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Chapter 10 and 11 Notes

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Chapter 10 and 11 Notes 225

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Listening Behavior
Study Guide
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This 13 page Study Guide was uploaded by diamond tirado on Sunday April 24, 2016. The Study Guide belongs to 225 at Eastern Michigan University taught by in Fall 2016. Since its upload, it has received 26 views. For similar materials see Listening Behavior in Computer Programming at Eastern Michigan University.


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Date Created: 04/24/16
Chapter 10 Notes * doctors tend to only let their patients talk for an average of 18 seconds, a decade later, it increased to 23 seconds; 15/16 of the patients who were interrupted failed to resume what they were talking about after they were interrupted * THE IMPORTANCE OF HEALTH COMMUNICATION * good doctor-patient communication leads to lower blood sugar levels in diabetics and lower blood pressure in hypertensive patients * infant “wasting-away” disease marasmus was found to be directly caused by a lack of nonverbal touch communication between baby and caregiver; without tactile stimulation, infants actually died - today we refer to this type of problem as failure to thrive; cure is active communication with the child *we have to be able to communicate our symptoms and physical ailments; good communication leads to improved symptoms, and results in improved management of chronic diseases; our overall satisfaction with both the people and the process of health-care delivery is directly related to good communication * satisfaction affects a number of patient-to-doctor communication factors, including the level of respect we feel toward health professionals as well as the level of openness we have with them; especially important for individuals with low health literacy * health literacy involves the ability to read and write, and also having access to health information as well as the willingness to research and use it effectively * social changes have also affected how we approach health care and have resulted in major changes in how health care is managed; managed care was introduced to cut costs th * social changes have also affected our perceptions of physicians; beginning of 20 century, doctors were viewed as godlike individuals who dispensed good health;paternalistapproach – good patients did not question their physicians, and they were expected to do as they were told * 70s, 80s, and 90s, attitude toward doctors shifted as did their relationships with patients; many doctors and patients developed and expected a moreconsumeristicapproach; patients were expected to actively participate in their health * today, patients and physicians are encouraged to take a more collaborativeapproach, jointly working toward good health LISTENING AND PSYCHOLOGICAL WELL-BEING * most prevalent approach to counseling today is the patient- or client-centered approach - focuses on the client as the primary source of identifying means to solve his or her problem * quality of the relationship between the patient and counselor/therapist is important; one study found it to be the strongest predictor of a positive outcome for the patient, no matter the treatment regimen * sometimes we need to be listened to by someone who is separate from our daily lives, someone who can listen compassionately but do so in such a way as to allow us to assess our lives, the situation, or the events so we can develop methods of effectively addressing our problems * all therapist use important communication skills, most of which are related to relational listening - asking open-ended questions– allow us to expand our story or comments and encourage us to continue speaking - reflection – “echoing”, includes restatement and paraphrasing; not only signals that the counselor is listening but also acts as a verbal prompt, encouraging the individual to continue speaking - selective reflection – more refined; used by counselors to identify information that the client appears to be emphasizing or that is emotionally charged - empathy-building statements– allow therapists to acknowledge their clients’ feelings and indicate they understand those feelings - checking for understanding – can be an important method of ensuring accuracy; verbal check by counselor to determine if he or she has identified the primary issues troubling a person; also used to review topics that have been covered over the course of a session * empathy and empathetic listening are important also LISTENING AND PHYSICAL WELL-BEING – EXPLORING THE PATIENT-PROVIDER RELATIONSHIP * negative outcomes for poor listening can range from mild to severe (stomach ache – death) * Listening MATERRS – the type of information re receive appears to affect our ability to recall it * the more information that was provided, the greater the chance for information overload and the less a patient can remember * your schema about physicians will affect how you interact with your doctors; if you believe that physicians have a higher status than you, you will likely feel at a disadvantage when interacting with them and this may keep you from getting the full benefit you need from the medical visit - one important schema is the one we holdfor our personal health; if you believe you are healthy, you will probably expect to hear that whatever is bothering you is temporary and will go away; you may have difficulty listening to anything to the contrary FACTORS AFFECTING PATIENT-PROVIDER INTERACTIONS NATURE OF THE VISIT * why you are visiting the doctor and the diagnosis can affect how you listen - general checkup and doctor says all is fine, you may not pay much attention to her directions to cut down on fatty foods in your diet because of a slightly elevated cholesterol level - chronic kidney disease, it is unlikely that you will really hear much she says after making the diagnosis; such a message creates both anxiety and fear, both of which interfere with your ability to attend to the message GENDER * women are more likely than men to go to their physician; one study suggest that women’s greater contact with health-care providers and the health system leads them to expect greater involvement in health-care decisions and to develop a more consumeristic approach to patient-provider interactions EFFECT OF CULTURE * affects how we view health and illness * people from Eastern cultures refuse to acknowledge mental illness; Malawi, women who openly discuss sex are seen as bad mannered and promiscuous; other parts of the world, men and women must see physicians of the same sex, problem is most severe for women patients * many Western societies have adopted an organic or biomedical view of health; health-care providers seek to identify signs of ill health (e.g., fever, bacteria, rash); health is seen more in terms of “health versus illness” – no signs or symptoms, you are assumed to be in good health * other cultures take a more holistic approach, conceptualizing “health as harmony”; health incorporates more than just signs and symptoms, it’s based on a combination of our physical, social, and psychological well-being RACE AND ETHNICITY * research reveal differences in who does or does not receive prescriptions, health information, or access to certain medical facilities * racial stereotypes can affect how we listen to messages and the quality of the interaction - research indicates that patients get more involved in medical decision-making when the doctor is the same race they are * race differences can be compounded for individuals who are not native English speakers - language differences can lead to avoidance, misdiagnoses, improper treatment, and lower patient satisfaction - language proficiency can affect patient compliance;it is difficult to follow instructions that you do not understand AGE * by 2050, 25% of our population will be over the age of 65 * negative stereotypes tend to present older individuals as cranky and dour, often lonely and unhappy; they’re also often believed to be commonly ill and befuddled - providers may treat their elderly clients as if they cannot care for themselves or as if they are not interested in or cannotunderstand health information - on way this is manifested is through “elderspeak”; “sweetie” or “dear”; many older people find it demeaning and upsetting, in part because it suggests they are incompetent * communication patterns between the older patient and health-care providers can be affected by other factors - older individuals are often not assertive during medical encounters, despite their wish to be informed; they may be even less assertive when a family member accompanies them to a medical appointment - it is not unusual for the older patient to be “sidelined” while the family member and provider converse * problems associated with caring for elderly patients are exacerbated when the patient is also chronically ill - when physicians listen, treatment programs can be adapted to important aspects of the elderly patients’ lives WHAT YOU CAN DO AS A PATIENT * five things you can do to enhance your listening effectiveness in future health-care encounters 1. Be aware of your schemataabout the physician-patient relationship, your attitude toward health care, and the illness you are diagnosed with; schemata can have a major impact on our interpretation of information and our interactions with health-care providers 2. Come prepared - write down your symptoms or any questions you may have 3. Be assertive - be direct in stating your symptoms and in asking your questions 4. Make sure you have the physician’s complete attention - eye contact; when they turn away or you are unsure if you have their full attention, pause 5. Use the information-verifying skills you’ve learned - double-check your information by using restatements, summaries, and paraphrases; personally summarize the information PROVIDER COMMUNICATION AND LISTENING * caregivers are influenced by a number of factors - one is simply attendingmedical school, which affects providers’ schemata of health-care practice and patients; some schools in some health areas, such as nursing, operate from more of a patient-centered perspective, others generally do not (e.g., medical , dentistry) or do so minimally (e.g., physical, occupational, speech therapy) - few curricula, particularly medical schools’, provide in-depth training in patient-provider communication * caregivers frequently become data driven – they rely on the results of physical exams and other medical tests - they come to use and depend on what Howard Waitzkin calls the “voice of medicine - often become so comfortable with this “voice” (e.g., discussing symptoms, test results, medications, treatment options) that they are unwilling to listen to the “voice of the lifeworld” from their patients (e.g., personal or family issues, fears) * one survey found that 75% of the surveyed physicians had never been exposed to a communication class of any type; those who were exposed to communication most often learned about listening, observing patients, and interviewing * lack of training is reflected in findings showing that while approximately one-third of a medical encounter focuses on the physician providing information and instructions, general practitioners almost never attempt to determine their patients’ viewpoints or opinions either prior to or after providing medical information * most physicians tend to engage in physician-centered talk * part of the problem that physicians face is that they have to balance two roles: one technical and the other interpersonal PATIENT OUTCOMES: SATISFACTION AND COMPLIANCE * research indicates that patients value good communication skills as much as they value good clinical skills, and that patient satisfaction is more dependent on the providers’ communication skills than on their clinical skills * a patient can be satisfied with his or her care but actually dissatisfied with the communication that occurs during the office visit * QuEST model – address patient dissatisfaction; reflects a patient-centered approach in that it suggest that physicians ---- “1. Question and acknowledge 2. Evaluate 3. Set a course of action 4. Talk and discuss” ---- patient concerns and problems * communication skills that appear to positively influence patient satisfaction include overall friendliness of the communication; increased interpersonal involvement; low communicative dominance; less interrupting; focused active listening; clear, detailed explanation; acknowledgement of patient concerns; avoiding technical jargon; and maintaining eye contact * factors associated with patient satisfaction - a caring and understanding manner on the part of the health care provider - a balanced inquiry into psychosocial and biomedical concerns - the expression of patient and provider expectations * nearly 20% of newly established patients (e.g., they had been seeing their physician for one year or less) indicated they changed physicians because they were unhappy with their pr evious doctors - of these, about 30% indicated they were dissatisfied with the attitude or personality of their previous physicians, while approximately 25% indicated they changed due to dissatisfaction with their previous treatment regimen * three communication factors seem to predict patient satisfaction with not only their doctors but also nurses and other hospital staff 1. Empathetic communication 2. Listening 3. Immediacy - these behaviors help reduce the uncertainty and relieve the anxiety often associate with hospital stays WHAT HEALTH-CARE PROVIDERS CAN DO * pointers for building trust 1. Be aware of personal schemata– also suggested to patients; know yourself because then you’ll be aware of issues that might inadvertently affect your relationship with others 2. Look interested (use immediacy behaviors)– patients respond better when health-care providers appear interested in and supportive of what they say - patients are more likely to speak freely and disclose when physicians and nurses maintain eye contact with them - nonverbal communication is one technique caregivers can use to validate patients’ experiences and confirm that they understand patients’ needs 3. Listen for distress markers – nonverbal can tell us much about how others are feeling, but nonfluencies can tell us a lot as well - patients may stutter or stammer and sometimes have extensive pauses when building up to important disclosures - health communication scholars suggested that caregivers avoid changing topics until they can determine what the disclosure addresses 4. Use silence (carefully) – opens space for someone to think and express an idea; it can also be negative – disproval may be tied to silence 5. Avoid abruptly changing topics– can make patients feel out of control; unlikely to lead to a trusting relationship 6. Be empathetic– in the health-care setting, empathy has been described as a primary dimension of developing a caring relationship, which is based on acceptance and respect for the patient - especially important when working with children and elderly patients - caregivers should strive to establish a supportive environment that empowers patients 7. Listen more than you talk – patients sometimes use indirect questions when they want to avoid appearing ignorant or foolish; it is important to “listen between the lines” 8.Allowing patients some control (i.e., allowing them to talk) – emphasizes the responsibility that both parties have in receiving and disclosing info rmation as well as in requesting and providing information; treat patients as equal and use collaborative communication 9.Take steps to ensure understanding– important because medical interactions often include medical jargon, which can be incomprehensi ble to patients and their families - ask for feedback, paraphrase, restate information Chapter 11 Notes PUBLIC SAFETY OFFICIALS LAW ENFORCEMENT OFFICERS * first legal-related person we have contact with is a police officer; their training includes a significant communication component, including mediation training, which includes a great deal of listening training INVESTIGATIVE INTERVIEWING * interviewing eyewitnesses about the particulars of a crime * when witnessing a crime, you often center your attention on just a few things; observation and attending skills of a witness are tested to their limits * the way a question is asked can shape the response of the witness; witnesses should listen carefully to the questions and be mindful of the potential effect of the wording * if a questioner introduces the existence of an object that was not at the original scene, the eyewitness will integrate the information into his or her memory of events * law enforcement officials must listen and not lead the other person; less talking and more listening aids a witness’s ability to accurately recall events and details * comprehensive listening allows officers to gain accurate understanding of what occurred; critical listening helps the witness separate what he or she remembers from anything that might be included in a question * 2 types of information 1. Estimator variables– elements not under our control but directly related to the crime events 2. System variables– related to events within the criminal justice system; include factors such as the time lapse between when someone witness the event and the actual testimony * important that officers take time to engage in empathetic listening to calm witnesses; people who are calm are more likely to recall events and recall them more accurately * officers also use critical listening to assess the veracity of a witness’s statement as well as identify any missing information CRISIS NEGOTIATION * e.g., hostage taking, some instances of domestic violence, suicide attempts, and standoffs * negotiators have psychology and counseling backgrounds and strong communication skills; research shows that FBI agents trained in hostage negotiation have stronger active listening skills and a lower tendency to engage in problematic behaviors such as problem-solving * crisis negotiators use his or her training to connect with persons in crisis to bring them to a more balanced state with the expectation of bringing the crisis to a conclusion that will preserve some of the individual’s self-respect * relational listening – negotiators make a connection with the party in crisis using specific techniques 1. Listening techniques– clarification, paraphrasing reflection, and summarizing 2. Action techniques– probing, confrontation, interpretation, information giving, and instructions 3. Sharing responses– reflect relational listening; include self-disclosure, immediacy, and reinforcement * confrontation– used in a very specific manner to address inconsistencies or discrepancies in a person’s statements, in behaviors, or between statements and behaviors * self-disclosure– when a negotiator engages in this disclosure, it is strategically done to further the negotiation * immediacy responses– involve statements of the negotiator’s feeling about the individual at that particular time; e.g., when someone calls reporting a break-in then stops talking, a negotiator may say “do you know that when you stop talking to me, I think that something has happened and it really upsets me?” * reinforcement– encourages someone to start or continue with a behavior (e.g., “you really showed good faith when you released that hostage”) ATTORNEY– CLIENT COMMUNICATION * good listening skills – from you and your attorney both –results in a more effective and satisfactory relationship * younger attorneys often fail to recognize the importance of listening * active listening is the guiding force behind effective communication between attorneys and their clients ADVICE FOR ATTORNEYS *suggestions for developing your listening skills INTERVIEWING– STAGE ONE * establish rapport– primary purpose; if clients feel that the attorney is unresponsive or indifferent about their cases, it is unlikely they will remain clients for very long; it is important that attorneys must assess the merits of a case and the needs of the client during the initial stages of the interview * how to establish rapport - putting clients at ease by presenting a professional image and keeping distractions to a minimum (e.g., inappropriate clothing, ringing phones, loud conversations, and other external noises can interfere with a quality interview) - allowing the client to direct the initial part of the interview - attorney should focus on active listening and asking open-ended questions that encourage the client to talk - engaging in relational listening - lawyers may be required to focus on the emotional effect on their clients as well as attempting to gather information about the case * a good attorney will be attuned to when the client has truly finished talking, is uncomfortable opening up, or expects him or her to direct the interview * therapeutic or empathetic listening is an important part of attorney-client interviews * through paraphrasing and direct assertions of empathy, lawyers can acknowledge not only the content of the client’s communication but the underlying emotions as well INTERVIEWING– STAGE TWO * focuses oninformation gathering - comprehensive and critical listening are most useful - comprehensive listening is central to translating or interpreting a client’s communication and is necessary for fully understanding the client’s needs * counseling, or giving advice, too soon can prevent an attorney from getting needed facts; problem solving can be viewed asan indication that the attorney is more focused on his or her assessment than on the client’s information * critical listening is important in this stage so lawyers can evaluate the information and ask for needed clarification - briefly outline the purpose and goals of the interview - by letting the client know what to expect in the interview, the attorney helps establish a framework from which the client can listen and process the information - ask questions - the wording of questions is critical * leading questions tend to predispose the client to answer in a particular way * probing questions don’t have to lead to client to answer in a specific manner - asking someone to elaborate or complete his or her thoughts opens the door for more accurate information - take brief notes (if necessary) but avoid writing down large amounts of information - clients may slow their narratives to match the speed of note taking or start wondering about what is being written - be respectful - helps an attorney (and others) establish a climate in which the client is able to give the necessary information, regardless of how painful it may be - topic might be emotional; attorneys and clients may need to take a break to emotionally gather themselves - saying “please”, apologizing for delays, and giving your full attention to the client when listening are just a few ways of showing you respect your client - listen for truthfulness, accuracy, omissions, and contradictions - clients do forget, misremember, and occasionally outright lie; omitted information is potentially detrimental to a client’s case - active listening, can help attorneys better assess the strengths and weaknesses of a client’s story and identify and address any contradictions - avoid prejudging - attorneys have biases that can affect the interpretation of messages - it is important for attorneys to assess their biases and determine if they can listen without prejudice an defectively handle the case INTERVIEWING– STAGE THREE * counseling the client – attorneys move from comprehensive listener to adviser and problem solver - evaluating the facts of the case - first, the attorney must use critical and comprehensive listening to assess whether the situation should go into thelegal system at all, and if so, is it one that is “provable” and worth pursuing * assessing viable courses of action open to the client - through active listening and closely watching the client’s nonverbal, an attorney can better assess client responses to the different options and resulting scenarios - attorneys use listening and related observation skills as well as their knowledge of the legal system to realistically analyze risks, costs, time, effort, and other realities of taking a case to court (or negotiations) - then attorneys present the information to the client in such a way the client can listen and absorb the truth of that assessment even when the client doesn’t want to hear it - it is important that a client clearly understand the possible realistic outcomes of her case ADVICE FOR CLIENTS * set the stage for effective listening by being prepared - having all pertinent documents organized and with you when you meet with the attorney, also helpful to create an outline of the situation to help you remember and to present a balanced overview of the situation * suggestions to be a better listener - recognize your own biases and the strength of your emotions - be as accurate and objective as you can when presenting information about your case to the attorney; try to keep emotions form clouding your description of events - look for an attorney who listens - a lawyer who does not fully understand the situation cannot offer you adequate advice or appropriate legal options - engage in comprehensive and critical listening - you will need to understand and evaluate the relative merits of each option; if your case is turned down, use the responding aspect of listening to ask why - fully understand the attorney retainer and fee agreement - when you are under stress or emotionally charged, it is easy to zone out on information that doesn’t specifically address the case, such as information about fee agreements - ADR (alternative dispute resolution) LISTENING CHALLENGES OF THE JURY THE JURY AS AUDIENCE * voir dire – jury selection; beginning of the jury process - attorneys use it to build or establish their cases, introduce case themes, and favorable introduce their clients - goal is to impanel jurors who will be the least biased against their cases; therefore, attorneys will be listen for any information that might indicate a potential bias or predisposition against their clients * 80-20 rule– attorneys listen 80% of the time and talk 20% of the time IF YOU ARE CALLED FOR JURY DUTY * suggestions to be a better listener - use comprehensive listening - judge and attorneys will introduce case, general background, and primary players; need to listen because there may be a legitimate reason for you to be excused and this information provides you with background on the case if you are actually picked for jury duty - be aware of potential biases and schemata - attorneys introduce their cases and are trying to influence how you interpret evidence - be honest about your own biases and the experiences that have caused you to have these biases - stay focused - avoid distractions, concentrate, use active listening skills - ask for clarification - responding is an important part of listening; if during the voir dire you don’t understand what the attorney is asking or a word being used, ask for clarification - volunteer information if it is needed - be direct when answering questions, but recognize that the question requires more than the obvious answer COURTROOM CONTEXT * you will need to be prepared to listen to the different stages of the trial OPENING STATEMENTS * opening statements and arguments; use curiosity motivation to focus on the schema formation aspect of the opening statements - provide a framework through which later evidence and information are interpreted * schema activation naturally occurs during opening statements; affect what information we attend to, what meaning we assign to incoming information, how we draw inferences, and how we organize and store information in memory THE IMPORTANCE OF STORIES AND SCHEMATA * story model of decision-making helps us understand how jurors process information during the predeliberation stage of the trial - underlying themes in a story help jurors organize case information along the lines that the attorney wishes, and help them to overcome disputes or conflicts with specific evidence - not all information in a trial is presented in order; the story helps listeners reorder the information into an easier-to-understand narrative format - stories help us identify and process important information (such as motives or means) and pay less attention to background or less important information (what the defendant and victim at for dinner at the restaurant) - case themes 1. Evaluative – characterizing character traits, behaviors, and motivations) 2. More powerful than fact– characterizing evidence - stories aid the listening process; we find it easier to remember trial evidence when it is organized narratively TESTIMONY * each side presents the evidence supporting its case – photographs, diagrams, physical evidence; most influential is witness testimony, especially when it is live testimony rather than written or recorded * jurors need to evaluate all of the testimony, especially when it is contradictory; they have to assess witness credibility by following the attorneys’ questions and evaluating witness responses, all while closely watching the witness’s nonverbal CLOSING ARGUMENTS * influential in their ability to synthesize trial information and remind jurors of evidence deemed important to an advocate’s case * attorneys openly attempt to affect attitude change; good-listening jurors will want to listen closely and be aware of attorney attempts to persuade them to adopt a certain version of the case facts JUDICIAL INSTRUCTIONS AND JURY DELIBERATIONS FISHER’S PHASES(elaborations in book) * orientation phase * conflict phase - avoid early votes - false consensus * verdict driven * evidence driven * substantive conflict * affective conflict - take breaks when necessary * emergence phase - preludes to agreement - avoid interrupting * reinforcement phase ALTERNATIVE DISPUTE RESOLUTION * term used to describe a number of methods of resolving disputes without litigation;two major approaches used are mediation and binding arbitration TYPES OF DISPUTES * issue-oriented – connected to rules, regulations, or the guidelines we follow in everyday life - it is not unusual for judges and arbitrators or your boss, principal, or teacher to take on the role of an evaluator in these instances - whoever is called on to resolve the dispute, that person relies on listening to all sides to be fair, unemotional, and objective when deciding the outcome * emotionally-oriented – calls on professionals such as counselors, psychologists, social workers, ministers, or others in the helping professions to assist in resolving the dispute * issue-emotion – addresses both issues and emotions - a neutral third party (e.g., mediators, professional negotiators) is needed to help individuals to resolve their differences - usually, the neutral third party aids in facilitating an open dialogue among those involved while ensuring the discussion is fair and balanced LISTENING AND ADR * in many cases, the parties coming to negotiations and mediation are so focused on proving their points that they fail to listen to the other side or the mediators * through listening, parties are able to reach a fair and workable solution, and that individuals become people instead of being viewed as the enemy MEDIATION * a neutral third party (mediator) facilitates negotiations between two or more parties in hopes of reaching a mutually satisfactory resolution * disputes that revolve around conflicts of interest are particularly appropriate for mediate; usually stem from scarcity – both parties want the same thing, but there is not enough of it to be had by all * prone to compromise, in part because bargaining is not associated with deep-seated values (ethical, moral, or religious differences) * mediation differs from other types of legal and ADR methods in that while there is a mediator who helps to facilitate negotiations, the mediator is not charged with imposing a solution on the disputing parties WHY DO PEOPLE CHOOSE MEDIATION? *generally, mediation follows a failed attempt at direct, unassisted negotiations * also used in a variety of other types of disputes: *one or both parties - want to avoid the high costs of going to trial - wish to maintain confidentiality and/or avoid publicity - need to continue a working relationship with the other party - know that litigation will not fully address the issues - recognize that those involved are so emotional that it is doubtful that they could negotiate a settlement on their own * mediation leads to between 40% and 70% of disputes reaching a lasting, formal agreement; parties tend to be more satisfied and believe the agreements are fairer, in part because both parties have contributed to the outcome and solution WHAT MAKES MEDIATION WORK * introduction of a neutral third party who listens changes the communication between the disputing parties * mediators are better able to see the bigger picture, including aspects of the conflict that go beyond legal issues to underlying areas of interest to both parties * mediators listen to both sides– they are often in the best position to not only identify barriers to resolution, but also recognize the “blinders” parties in a dispute might have * best mediators are impartial, supportive, active listeners * three primary mediation skills: paraphrasing, reframing, and reviewing * paraphrasing – allows the mediator to essentially pause the mediation process and sum up and point out the primary points in a concise manner * reframing– necessary when disputants use language or messages that could potentially inflame the discussion or lead to a breakdown in the dialogue - generally the mediator attempts to reframe the message so it is more acceptable for the opposing party, thus allowing the mediation to continue * reviewing – used when an extended silence occurs during discussion; essentially you review the major issues or themes that have been discussed - helps identify new topic areas as well as help put discussion back on track


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