Yes = score as shown
No = zero

Score:

More than 60 – you have excellent functioning as a partnership, well done!

Around 24 – you have adequate functioning, but it could improve!

Less than 10 – you are running into serious trouble and need to take action.

© CPDForum, 2010

Things change. Nothing is ever the same.

This is a simple fact of existence and one which we struggle against and resist.

We resist it because it means we can only ever stand on shifting sand and nothing can be taken for granted, and this is a painful and demanding truth to live with.

In order to live with it we create habits of mind and habits of action and create social structures which provide reassurance and safety.

The downside of these habits is that we can easily trap ourselves in empty routine, and rob life of its magic and excitement.

This is certainly true of relationships where we can substitute the real pleasure of constant discovery and communication with someone for the dull ritual of the known and tried. We can easily slip into habitually negative ways of relating to people which are unproductive. We can habitually not take action to correct difficult relationship issues. We can decide that our relationship with Ms, Mr. or Dr. X is thus and therefore impossible to change or modify.

Often poor relationships are powered by unresolved issues, and deep-seated or historical difficulties will need to be uncovered and repaired before improvement can take place.

The important factor in common in all such scenarios is our own willingness to change, to embrace the idea that change is desirable and to understand that the only person we can change is ourselves.

One of the most important requirements for change within an organisation is the culture of that organisation. This can be difficult to achieve but is possible providing your team is resilient enough.

Becoming conscious of inner states

A simple way of increasing awareness of inner states is to pay attention. Attention can be directed at feeling, at breathing, at physical aspects or by asking oneself ‘What is it I want to do right now?’ Or ‘What thought is uppermost in my mind right now?’ If one is unused to paying this kind of attention to oneself, then some things will be easier to focus on than others.

Often people don’t know what it is they are feeling although they may be aware of tension. Others may be unaware of tension but not notice that their breathing is shallow and depressed.

The idea of focusing attention is not to make whatever is being experienced disappear, but to simply notice what is there and use that recognition to make a more informed choice about the actions or non-actions which follow. Here are some examples:

Paying attention to feeling

You are in your consulting room or office organising it for the next day. As you reach for the diary or click through computer files notice, how do you feel about it? Focus on the whole activity. Do you want to be in the room? How does the decor affect you? What about the lighting? Are you enjoying the experience of setting the room up? Are you thinking about something else? How do you feel about the people you are currently treating or working with? Are they good to spend time with? Are they still strangers? Do you feel any good connection with them? Any attraction or repulsion to individuals? Are you happy with the way you are relating to them as a whole? Could you articulate what that way is? If so how did you do it? If not, what prevents you? Can you identify any of your responses to these questions as something which you do habitually? Can you change just a tiny aspect of your habitual behaviour so that it becomes more under your conscious control?

Paying attention to breathing

You are talking to some colleagues about the benefits of rescheduling appointments. The discussion becomes polarised with some supporting its adoption in certain circumstances and others being vocally against. You think you take the middle ground but when you check your breathing you discover it has become shallow and rapid. If you take this as an indication that your normal, balanced state is out of equilibrium in some way, are you able to identify quite how? Are you excited because you are about to go into intellectual battle? Are you disturbed by the disagreements? Are you angry with one side or the other because you agree or disagree? Is it the way the argument is being conducted? What do you want to happen next? Are you able to achieve that desire in any small measure?

Paying attention to physical aspects

You are having coffee with a colleague and you start to recount an incident which occurred with someone the previous day. As you talk you notice that your left hand continually massages your right shoulder and that you are blinking rapidly. Again these might be indications of some internal disequilibrium. Sometimes a useful way of discovering more about this internal state is just to start a sentence either to yourself or out loud which describes what you are doing and then continues it. For example ‘I’m rubbing my shoulder because I feel that I should not have had to intervene as I did and I’m consoling myself.’or ‘I’m blinking rapidly because I’m feeling tearful about what happened.’ Exaggerating the movement that you notice also helps to clarify how you are feeling particularly if you then describe either the movement of the feeling it induces.

Noticing what you want to do

You are in a meeting with colleagues. The meeting has got bogged down in a fruitless discussion between two people about a seemingly insoluble problem. What is your inclination? Do you want to help them? What does help mean? Would it be helping them if you ‘helped’ them or would it in fact be more helpful to let them struggle a little longer with each other? Are you able to arrest the action you intended long enough to question both its wisdom and its possible outcome?

Noticing what you are thinking

You go to a clinical meeting. The speaker is a woman in her late forties. You notice yourself thinking, ‘I like her voice’. Perhaps you could ask yourself some questions about this thought such as ‘Does her voice remind me of anyone’s?’ ‘What is it about the voice I like – pitch, timbre, nasality, pace – and why do I like it?’ ‘Why should a voice be important?’ ‘Are voices important to me generally?’ ‘How would her voice have to change to make it less acceptable to me?’ ‘Do I like my own voice?’ ‘Is there something ‘I’d like to change about that?’

Paying attention is a simple step towards increasing self-awareness, rather than allowing ourselves to be flooded by the ebb and flow of the tides of emotion that sweep through our lives in a seemingly chaotic way. This does not imply that what we become aware of must be changed, but heightening awareness increases the range of possible choices, and thereby shifts reaction to informed response.

First and foremost it means that to achieve well-balanced, nurturing, enjoyable working relationships, deficiencies in emotional competency will need to be identified and strengthened. You will need to take a good, unflinching look at habitual attitudes, responses and ways of relating to see whether these have become negatively entrenched and unproductive. There are many ‘personality’ type quizzes which point in this direction, but infinitely more telling are some simple, basic questions:

1. Are you happy with your GP colleagues?
2. Are you happy with the staff at your practice?
3. Can you trust the people you work with?
4. Can you speak openly and freely about your concerns with them?
5. Do you like them?
6. Do you feel liked?
7. Do you feel valued?
8. Do you value those with whom you work?
9. Do you feel that your working relationships nurture you and ease you through your day?
10. Do you feel that you nurture others at work?
11. Do you think you are easy to get along with?
12. Is work a place where you experience enjoyment with others?
13. Do you feel part of a team?
14. Are you happy with yourself in your role in the practice?

If your responses to these questions is largely negative and you want to change this, then a good way to make a start is by looking at your own current behaviour.

A willingness to heighten one’s awareness of current behaviour patterns is perhaps the most significant move one can make in the direction of strengthening emotional competence.

It is often the case in General Practice, as for other busy professions, that the clients get the lion’s share of the nurturing, considerate, caring side of the team, leaving little available for colleagues.

Remember that in all relationships with others the only person you can change is yourself.

The Concept of Emotional Intelligence

Heron (1975) defined emotional competence as the ability to help others without attempts being driven or distorted by our own accumulated anxiety and distress. In his 1995 book ‘Emotional Intelligence’ (EI) Goleman extended these ideas by isolating the faculties contributing to this core competence. They are:

Self-awareness

Being able to recognise ones own feelings, to build a vocabulary for them and to know the relationship between thought, feeling and action.

Personal decision-making

Examining actions to predict possible consequences. Being able to know whether action is ruled by feeling or not and whether this is appropriate.

Managing feelings

Being aware of negative inner voices. Recognising projections and personal emotional triggers. Knowing how to deal with negative affect such as jealousy, anger and fear.

Coping with stress

Knowing when one is stressed and having strategies to manage it.

Empathy

Recognising, accepting and understanding the feelings of others.

Communications

Being able to talk about feelings easily without shame or fear. Owning and taking responsibility for feelings and being able to discriminate between one’s own feelings and those of other people.

Insight

Being able to identify and understand one’s own habitual behaviour and that of other people.

Self-acceptance

Feeling comfortable with oneself and one’s strengths and weaknesses. Having the ability to laugh with others and to laugh at oneself.

Personal responsibility

Taking responsibility for one’s feelings, for the consequences of one’s actions and honouring one’s commitments.

Assertiveness

Being able to state one’s concerns and feelings without emotional overload.

Social skills

Being capable of taking an assured part in all kinds of social interaction including being a group member and leading a group.

Conflict Resolution

Being able to recognise and face conflict situations and having strategies to deal with them.