skills communicating in the treatment room

102 M A S S A G E & B O DY WO R K • A U G U S T / S E P T E M B E R 2 0 0 7

B y A n i t a S i m o n a n d B e n E . B e n j a m i n

Communicating in theTreatment Room

Anger in Code: Understanding and Responding to Attack and Blame

Part One

ESSEN

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In massage therapy, as in other help-ing professions, some of our mostdifficult work is in areas that are not

the focus of our professional training.Many of us can relate to the old saying,“My work would be so easy if only Ididn’t have to talk with clients!” Thepeople part of massage therapy can bevery challenging, particularly whenclients are angry or disappointed orwhen we are annoyed at them. Whohasn’t experienced tension, irritation,or worse when hearing a client say, inan aggrieved voice, something like:

• “You’re raising your fee? You’llmake it impossible for me to gettreatment!”

• “All of my friends are getting thisnew treatment. Shouldn’t you bedoing that with me?”

• “You don’t pay attention to meduring my treatments. You talktoo much about yourself.”

These examples are instances ofAttack/Blame, a communicationbehavior that typically evokes astrong response from a listener.Think back to your instinctive reac-tion when you first read the client’sremarks that were critical of yourfee. It was most likely one of the following:

• Defensive (“I have bills to pay too,” “I chargeless than many other therapists.”).

• Self-attacking (“How could I be thinking ofraising my fee when times are so tough?!” ).

• Self-righteous (“You don’t appreciate how mucheducation I have to pay for to keep up withwhat’s new in the field.”).

If you keep such thoughts to yourself, yourresponse will remain internal—the effects mayinclude an increase in your blood pressure and aflood of stress hormones in your body. However, ifyou broadcast these reactions to your client, a likelyresult is further Attack, leaving both you and yourclient feeling more upset and probably misunder-stood as well.

This is the second in a series of articles based on theSAVI® (System for Analyzing Verbal Interaction) com-munication system1. Our goal in these articles is to pro-vide massage therapists with the knowledge and toolsthey need to make conversations work better.

SAVI identifies all the different behaviors people use toexpress themselves verbally2 (Complaint, Opinion,Paraphrase, Proposal, and so on) and explains how theyare likely to affect communication. In studying SAVI,you come to understand why some conversations workwell and others end in frustration and misunderstand-ing. You also learn strategies for successfully communi-cating your ideas and responding more effectively to thecommunication of others.

In the first article, “The Anatomy ofCommunication,” (published in two parts, inFebruary/March 2007, page 110, and April/May2007, page 122), we provided a general introductionto SAVI—discussing its underlying principles, thenuts and bolts of the SAVI Grid, and some of the wayswe can use SAVI to get unproductive conversationsback on track. (If you missed these pieces, you canaccess them online at www.massageandbodywork.com.)Here we’ll narrow the focus to look closely at onebehavior that has a toxic effect on communication,with the potential to turn any discussion into anargument. In SAVI, this behavior is known as“Attack/Blame” (see Figure 1).

Figure 1

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In some situations, it’s the therapistwho launches an Attack at a client. Forinstance, you may find yourself gettingfrustrated with clients who repeatedlyarrive late for appointments or who,again and again, don’t follow the adviceyou’ve offered them. When giving themfeedback or recommendations, you mayfeel tempted to use Attack behavior:“Why don’t you listen? I’ve told you adozen times that if you keep runningthrough your back pain, it’s going to getworse!”

Getting a better grasp of the under-pinnings of Attack/Blame is crucial forresponding effectively in such situa-tions. That’s what this article is about—we’ll explore what’s really going onwhen someone uses an Attack/Blamebehavior, examine the effects this behav-ior tends to have on communication,and discuss several strategies you canuse when someone Attacks or Blamesyou, or when you feel an impulse toAttack or Blame another person.

Attack/Blame: Fighting with Words

Aconversation filled with Attack/Blame sounds likea fight. Whenever we hear an Attack statement,

whether or not it’s directed at us (and even if it’s com-ing from us), we can feel it in our gut. An Attack hasa hostile or threatening quality. It may include cursing,name-calling, or threats, and is usually delivered in anangry tone—the voice may not be loud, but there’s anedge to it. Note that how you speak can be just asimportant as what you say. The same words can be anAttack or not, depending on the voice tone. (For exam-ple, “How much did you spend for your shirt?” is areal question if asked with genuine curiosity and anAttack if said with hostility or a demeaning tone).

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


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e s s e n t i a l s k i l l s

What Makes a Statement an Attack/Blame Behavior?� Blameful, accusatory, or retaliatory remarks� Hostile voice tone� Name-calling or negative labeling� Put-downs� Threats

What Does an Attack/BlameBehavior Sound Like?

� “If you don’t start cleaning your room,you’re going to be in trouble.”

� “It’s all your fault!”� “You only think about yourself! You

never listen to me.”� “You son of a…”� “You’re such a jerk! You’re so catty!”� “Well, it’s just going to be your own

fault if you don’t get better, becauseyou’re not exercising.”

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This basic description of Attack/Blame statements isfairly straightforward and generally not surprising ornew for people. What is a new insight for many people isthe core dynamic at work with this type of behavior.What’s happening is that the speaker is sending out twodifferent messages at the same time. With the tone oftheir voice, they’re expressing something about them-selves: “I’m furious!” or “I’m so frustrated!” But theirwords say something completely different—not aboutthe speaker’s feelings, but about the listener’s failings:“Here’s what’s wrong with you … !” Consider the exam-ple of a client fuming, “Your fees are too high.” Here, thefocus seems to be on you and your fees. Yetthe main message that comes barrelingthrough is the one encoded in the voicetone: “I’m angry!”

Meanwhile, one of the most criticalpieces of information is not expressedat all. While the speaker’s voice tonetells you that he’s upset, and hiswords give you some idea of what’supsetting him, there’s no indication ofwhy it is upsetting. For instance, theclient who says, “All of my friendsare getting this new treatment.Shouldn’t you be doing thatwith me?” may be frustratedbecause he expected to behealing more quickly than hehas been; he may have heardreports from friends that theother treatment works morequickly. Alternatively, it could bethat he feels competitive withthose friends and doesn’t wantthem to be doing somethingcool that he’s not doing. Orthere could be something elsebothering him that hasn’t evenoccurred to you. It’s impossibleto know exactly what his rea-sons are until he tells you, andwithout that you can’taddress the real problem.

This basic dynamic(expressing angry or irritatedfeelings without talkingabout those feelings orwhat’s causing them) is keyto understanding what’sgoing on in every singleAttack statement. Itmakes no differencewhether the conversa-tion is happeningbetween a client andtherapist, father and

child, boss and employee, or two complete strangers.This dynamic is also crucial to understanding whyAttacks often lead to interpersonal difficulties. Any com-munication that expresses angry feelings, but only indi-rectly, will tend to increase uncertainty about what thespeaker is feeling about us. This uncertainty causes acommunication problem: all of us like to know what’sgoing on, and when we don’t, energy gets diverted awayfrom the content of the conversation and onto figuringout what state the speaker is in—particularly to deter-mine if he is mad at us.

Because the person has not directly told us why he’supset, we may come up with our

own (often incorrect) conclusions.For instance, if a client Attacks youwhen you tell him about yourraised fees, you may assume thathe’s angry with you because hebelieves your new fees are too high.However, it’s possible that he’s

been angry at you for a whileabout something different (for

instance, because his treat-ment is taking longer than

expected or because yourepeatedly keep himwaiting for appoint-ments). Or he may notbe angry with you at

all, but may be upsetbecause his boss just told

him he’s getting laid off.When we communicate

anger or irritation throughvoice tone only, the infor-

mation about what we’refeeling and why we’re feelingit (our wants and needs thataren’t being fulfilled) gets lost.This emotional and cognitivedata, which is needed toresolve the conflict, stays hid-den from the listener—andfrequently from the speaker aswell. In the example givenearlier, the client using Attackbehavior about your increasedfees does not directly accesshis anger, his worry that hisinjury might never be healed,his frustration at your keeping

him waiting, or whateverelse is upsetting him.

Since the speaker’sthoughts and feelingsare not explicitly stat-ed, they cannot easily


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be addressed by the listener. This makes resolution byboth parties more difficult than it needs to be, though farfrom impossible. Later on, we’ll discuss how a skilledresponder can use the data hidden in Attack/Blamestatements to foster a very productive conversation.

Information Impasse:The Impact ofAttack/Blame

Attack/Blame is a potent communication stopper:whenever it’s used in a conversation, information

flow tends to come to a screeching halt. Heated wordsmay be exchanged for hours (or years) on end—“Howcould you?” “It’s your fault.” “You never listen.”—but interms of understanding or problem solving, a dialoguefilled with these Attacks almost always goes nowhere.Frustration and agitation only build as time goes on.

Let’s look deeper inside a dialogue of Attack behav-iors. Communication starts to break down wheneverone person initiates a ver-bal fight and another per-son fights back. Noticethat it takes two people(at least) to keep the fightgoing. It can be temptingto lay all responsibility onthe individual who makesthe first Attackingremark. However, the lis-tener’s response is just asdecisive in determiningwhether or not a fightwill develop. As we’ll seelater in this article, whileit takes some work, it ispossible to respond toAttacks in ways that fos-ter empathy and realunderstanding.

Typically, the inclina-tion to fight back isextremely strong. This is because the ambiguity in theAttacking comments provokes irritation. As a result, thelistener often feels a strong impulse to retaliate. There isa pull to keep the fight going—it’s really hard to stoptalking until we get the last word in. It’s as though theanger acts as emotional glue, keeping us stuck in theconversation. And while we’re determined to get theother person to see our point of view, it’s difficult for usto see any value in his point of view. When someonehas attacked us, fighting back usually comes much moreeasily than actively listening to his perspective.

In addition to the negative effects an Attack mayhave on a listener, this type of communication is gen-erally counterproductive for the speaker as well. Theperson may gain some sense of emotional release, but,in the long run, will almost always end up dissatisfied,

since the underlying source of conflict has not beenresolved. Note that Attack and Blame are not inherent-ly bad; they are problematic only if 1) they are chronicand 2) your goal is to communicate information insuch a way that the listener can hear it and use it tohelp solve a problem or meet a need.

Understanding Anger, Rediscovering Choice

At the root of all Attack statements are feelings of frus-tration or anger. Therefore, learning to understand

and effectively deal with these feelings (in ourselves andothers) is crucial to finding alternative responses. It isimportant to differentiate our feelings, which are experi-enced internally, from our words and actions, which arebroadcast externally. When we’re frustrated or angry (afeeling), it often feels good to lash out (a behavior). So thepersonal desire to retaliate comes into conflict with ourrational self that knows that bashing someone verbally

does not resolve the problem that generated the feelings inthe first place (see Figure 2).

Wanting to go in these two different directionswhen we feel irritated or angry is an internal conflict.Recognizing when you’re experiencing this conflict isa first step away from automatically Attacking. Thenext step is recognizing the many behavioral optionsyou have when you’re angry. As an alternative toAttacking, you could help get information flowing bychoosing any behaviors from the Yellow light or Greenlight rows shown in Figure 1. For example, you cangive information (say you’re upset, suggest taking abreak, or say you’d like to take time to think about theissue), you can seek information (ask questions), oryou can check to see whether you heard correctlywhat was just said (paraphrase).

Figure 2


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While there are many different ways we couldbehave when we’re angry, each of us has certaindeeply ingrained, habitual responses. Early in life, welearned how to express anger from the examples set bythose around us, primarily our parents. Their behav-iors may have tended toward flight (going away angryand never talking about the issue again), external fight(yelling or worse), or internal fight (getting upset withand yelling at oneself or becoming anxious). In timesof stress, we generally respond in the modes that aremost familiar to us; these are the procedures that comenaturally and feel “right.”

Often, parents do not teach their children the distinc-tion between having an emotion and how that emotionis expressed (indeed, few under-stand this distinction themselves).Therefore, most of us were neverencouraged to notice the behav-ioral choices we have when we’refeeling strong emotions, and wehave little experience to drawupon to teach our own childrenthese skills. Moreover, very fewfamilies provide good models ofputting feelings into words with-out Blaming themselves or others.But fortunately, these skills can belearned at any time in life.

Let’s look at a concrete exampleto see what different behavioraloptions might sound like in an actual conversation.Think back to the case of the client who’s angry becauseyou raised your rates. Imagine that you’ve been treatingthis client for a long time, you care about her welfare,and you hope to maintain a positive professional rela-tionship with her. She’s visibly angry, and tells you,“You’re too expensive. You’re making it impossible forme to get the treatment I need.” How do you reply?While there’s no right answer, there are several produc-tive alternatives to Attack/Blame. (Remember that yourvoice tone is important—a comment or question thatmay be helpful when spoken with genuine empathy orcuriosity is an Attack behavior when spoken hostilely.)

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

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

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

� Join truthfully. “I also remember being very upsetwhen a therapist I was seeing raised her rates. I was

worried I wouldn’t be able to continue getting treat-ment. Is that concerning you, too?”

� Involve the other person in problem solving.“What would make it easier for you to afford treat-ment? Would it help to set up a payment plan spreadout over several months? Are there insuranceoptions you could look into? Would you be willingto see another therapist some of the time?”

� Invite the other person into your shoes.“Suppose you found yourself in my position—hav-ing decided to raise your rates, and yet wanting tomake it possible for your clients to receive treat-ment. What would you do?”

Most people are surprised to learn just how muchpower they have to turn a conver-sation around. In the context of anAttack, the road to constructivedialogue doesn’t have to beginwith the person who’s usingAttack behavior changing his atti-tude or admitting he was wrong.By resisting the impulse to retali-ate (Attack back) and trying a dif-ferent response instead, you canshift away from habitual patternsof fighting. The payoff is not just areduction in conflict, but a greaterpotential for mutual understand-ing and more rewarding emotionalconnection.

***In the second part of this article, we’ll discuss some

more specific strategies for dealing effectively withAttack/Blame behaviors—both when others use themand when we catch ourselves using them. If you don’twant to wait for the next issue, you can access part twoonline now at www.massageandbodywork.com.

Anita Simon, EdD, is codeveloper of SAVI with Yvonne Agazarian. Shehas been writing about SAVI since 1965 and has delivered workshops onthis and related topics since 1968. Simon is in private practice as a psy-chotherapist in Philadelphia, specializing in work with couples, businesspartners, and individuals. She can be contacted at [email protected]. The SAVI website is www.savicommunications.com.

Ben E. Benjamin, PhD, holds a doctorate in education and sports med-icine. He is senior vice president of strategic development for CortivaEducation and founder of the Muscular Therapy Institute. Benjamin hasbeen in private practice for more than forty years and has taught commu-nications as a trainer and coach for more than twenty-five years. He teach-es extensively across the country on topics including communication, SAVI,ethics, and orthopedic massage, and is the author of Listen to Your Pain,Are You Tense? and Exercise without Injury and coauthor of TheEthics of Touch. He can be contacted at [email protected].

Notes1. SAVI® is a registered trademark of Anita Simon and Yvonne Agazarian.2.This article focuses on just one of the communication behaviors categorized by SAVI.The

complete system includes a variety of different categories of behavior organized in a grid. Eachbehavior’s location within the SAVI Grid is based on the type of information it carries andwhether it helps, hinders, or is neutral with regard to effective communication.As shown inFigure 1,Attack/Blame falls in Square 1,“Fight,” the intersection of Column 1 (person informa-tion) and Row 1 (avoidance). For more information on SAVI, visit www.savicommunications.com.

M&B


Most people aresurprised to learn

just how muchpower they

have to turn aconversation around.

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