and challenges since the agreement was reached.

There was a time when I considered a follow up a courtesy, something non essential but ‘good’ to do. More and more, I am of the view that follow up is a vital part of any mediation, especially in workplace mediations where the disputants have worked out new behavioral arrangements.

Reasons to Follow Up

First and foremost it signals care. The participants know that you share in their desire to succeed. In addition, it signals your realism. We all know how hard it is to change habits. Over time, people develop dysfunctional ways of relating to one another. Agreeing to change behavior is one thing. Actually changing it is another. It also signals an opportunity. Fine tuning an agreement or making adjustments based on lived experience is not a sign of failure but of maturity. By following up you are creating an opportunity for the participants to trouble shoot and consolidate lessons.

The entire focus of the follow up meeting is learning. Following up is not about blame, but continuous improvement.

How to Follow Up

My preference is to follow up about 45 days after a mediation has produced a behaviorally specific agreement. Sometimes I check in with each of the participants by way of a phone call. At others, I actually convene a meeting where we all share how things are going.

I establish rapport by listening reflectively to whatever is said when I call or we start our meeting. As much as possible I validate emotions and explore whether it is possible to reframe any frustration as care, disappointment as commitment, and anxiety as courage.

Once I sense that the participant/s are comfortable and ready to open up, I orient them to what we are about to do. I remind them that the process is still confidential and may use open ended questions such as:

• What aspects of the agreement you reached have been working well?
• What have you done differently since reaching the agreement?
• What has the other person done differently since reaching the agreement?
• What aspects of the agreement are causing frustration/disappointment/anxiety?

I may also used close ended questions, as needed, such as:

• Have you been following the terms of your new agreement?
• Have you been meeting regularly as proposed?
• When last did you look at the agreement?

When we follow up in a shared meeting I get participants to share specific situation that have been challenging. Based on what they share, we may do some additional skill building and then I have them do what I call a ‘Take Two.’ They get to replay the situation and with some supportive coaching and encouragement, see that it could have worked out differently.

Conclusion

To make sure that follow up gets the respect that it deserves, I now include it in my proposal when asked to mediate. I explain that it is an important part of the process and just the way that I work. In many ways, mediators are like coaches, asking the accountability questions, while leaving decision making and implementation responsibility where it belongs-with the participants themselves.

Managerial Mediation and Arbitration

I will always be indebted to Dan Dana for introducing the concept of the manager as the mediator to me. It formed the basis of his powerful training – with the same name- that helped shift the managerial paradigm for thousands of managers who have benefited from his training. Dan was the pioneer who blazed the trail.  In this short practice note I want to consolidate and reiterate his fundamental insights, and of course add my two cents!

A review of the history of conflict management in the workplace suggests that the way in which decisions that impact the employment relationship have been made, have shifted from a focus on the power dynamics, to who has the legal or contractual right and finally to what is in everyone’s best interest. Yet there is a way, like the evolution of our triune brain, in which each iteration has built on the other. So to talk about a purely interest based approach does not make sense, as the rights and power dynamics are always being considered, if not consciously, then unconsciously.

In fact, Managerial Mediation represents an approach to addressing workplace conflict that is supportive of interest based relationships, yet also addresses rights and power. It allows managers to bring employees together with the stated purpose of reaching an understanding based on what is important to them (their interests) within the bounds of the law, contract, and policy (their rights), without the manager having to impose the decision him or herself. It does so within the context of the existing power differentials that do exist between the employer and the employee, between the supervisor and the employee and even between two peers (their social power).

Managerial Arbitration also has the potential to address power, rights and interests. It is an approach where the manager brings employees together, listens to their ‘stories” and makes a decision for them based their status in the organization (their social power), their rights (by virtue of applicable company contract, policy, and law) and finally, but to a lesser extent, their and the managers own interests.

The vital difference that makes the mutual decision of the employees’ superior to that of a decision imposed by a wise manager is that there is buy in through commitment to their own decision. In addition, when we create a forum where the perception of right and wrong will be inferred from a decision, as is the case with arbitration, the communication that takes place is more likely to be adversarial and combative. By contrast, when managers facilitate two employees trying to work something out, as with mediation, the communication is open, there is more opportunity for reflective listening, and of course creative problem solving.

Finally, and this to me represents the new frontier, organizations are showing a willingness to address the emotional impact of their decisions. They are recognizing that when decisions are based on power, rights and interests alone, they settle the issues, but don’t necessarily resolve or reconcile them. If Managerial Arbitration was spread thin in its attempt to address interests, then it is really found wanting when emotional impact is considered. Managerial arbitrators of right and wrong, who adjudicate and impose decisions in the way they manage do not typically take into account an employees feelings.

By contrast, the manager as mediator is able to facilitate an approach that is informed by it all-the power dynamics, the rights at stake, the interests at the heart of it all, and significantly the way everyone feels about it. When they are successful, the employees address their challenges in ways that generate creative solutions that last.

It is worth remembering that if managerial mediation doesn’t work out-whether through a lack of skills, time or even willingness, the manager can always revert to the more directive managerial arbitration route and impose a decision.

From Reaction to Response: Conflict As A Choice

Once we embrace that conflict is inevitable in social relationships, the question we have to ask is “how do we respond?” Responsibly, we’d hope. Yet, for the most part, when we are in conflict, we are not very responsive, and tend to be reactive. Shifting to a responsive approach to conflict is easier said than done. When we are in conflict situations, we are typically being triggered and reverting to our unconscious conflict handling scripts.

What’s the difference between a responsive and a reactive approach? When we respond to the challenges of life-including our conflict situations-we take responsibility for our role in the situation, we are in tune with what we are feeling and why, and our thoughts, words and behaviors are conscious of the bigger picture. By contrast, when we react, we shift responsibility for the situation to the other through blame; we assume the victim role and are ‘justifiably’ carried away by powerful feelings like anger, fear and grief. We use an unconscious template for reaction that seeks acknowledgement, justice, restoration, and even revenge.

One of the reasons that it is so hard to be responsive is that we experience and are typically exposed to unproductive conflict scripts from the time of our birth. Our earliest lessons come from the approach our parents take to their own conflict, our experience of how our parents deal with us, and as we grow up, through our interactions with siblings, friends, colleagues, teachers and bosses. If we struggle to deal with our differences with the aid of language, try and imagine how hard it was during those early pre-verbal years when we didn’t even have a word to describe conflict.

As a species we have achieved great physical and mental milestones, and yet when we are threatened by another’s behavior-as is typically the case in conflict-we reveal how immature we are emotionally. It is as if we revert to our childhood mentality when we are triggered.

Knowing this at an intellectual level is one thing. Being able to shift our physical and emotional behavior from reaction to responsive choice when we are actually triggered is another. If only, because when we are triggered, we are by definition not in our most conscious state. Our well worn neural pathways take us away from the perspective taking cortex, into the reflexive limbic structures such as the amygdala. We are in a reactive survival mode.

As modern neurologists, such as Antonio Damasio, have helped us understand, emotions are enmeshed in the neural networks of reason. In other words, there is no such thing as a decision free of emotion. Yet in our culture, we continuously hear expressions that extol the virtue of not making emotional decisions. This is one of the great challenges of our time-how to mature emotionally, such that we can make responsible emotional decisions about how to deal with our differences (aka conflict).

There are two ways we can approach our penchant for reactivity. One focuses on the moment that we are triggered, and seeks to restore short term balance. It is really the symptomatic response-the band aid-that helps the person in conflict calm down, and release the primal grip of the amygdala so that the cortex can come into play. There are a variety of calming techniques that help with this. Until the next time we are triggered!

The other is more causal and seeks to transform the trigger mechanism itself. This approach is centered on taking responsibility for our own emotions and learning new templates for our emotional responses. It relies on the inherent plasticity of the brain to rewire its well worn templates.

Stuff happens. We all experience pain and discomfort. The shift is in seeing that when we are triggered, it is not because of something out there that is happening, but rather the interpretation we give to the situation. A blue sky can mean hell for a farmer desperate for rain, and joy for a sunbather at a beach. What triggers one, will not necessarily trigger another. Playing the victim is a choice. And when we do, it feeds into our tendencies to react.

If we can make the shift from victim to navigator of the quality of our own experiences, we can start to work with the energy of the emotion. So often we suppress what it is that we are feeling, or just give our emotions free reign. Both of these reactions are tempting, but do not help shift the trigger mechanism. In fact the unresolved emotional energy continues to seek release and sets in motion the characteristic spiral dynamic of destructive conflict.

Gestalt therapy has a simple suggestion for change-feel what you are feeling. It is only when we are able to experience where we are emotionally that we can move somewhere else. Some find this scary. Imagine, allowing yourself to feel the anger. Almost immediately you tell yourself to be bigger, and to show compassion. Or if you are disappointed at a friend, you chastise yourself for being judgmental. Yet, to change the way we are triggered, we must allow ourselves to feel what it is that we are feeling.

This does not mean that we wallow in our feelings. We use the attention of our mind to focus and clearly identify what it is that we are feeling. If we are able, we trace back in time, other experiences where we were triggered in a similar manner. You have probably heard people asking in exasperation, “why does this keep happening to me?” It is because they are carrying unresolved emotional energy that in all probability will take them back to an incident that occurred in the earliest years of their lives.

Once we have identified the emotional signature that we associate with the trigger, and explored its commonality with other life experiences, we can allow ourselves to feel the emotion, ideally with a mind that is compassionate. In other words, we do not judge ourselves for what we are feeling. When we can do this, the energy of the emotion can move, and not be hijacked by limiting neural structures like the amygdala.

When we allow our feelings, when we start to experience them fully, and to welcome them into the neural hallways of reason, we can start to respond in a more mature way to our life challenges. We are able to take the stock of the bigger perspective and incorporate the significance of what is happening to us right here, right now.

As long as we have unresolved emotional energy, we will always be triggered by this or by that. Each of us discovers through his or her triggers, the areas that seek integration. When we allow these situations to morph into conflict situations, we have choices. One path takes us toward the well worn templates of reaction. Another takes us toward calming techniques, and ways that work with (not against) the energy of the emotion.

This path is not easy, for in the moment of being triggered we are outraged that we are being treated the way we are. The situation in our mind rises to a level that demands a reaction-and when we don’t get the ‘response’ we expect, our ire only increases, and we set in motion the destructive cycles that we ultimately call conflict. A shift that is honest about our proclivity for reaction and which moves us toward-not away- from our emotions increases our chances of a conscious response to the challenges of the inevitable conflict that comes our way.

Being aware of the difference between a reactive and responsive approach is the start. Then the hard work begins. As we uncover the contours of our unconscious conflict handling scripts we can begin to shift. We learn how to calm down, to take responsibility for our reactions, and hopefully to feel what is going in a wholesome manner that doesn’t exclude our most creative problem solving capacities.

What Would An MBA Student Do?

Exploring alternatives with disputants (the things they can do on their own away from the table) requires tact and is best done after high levels of rapport have been established. Given the sensitivity of the communications, it is often done in the privacy of separate meetings (caucuses). Another frame we often use to describe alternatives analysis, is reality checking. We help the disputants explore the consequences of not reaching an agreement at the mediation and make their own informed decisions.

If the parties are represented, their attorneys can play a valuable role and become a mediator’s ally. You ask the questions, and the attorney answers them. As a simple example of what I mean, consider how helpful it is to be able to ask an attorney:

• How long do you think it will take to get to trial?

• And, will that forum-the court of first instance-represent the end of the road if you ‘win’ in court?

• By the way, if you are not willing to guarantee the outcome to your client, how confident are you that you will ‘win’, expressed as a percentage?

All of these questions are important reality checking questions that help the disputant explore the classic alternative (court) and are better answered by someone other than you, and importantly, by someone they trust. In a legal setting, normally that person is their attorney.

But what if the disputants are not represented?

As a mediator, answering any of these questions can be dangerous if only because it many appear that you have an agenda. You are trying to convince the disputant to settle because it will take so long, or because you don’t think they have a strong case. If that perception forms you will have compromised your perception of even handedness.

I once mediated a dispute that involved legal issues, and for which an EEO complaint had been filed. However, neither the complainant-a high ranking employee who was still employed, nor the manager were represented at the mediation.

When we got to the stage in the mediation where it is customary to reality check the disputants alternatives, we stayed in a joint session, and I commented that it was actually a pity that neither side was represented in the mediation. I explained that if we were going to reach a settlement they would have to conclude that what they worked out together was better than going to court. And that answering the questions that I would normally pose to their attorneys would compromise me.

They seemed to get it, but both reiterated that their counsel had told them they had strong cases. As mediators know, when impasse occurs you have to do something different. Clearly, being transparent about my dilemma wasn’t going to carry the day. I needed to change tack.

It then dawned on me that while attorneys were credible in this situation, the legal issues were not that significant, and that what it really came down to was whether it made business sense for them to litigate over the dispute.

I needed to introduce an agent of reality that would get them to shift.

Knowing that they were both business majors, I asked, what they thought an MBA student would recommend, if they were presented the fact patterns that they had presented to me. In other words, I was asking them to write a paper on what they thought the best course of action would be. Would they recommend settling and making peace or would they argue for litigation and all out war?

It worked! I could see the dissonance forming before me. Of them realizing that the brightest students would be saying, compromise, find a way to work this out and take care of business in a manner that felt fair to both.

As is so often the case, once the let go of the fight and committed to working out a solution, they were able to. I’m not saying it was easy, and that they just rolled over. But they were determined to work something out before I left.

As we finalized the terms of the memorandum of settlement they both joked with one another that it was those MBA students that had got them! Never discount the importance of reality checking, and of finding a credible agent of reality, even if they are not able to make the mediation!

Tears In Mediation

It is only a question of time before someone cries during one of your mediations. For a new mediator this can be unsettling. What does it mean and what intervention options are available and indeed advisable?

Someone once said to me that tears on the outside are a sign of healing on the inside. If we remember that when people are stuck in conflict, it’s almost like they are frozen, then tears can also be a sign that they are starting to thaw, and change. Both these frames to look at tears suggest potential, and that as a general rule, tears are a good-not bad-thing.

In my experience, being comfortable with crying (like the exhibition of any strong emotional states) and being able to fully validate what it is that the person who is crying is feeling, can go a long way to facilitating a lasting resolution of the conflict.

Ken Cloke (an insightful thought leader in the field of conflict resolution) has articulated how there are different levels at which we can resolve a conflict. It starts at a physical level when the parties stop fighting. The image that always comes to mind is of two children being pulled apart.

We can settle the issues-as we typically see happening in a court arena. At a cognitive level, there is agreement on what needs to be done. Another good example is the way the dispute between Israel and Lebanon was resolved in 2006. They stopped fighting, and resolved the border dispute. I think we are all know that the conflict is still simmering.

Getting to a lasting resolution requires that we traverse the emotional waters and deal with our pain and discomfort. This is not easy. For the most part our emotional templates were developed when we were young and unless we have worked on increasing our emotional literacy, we and the disputants we encounter in mediations will be unaware of their templates.

If people are to move beyond their anger, grief or fear they must feel it. Suppressing or sedating emotional pain or discomfort doesn’t work over a long period of time. Tears are typically a sign that the emotional pain and discomfort are being addressed –that a thawing or healing is taking place.

The cynics amongst you will correctly point out that tears can also be used to manipulate and deflect responsibility. Even if that is true at times, my view, as a mediator, is that something significantly upsetting is still occurring, and that the tears remain a sign of desperation that should be validated with respect.

Beyond validation-letting the person know that their emotional response is valid from their perspective-we should consider whether to meet with the person who is crying in private. However, beware of sending a message that tears are not a good thing, by ushering the person away.

Given that crying can constitute a loss of face for some, and that they would prefer the opportunity to cry in private, it is wise to check in and get a sense of what is needed. When someone’s tears follow what appears to be an ambush, or where they feel out of control, meeting in private may be a good idea.

Obviously, having handkerchiefs is a good idea, but offering them should not necessarily be the first response. Better to anticipate and have them available. Offering them can imply that the response is inappropriate and worse, take the person away from what they are feeling.

Beyond the more intuitive reasons to value tears, it is interesting to know that from a physiological point of view tears are a way that the body releases stress related hormones like cortisol.

So the next time you notice someone start to tear up during your mediation, see is as an opportunity to address the emotional energy. Be sensitive, and work to validate the emotions associated with the tears. It could be the very thing that helps the parties reach a lasting resolution.

How to Recognize Conflict Situations Early

Conflict is inevitable. Disputes are not. A dispute begins when someone makes a claim or demand on another who rejects it. For the most part when people think of a conflict, they are already in a dispute. Being able to distinguish between a conflict on the one hand and a dispute on the other is a key skill. If we want to address conflicts early, before they become full blown disputes, we have to know how to recognize them early.

Most definitions of conflict focus on the substance of the conflict-the fact that there are differences about resources, communication, roles, etc. For example, conflict may be defined as differences about how expected needs will be met.

However, there are two other dimensions of a conflict that are often neglected-the psychological and procedural. If we expand our definition to include them, we increase our capacity to detect conflict early.

Let’s start with the psychological dimension. We all know that conflict surfaces a range of emotions, typically those that fall within the negative range of the spectrum, like anger and fear. We often experience awareness of these emotional states before we have cognitive awareness that we are in a conflict. So if we use emotional tension as an early warning sign we are going to be ahead of the game.

Turning to the procedural dimension- When all is said and done, there are really three core responses to conflict- some form of avoidance (flight), some form of combative engagement (fight) and some form of collaborative engagement (talk). Again, we often exhibit or see others exhibit these behaviors before there is awareness that there is a conflict.

So, next time you notice that you have a negative emotional charge in respect of someone that you didn’t normally, and that you are starting to avoid them, then chances are that there is a conflict brewing. Now is your best chance to do something.

That is, if you want to head off a dispute, which is really a conflict that has moved from a difference to a disagreement.

Welcome!

This new blog is the result of feedback I received from readers of my Conflict Managment E-Newsletter. Many indicated that they wanted me to write more, and to share my pracitical insights about the management of conflict through articles, case studes, practice notes, and in the form of tips.

I have created a number of categories that appear in the left hand navigation bar. My intention is to add at least one new entry a month that will address the categories that I have created.

Please feel free to comment and add your thoughts as we go along.

With appreciation for your support,

John Ford