Category: Ćwiczenia

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Strategic management

Szczeliny

Zarządzanie strategiczne

Synchronizacja, kalkulacje, innowacje

Kiedy ktoś zwraca się do nas po indywidualną pomoc rozpoczyna najczęściej od przedstawienia krótszych lub dłuższych opowieści, które wiążą się dla niego z lękiem, smutkiem, wyczerpaniem lub złością. W czasie rozmów poznajemy szczegółowo kolejne zdarzenia, bohaterów i konsekwencje tych historii. Wiele z tych opowiadań, w sytuacjach kryzysowych, kończy się formułowaniem następujących ocen:

  1. Jestem do niczego. Jak mogłem/mogłam doprowadzić do takiej sytuacji. Jeśli pozwoliłem/pozwoliłam, aby coś takiego się stało musi być ze mną coś nie tak. Zepsułem/Zepsułam wszystko!
  2. Nie poradzę sobie. To,  co chciałbym/chciałabym lub muszę zrealizować jest ponad moje siły. Moja historia w tym obszarze to wyłącznie ciąg porażek i błędów. Nic mi już nie pomoże! Nadzieja to jedynie oszukiwanie siebie.
  3. Nie zasługuję na: szacunek, przyjaźń, miłość.
  4. Jestem złym człowiekiem. To, co zrobiłem/zrobiłam świadczy o tym, że myślę wyłącznie o sobie. Jestem nic nie wartym/wartą egoistą/egoistką!
  5. Moje życie jest żałosne! Powinienem/powinnam być najbardziej samotnym człowiekiem na świecie.
  6. Świat jest wrogim miejscem w którym każdy myśli tylko o sobie. Też będę tak robił/robiła.

Czasami wypowiadamy to wszystko wprost. Czasami tak myślimy i nie mówimy o tym innym. Zdarza się też, że tylko niejasno rozpoznajemy, że żyjemy w więzieniu zbudowanym z własnych ocen i strachów. Przemijamy zamknięci w naszych oskarżeniach. Zaklęci w żabę ograniczamy marzenia. Sami siebie sądzimy, sami siebie skazujemy, sami sobie wymierzamy karę samotności i wewnętrznej pogardy lub decydujemy się na życie w świecie, w którym najważniejszym doświadczeniem jest samotność

Na szczęście tak bywa tylko w sytuacjach kryzysowych. Nie jest to czas łatwy, ani bezpieczny. Kiedy cierpimy, boimy się, złościmy, przeżywamy osamotnienie nasze historie układają się w złe bajki i mity, które chciałyby nas przerobić na swoich bohaterów.

Rozbicie tych ciemnych historii zaczyna się często od zadania pytań, które pozwalają zobaczyć, że to na czym skupiła się nasza pamięć i uwaga to jedynie wycinki rzeczywistości tendencyjnie ułożone w złą opowieść. Z opisu ubogiego i rozrzedzonego przechodzimy do opowiadania bogatego i złożonego. Nazywamy nasze trudności, aby móc uwolnić się od ich wpływu. Przytaczane są inne pomijane fakty i zdarzenia. Pojawiają się nowi bohaterowie, którzy do tej pory milczeli lub byli niezauważeni. Historia opowiadana jest raz jeszcze – od nowa – uzupełniona o dobre relacje, w których mówimy i myślimy o powodzeniu, o radzeniu sobie, o własnej kompetencji i wartości, o szacunku do siebie, o radości, o przyjaźni, o pięknie, o miłości.

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Building solutions

Solution focused work

Solution Building

future and goals, ideas and solutions, exceptions, opportunities, strengths, testing

Exercise 1. Repeat aloud after the voice-over the key phrases and expressions that directly relate to the most important aspects of building solutions. By saying individual sentences out loud, the learning process is many times more effective than if you were only reading or thinking what you could or should say. By repeating individual words, you considerably increase the likelihood of their use in real-life situations. The exercise is like learning a new language; its logic and mindset will change your conversations with others; it will help you avoid conflicts and implement important objectives and tasks together.

 

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Questions that enable to formulate objectives and describe the future

 „What would be important for you in the near future?”, „What would be important for you in a long-term perspective??”, „What would you like to achieve?”, „What is the expected result of your action?”, „What do you care about?”, „When will you determine that you have reached what you wanted?”, „What change do you expect?”, „What would you like to do in the future?”, „What is your objective?”, „What is your task?”, „How do you see yourself in a few years?”

„Questions about the miracle”, that specifically direct our attention on the future and release our focus from problems and the past

„What would be possible if the problem we are talking about was resolved?”, „What could you do if this problem ceased to exist?”, „What would happen in your department or company if you dealt with this problem?”

Pay attention to these words and expressions: „What is the problem?”, „What exactly happened?”, „Why did you do what you did?”, „What was the cause of your behaviour?”, „What is the reason for what happened?”, „Why did this problem appear?”, „Did you do what you did because.. ?” – these and similar expressions focus the attention of the person you are talking to on the past and problems, often activating defensive attitudes and behaviours:”It was not me; it was others or objectively adverse circumstances”.

 

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Building the sense of effectiveness and sense of value

„What you did shows that you are capable of…, that you can…” (after these words, describe the competencies and commitment of the person you are talking to)”, „Recall a situation when, (describe the situation) – what you did then shows that you are capable of (describe capabilities of the person you are talking to), that you are able to…, that you can (describe competencies and commitment of the person you are talking to)”, „I remember very well the situations in which your knowledge, your competencies, your commitment resulted in the achievement of (describe achieved results)”, „Your skill  (describe the skill) allows you to (describe the result) – it is probably very important for (determine the person(s) for whom this is important), it is very important for me”.

Pay attention to the following words and phrases that make it difficult to build solutions and focus attention on gaps, deficiencies and weaknesses: „You cannot”, „You are unable to…”, „You are incapable of…”, „You are inadequate to…”, „You miss…”, „You do not have…”, „You are…”, „You are not…”. Also pay attention to phrases that make the assessment of an action or person dependent on subjective or vague assessment criteria: „I really like it”, „I like/I do not like”, „Great/Super/Excellent/Beautiful/Perfect/Cool”


 

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Questions about solutions

 „What will you do in this situation?”, „What will you suggest in this situation?”, „What do you intend to do in this situation?”, „What solutions do you suggest?”,  „What can you do to achieve the objective that we are talking about?, „What do you want to do in order to achieve this?”

Be particularly attentive to the expressions: „You should”, „We should”, „You must”, „If I were you, I would…”, „Make it like so…” – these expressions most often limit abilities and motivations to generate ideas; they sound like good advice, instructions, speculations or forcing.


 

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Questions about an exception

„Can you remember a situation when it was better, when the problem did not exist?”, „When was your cooperation with (here, determine the person(s)) unproblematic?”,  „When did it work?”, „Recall situations in which the problem did not exist or its intensity was smaller. What was different? What did you do then? What did others do?”,  „The bad is never the same all the time; when was it easier/faster/better?”.

It often happens that, in the face of problems, you focus your attention on what is not working and you are looking for the causes of the situation: the question about an exception enables to analyse the past from the perspective of strengths and opportunities. Avoid the words: „never”, „always”, „everything”, „everybody”.


 

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Testing solutions

„If you do what you are suggesting, how will others react? What will they do?”, „How will your action enable to achieve the objective we are discussing?”, „If what you are suggesting does not lead to the objective, what will you do in this situation?”, „Let us assume we are accepting your solution; how will other people involved in this action react? What will they do? How will they feel? What will you do then?”, "Does it lead to the objective we are discussing?”, „What happens if you are going to do what you said you would?”.

Pay attention to judgements containing the word „no” and „but” and expressions including „no” and „but”: „unfortunately”, „impossible”, „this is not a good idea”, „we cannot do that this way…”, „it does not lead to the objective…”, „it does not take into account…”, „yes, but”, „possible, but”. A large number of „no” and „but’s” most often leads to long discussions, arguments and conflicts.


 

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Setting limits

„For me, it is important that…”, „What is important for me is…”, „In this situation, I cannot agree to…”, „I cannot accept a situation in which… (here, describe the consequences of a prudent action) What do you suggest in this regard?”, „Like I said, for me, it is important that (say what is important for you)”, „I would like you to take into account what is important for me…”, „In this situation, I care the most about…”.

Pay attention not to excessively use the plural form: „we cannot..”, „we will not…”, „we will not allow…”, „we should”, „we should not”, („we, the king”).


 

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Small steps

 „Tell me how can you start this action? Choose something simple to be sure that you will surely do what we are going to agree”, „What could you do over the next few days?”, „Exactly specify what you will or intend to do about his tomorrow”, „What is the next action associated with what you are suggesting?”.

Avoid general, unspecific and complex plans – mostly, they are never accomplished.

 

Exercise 2. Select a person with whom you need to talk about a difficult and serious problem that has recently appeared in your cooperation. Hold a meeting according to the following pattern:

  1. Determine the objectives that you will accomplish together in the future: first in the near and then in the distant future; talk about this; see how the person you are talking to sees the future.
  2. Describe and highlight what your collaborator can and is capable of. Determine available resources and opportunities that you both have.
  3. Ask for a solution, i.e. what your collaborator(s) will do to achieve the objectives you have both discussed. Speak of what you want to do.
  4. Test the solution formulated by the person you are talking to and set limits, indicating what is important for you and what you care about. Accept those that will enable to achieve the set objectives.
  5. Plan “small steps” related to this solution (phone calls, emails, meetings, shopping, etc.)

Repeat such conversations until achieving full smoothness in using the words, expressions and phrases that build solutions. Avoid those that lead to quarrels and conflicts.

 

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Communication

Basics and starting point

Communication

open questions, paraphrasing, the logic of expression, reflection

Exercise 1. Repeat aloud after the voice-over the key phrases and expressions that directly relate to the most important aspects of communication. By saying individual sentences out loud, the learning process is many times more effective than if you were only reading or thinking what you could or should say. By repeating individual words, you considerably increase the likelihood of their use in real-life situations. The exercise is like learning a new language; its logic and mindset will change your conversations with others; it will help you obtain more information, listen to others and understand what they want to tell you.

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Open-ended and closed-ended questions

Open-ended questions are those that allow others to provide a free answer and that begin with the words: „What”, „Who”, „How”, „In what way” „When”, „Where” np.

„What do you mean by saying…?, „What do you want to do?”, „What do you need?”, „Who do you think…?”, „How do you see this?”, „How would you like to achieve this?”, „When would this be possible?”, „Where exactly do you want to meet?”

Open-ended questions enable to obtain large quantities of information; they do not restrict the freedom of expression; they encourage speaking.

Closed-ended questions start with auxiliary verbs, such as „Do” e.g. „Do you want to say that…?”, „Do you mean that…?”, „Can we do this, so that…?”, „Do you need…”, „Can e.g. Tom do this…”, „Can you deal with this later?” etc. They are used to detail expressions of the person you are talking to and making sure that you have properly understood what he/she said. The most common communication mistake is the use of too many closed-ended questions, starting with auxiliary verbs, such as “Do”. Instead of listening to the person we are talking to and acquiring information, you are only confirming their assumptions and speculations. So, in fact, you are talking to yourself. Others can only say “yes” or “no”.

A particular type of open-ended questions are in-depth questions that encourage to speak and communicate information even more. These questions begin with naming the emotions, feelings or motivations of the person asking the question, e.g.

„I got interested when you said that… What do you think results from that?”, „I was surprised when you said that… Can you tell me a bit more about this?”, „I cannot understand this; tell me how you would like to accomplish this?”, „I was concerned when you mentioned that…”

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Listening and paraphrasing

Active listening and paraphrasing involves repeating, with your own words, what you have just heard from the person you are talking to. In most cases, this behaviour makes the person whose words you are paraphrasing fee important, listened to and treated with respect. A paraphrase is particularly difficult in a situation where you completely do not agree with the statement you have heard; it is difficult to repeat something that, in your opinion, is wrong, unimportant, unreasonable, hurtful or threatening.

Usually, start paraphrasing with the words:

„I understand that…”, „That is, as I understand…”, „To sum up what you said, one can say that…”, „I understand that you mostly care about…”, „I understand that your idea involves…”, „What I heard can be summed up as this…”

Particularly avoid:

  1. Negating what others said by using the word „no” and all the expressions containing „no”, „unfortunately”, „impossible”, „irrelevant”, „unrealistic”, „I cannot”, „I will not let”.
  2. Undermining the value of what you have heard through the structure: „Yes, but…”. „Yet, but” most often leads to unnecessary discussions, arguments and conflicts..
  3. Listening to what others say in silence: this behaviour does make the person who speaks sure that he/she is actually important in this situation and that somebody else actually listens.

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Speaking clearly

Before starting a longer statement, it is worth sorting it in a simple logical whole: introduction, development and conclusion. At the stage of introduction, gain the attention of listeners and then, using several points in the form of a short list, present what you will be talking about.

„At the beginning of our meeting, I would like to present a few specific points regarding the topic I will be talking about”, „What I would like to talk about today is: point 1, point 2, point 3, point 4” (do not present complex lists of many topics and threads)

During the meeting, ask others for their opinions and ask questions.

„What do you think about what I have said?”, „What do you think are consequences of my idea?”, „What would you like to add or change in what I have suggested?”,  „What would like to ask about now?”, „What are your questions to what I have said?”

The lack of structure or arrangement of the statement usually makes others receive it as chaotic skipping from one thread to another, which is often perceived as a sign of uncertainty, unreliability and feeling of being lost.


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Referring to ideas and arguments of others

Use the following expressions:

„A few minutes earlier you said that…”, „You mentioned that…”, „I would like to go back to the beginning of your statement. Tell me more about…”, „I remember when you said that… in this situation, I will suggest…” etc.

Reflecting the statement makes us gain more information, and the person we are talking to thinks he/she is speaking to a communicative person that is able to listen and treat him/her with respect.


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Eye contact, gestures, facial expressions, tone of voice and speech rate

Keep a natural eye contact, i.e. look into the other person’s eyes for about 60% of the time. 100% eye contact happens most often in case of strong conflicts, whereas the complete lack of eye contact shows anxiety or embarrassment. Avoid gestures and facial expressions that, without your intention, cause distress or astonishment of others. Adjust your tone of voice and speech rate to the tone of voice and speech rate of the people you are talking to.

Exercise 2. Record longer fragments of your meetings and conversations. Listen carefully to what you said. Write down the words and expressions that made your communication easier and better, and those that clearly hindered or blocked it. Use the expressions and phrases from the first exercise. Be attentive during subsequent conversations. Practice so long until you are able to easily and effortlessly choose the words and expression that make others feel you are listening to them, encourage them to speak to you and work with you.

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H2H sales

Spryt, kontakty i wyniki

Human 2 human sales

Zdobywanie informacji, rozpoznanie wpływu i władzy, Rosyjskie Puzzle

Ćwiczenie pierwsze. Lisia analiza szansy sprzedaży. Wybierz jednego z Twoich potencjalnych Klientów, z którymi rozpocząłeś/rozpoczęłaś pierwsze rozmowy lub dopiero zamierzasz się spotkać. Wykonaj analizę szansy sprzedaży o której rozmawiacie. Posłuż się następującym kalkulatorem.

sprzedaży nie będzie

pewna sprzedaż

lisi_pasek_kolory

  1. Co wiesz o terminach, które obligują Klienta do rozpoczęcia i zakończenia realizacji zamówienia/projektu?
  2. Jaki będzie Twój zysk z tej sprzedaży?
  3. Jak realizacja tego zamówienia/projektu wpłynie na Twoje relacje z innymi Klientami?
  4. Jakie jest ryzyko Twojej straty?
  5. Jaką masz wiedzę o tym kto i w jakim zakresie podejmuje u Klienta decyzje związane z uruchomieniem i/lub realizacją zamówienia/projektu?
  6. Kim jest osoba, z którą prowadzisz rozmowy?
  7. W jaki sposób zamówienie/projekt odpowiada na potrzeby i oczekiwania osoby, która podejmuje decyzje o jego rozpoczęciu?
  8. Jakie są osobiste korzyści osoby podejmującej decyzję z realizacji zamówienia/projektu?
  9. Co wiesz o Twojej konkurencji?
  10. Jaka jest Twoja wiarygodność w oczach Klienta?
  11. Kim są Twoi sojusznicy?
  12. Jakie są relacje decydenta z Twoją konkurencją?
  13. Jakie jest zaangażowanie Klienta w realizację projektu?
  14. Jaką masz wiedzę o obowiązujących Klienta procedurach związanych z projektem?
  15. Czy są pieniądze na realizację zamówienia/projektu, o którym rozmawiacie?
  16. W jakiej kondycji jest firma Klienta?
  17. Jakie jest doświadczenie Klienta z podobnymi projektami?
  18. W jakim stopniu po stronie Klienta dostępne są wiedza i zasoby konieczne do realizacji zamówienia/projektu?

Najczęściej trudno jest zrealizować jakikolwiek projekt jeżeli większość odpowiedzi na powyższe pytania to „3” i „4”. Wykonaj podobną analizę dla kilku innych Klientów. Porównaj te, które zostały uruchomione i zakończyły się sukcesem z tymi, które były jedynie rozważane lub zakończyły się Twoją porażką. Porzuć projekty, którymi nie warto się zajmować!

Ćwiczenie drugie. Informator. Wybierz jednego z Twoich potencjalnych Klientów. Spróbuj nawiązać kontakt z osobą lub osobami, z którymi będziesz mógł/mogła poruszyć tematy, które pojawiły się w pytaniach w poprzednim ćwiczeniu. Zdobądź pełną wiedzę o sytuacji Klienta i Twoich rozmówców. Na tej podstawie podejmij decyzje dotyczącą dalszej współpracy. Powtarzaj to ćwiczenie tak długo z innymi Klientami, aż nauczysz się na pamięć najważniejszych pytań i odpowiedzi.

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Negotiations

Unpredictable stubbornness vs withdrawal

Negotiations

process structure, coalitions, listening, ideas and solutions, arguments

Exercise 1. Repeat aloud after the voice-over the key phrases and expressions that directly relate to the most important aspects of negotiations. By saying individual sentences out loud, the learning process is many times more effective than if you were only reading or thinking what you could or should say. By repeating individual words, you considerably increase the likelihood of their use in real-life situations. The exercise is like learning a new language; its logic and mindset will change your conversations; it will help you achieve the objectives that you have selected.

 

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Control of the content and scope of conversations

An effective negotiator decides or jointly decides of who says what, when and for how long. He/she controls the content and scope of discussed threads and topics. He/she can affect the extension or reduction of individual stages of negotiations, including the opening, presentation of positions, discussion, decisions, and ending. This does not mean that he/she speaks for most of the time; this means that he/she has the actual impact on the content, scope and dynamics of the conversation. The most frequently used phrases he/she uses include the following:

Stage 1. Opening of negotiations:

„I would like to welcome everyone; perhaps, we will start from introducing ourselves…”, „We have met here to discuss…”, „Maybe, at the beginning, we will agree what we are to achieve”, „Perhaps, I will start…”, „I would like to start from…”, „At the beginning, let us agree that…”, „I suggest the following course of our conversations; let us start from… and then (determine the meeting agenda)”

Stage 2. Presentation of positions:

„Now, I would like to ask you to present your idea/position?”, „I suggest that we talk one after another…”, „Please, do not interrupt; we have agreed that now everyone will present their ideas”, „I would like to ask you to shorten your statement; at this rate, we will run out of time.”

Stage 3. Discussion:

„Do not interrupt me”, „Do not interrupt him/her. Do not interrupt others” „Let me finish what I am talking about”,  „Let others finish what they are saying…”, „Do not raise your voice”, „I have to interrupt you…”, „Let us now turn to the matter…”, „Please, pay attention to…”.

Stage 4. Decisions:

„It is time to end the discussion; we need to make decisions…”, „We have less and less time until the end of the meeting; let us consider what to do in this situation”, „I would like to end the discussion regarding this issue…”, „We no longer have the time to discuss this issue in detail now”, „You have already mentioned this; let us not go back to the threads we have already discussed…”, „You are repeating this once again; we need to make a decision; I suggest that…”, „In this situation, I would like to suggest…”, „Yes, let us do that…”, „Let us agree that…”, „I would like to suggest that…”.

Stage 5. Ending:

„What we can to in this situation is that…”, „You have to agree that…”, „We have no other option than to…”, „This is the best solution”, „The only way out of this situation is that we do it like that…”, „Let us summarise our findings…”, „Again, let us briefly recap what we have agreed…”, „We have agreed that”, „Thank you very much for your commitment and involvement…”.

If you do not smoothly use these phrases during negotiations, you will be perceived as a passive participant of the talks on whom little depends and who has little to say.


 

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Forming coalitions

People who win negotiations try to have the maximum impact on who will sit at the negotiating table. Often, even before the talks begin, they block or eliminate opponents and invite those who will form a coalition with them. At meetings, they are able to gain support of others by using the following phrases:

„I agree with what you are saying; this is also very important for me…    (repeat in your own words what is important for your future ally)”, „I understand that you care about… (describe key needs of your ally), „I have a similar position regarding this matter…”, „Like you, I see the need/necessity of…”, „Therefore, I suggest the following distribution of funds… for you, I suggest you (present a favourable offer to your ally) because I agree with the fact that… (present your ally’s position), „In turn, for you, I suggest (present an unfavourable offer to your opponent) because, from my perspective, it is more important that…”, „I suggest that you receive (present an offer favourable to your ally) because I am completely convinced by the arguments you have presented”, „From my perspective, for this project, we can only allocate…  (determine the amount); I would transfer most funds to the task  (specify the task important for your future ally).

If others are ahead of you and are first to submit an offer to distribute funds and values that are negotiated, you will be limited in making decisions and, in the first place, you will respond to other people’s suggestions that will not necessarily be favourable to you.


 

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Determination of needs, objectives and values

Naming and highlighting what is important for others and what they care about gives you the opportunity to build solutions that refer to real needs, objectives and values of the people you are talking to. This way, you can avoid a situation where the extreme and unreasonable declarations and positions formulated at the beginning of the discussions block the achievement of an agreement that is most favourable to everybody. The two following communication techniques are primarily used to check needs, objectives and values: open-ended questions and paraphrasing, e.g.:

„What is your idea for an agreement?”, „What do you care most in this situation?”, „What is most important for you now”?, „What do you need most now?”, „How do you see the possibility of accepting this solution? What does this means for you in practice?”, „I understand that your idea involves…”, „So, I understand that the most important for you is…”, „So, I understand that you mostly care about…”, „I understand that you need most…”, „I would like to sum up what you have said; it follows that you would like to…”,

If you want to effectively name needs, objectives and values important for others, in particular avoid the words, expressions and phrases that include the following: „no” and „but” (e.g. „I do not agree with you”, „what you are saying does not make sense”, „it is not like you said”, „this is impossible”, „this will not be like that”, „yes, but”…, „fine, but…”, „unfortunately, but…”. Phrases containing “no’s” and “but’s” mostly undermine the possibility of coalitions, leading to sharp discussions and conflicts.

Notice that naming others’ needs, objectives and values leads mostly to building coalitions and alliances. Beware, however, as listening to others and paraphrasing what they have said may weaken your negotiating position if it is used to formulate a hard and extreme position.


 

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Formulation of solutions

Use the following phrases and expressions:

„I would suggest that…”, „My idea is that…”, „My solution assumes that…”, „I suggest that we introduce changes in the following items of our agreement; I would like to…”, „What do you suggest in this situation?”, „This project cannot wait; if we do not make a decision today to implement it, we will lose the chance to…”

When proposing a solution, notice that projects and activities that, for strategic and objective reasons, may not be postponed have the greatest chances of succeeding.


 

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Building an argument

Use the following expressions:

„Let us note that…”, „We have to remember that…”, „If we do it like that, we will still be able to implement…”, „I would like to present a calculation for my project/my idea now…”, „We have to take into consideration such facts as…”, „It is that…”, „From my perspective, it is important that…”, „I suggest this solution because, according to figures…”.

The solutions that are hardest to undermine refer mostly to specific facts, figures and calculations.

 

Exercise 2. Changing the style of negotiations. Look at the negotiations that you conduct. Use the words, expressions and phrases from the first exercise for the analysis. Mark the ones that you use most often and those that you use less frequently or not at all. During next negotiations, try to change your style: if you are mostly passive and listen to others, take control of the content and scope of the discussions, actively build coalitions, present offers and justify them with credible arguments. If you mostly dominate in discussions, try to limit your control of the content and scope of the discussions, name others’ needs, objectives and values, let them formulate suggestions for solutions, and listen to arguments. Practice until you are able to effortlessly select the style that you use. Obtain the ability to adapt your behaviour to the context of conversations and styles of negotiations of the people you are talking to.

 

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Conversations with patients <i class="etl etl-heart" style="color: rgb(20,175,180); padding-left: 10px; font-size: 23px;"></i>

Empathy and mindfulness

Conversations with patients

Illness, frustration, anxiety, suffering - exercises for medical personnel

Exercise 1. Repeat aloud after the voice-over the key phrases and expressions that directly relate to patient support. By saying individual sentences out loud, the learning process is many times more effective than if you were only reading or thinking what you could or should say. By repeating individual words, you considerably increase the likelihood of their use in real-life situations. The exercise is like learning a new language; its logic and mindset will change your conversations with patients. It will help you listen, understand and deal with frustration, fear, pain and suffering of the people you are assisting.

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Welcome and establish contact

 „Hello, how can I help you, sir/madam?” „Do come in, what seems to be the problem?”, „Please, come in, how can I help you?”

If possible, be the first to say good day. Keep a natural eye contact, i.e. look into the other person’s eyes for about 60% of the time. 100% eye contact happens most often in case of strong conflicts and quarrels. The complete lack of eye contact may be interpreted as a sign of embarrassment, uncertainty or disregard. Adjust your tone of voice and speech rate to the tone of voice and speech rate of the person you are talking to; avoid speaking too slowly, too quickly or using an abnormally low- or high-pitched voice. Avoid any highly mannered style (dragged y’s, a’s, o’s, etc.). Pay attention to the gestures and behaviour that cause anxiety or sense of disregard, i.e. do not touch patient’s body without prior conversation about the purpose and scope of the examination or treatment; do not yawn; do not tap your finger on the table; do not play with your phone or pen; do not play with medical tools; and, above all, do not look at the computer display or write on the computer without first informing the person you are talking to that you are doing it for him/her. During the first 20 seconds of the contact, every new patient will determine whether you are person worthy of his/her trust or not. If he/she thinks that you are not reliable, he/she will question whatever you say or do. At this stage, your experience and competencies will be meaningless. If the patient has not choice, you will be the necessary evil for him/her (and, after a while, also for yourself).

22

Questions or remaining silent for the patient to be able to tell you of the specific purpose of his/her visit

Leave a moment of silence for the patient to be able to tell you of the specific purpose of his/her visit – this is especially important if you cannot or will not ask detailed questions about patient’s condition (registration, medical procedure):

„A referral to… (silence) I understand… (silence) do you mean?… (pause)…”, „The referral says that… I understand that this is about…”, „Please, tell me what happened? When and what did you specifically notice, sir/madam?”, „Please, describe exactly where it hurts, sir/madam Can you tell me the kind of the pain? How often does it appear?”, „Please, tell me how long you have observed these symptoms, sir/madam?”, „Please, tell me how this injury happened, sir/madam?”, „Please, tell me about the current course of the disease, sir/madam. How did it start? What medications have you taken and what treatments have already been carried out in connection with this condition, sir/madam?”, „Please, tell me more about… What exactly happened then?”, „You mentioned earlier, sir/madam, that… Please, tell me what else you have noticed?”

Watch out for auxiliary verbs, such as „Do” – if you use them too much, you will only confirm your speculations and guesses; the patient will not tell you about non-specific symptoms of the disease because you will not give him/her a chance to talk about them. Ask questions starting with „What”, „Where”, „When”, „How/Which”. Keep questions starting with „do” for the end of the conversation only to clarify what you have heard.

Do not ask why?, e.g. Why have you not come earlier with your problem? Why have you not taken the medication as ordered, sir/madam? There are only two possible and reasonable answers to such a question: I am guilty; I am unreasonable. Usually, after hearing those questions, we feel negatively judged and we switch on the defensive attitude: this is not me – it is the circumstances; it is the others. The person who asks such questions is perceived as unfriendly and lacking empathy.

If you are in a public place, avoid talking aloud about diseases and conditions that may evoke shame or guild in the patient.

33

Paraphrasing what the patient has said

Repeat, with your own words, what you have just heard from the patient. If the person you are talking to is experiencing feelings associated with fear, pain or suffering, name them and ensure you remember about those feelings and respect them while performing a treatment or examination or when suggesting a solution. The lack of paraphrasing is the most common mistake in communication with the patient, whereas there will be endless queues in front of medical rooms of the medical professionals who are able to paraphrase.

„I understand that this situation is very difficult for you – what I can do now is…”, „I can see that you are very worried because of the result, sir/madam – I suggest that…”, „I can see that it hurts very much – in this case, I suggest that you immediately…”, „I understand that you did not expect that, sir/madam,… I see that you are in great pain… in this case, the best solution would be to…”, „I understand that this is a new situation for you, sir/madam, that it is very difficult to come to terms with the news… eyes fill with tears… I understand… in this case, I have three specific suggestions for you, sir/madam…”, „I see that you are worried about your health. I understand that you lack information… in this situation, I suggest that…”, „I see that you are very upset, I understand that. What I can do for you in this situation is… like I said, I can also…”, „I see that you are tired and exhausted; you have slept only for a few hours – this must be quite difficult for you… therefore, I suggest that…” (to a child) „Your mum says that you did not sleep; you did not feel well; your nose was blocked; you could not sleep, had a fever, did not have the strength to play… I understand, now I have to… I know that you are afraid, so I will be very careful”, „I know it hurts a lot and that is why I will be very careful” (to a child) „I know that you are afraid and worried what will happen during this examination/treatment. Let us agree that before I touch you, I will tell you exactly what I am going to do… I understand that it hurts – I will be very gentle”

When paraphrasing what the patient has said, never use „but” e.g. „I know that you are afraid, but I will have to…”, „I know that you are worried, but”. „But” eliminates the sentence that comes before the” but” in emotional terms; the person you are talking to feels you are questioning his/her feelings; that you do not hear what he/she wants to tell us; that you do not respect what he/she is experiencing; and that you will be careless, insensitive and inattentive.

When repeating what you have heard from the patient, do not go into discussions; do not present any arguments why it is not possible to do what the patient needs. Talk about what you can do (even if you can do very little), what you want to do and what you intend to do. Remember to name feelings. Do not be afraid to talk about them. This will help the patient – and it will help you too. Do not worry you will burn out this way – that empathy is a threat for you. Burn-out originates from ignoring and suppressing patient’s feelings in a situation where the person you are taking to needs so much to name them. This ends in thinking about yourself bad, accusing yourself of the lack of sensitivity, comparing to others to whom patients show commitment, trust and affection.

Remember that your patient may experience:

pain, suffering, anxiety, panic, fear, shame, anger, annoyance, frustration, uncertainty, confusion, exhaustion, fatigue, helplessness, loneliness, resignation, despair, grief, irritation, impatience, sadness; he/she may also feel cold, hot, itchy, numb, tingling, pricking, etc.

Learn how to talk about these feelings – if you do, everything you say and do for the patient will have much more significance and importance.


44

Inform the patient what the examination or treatment will specifically involve

„This treatment is painless, what I need to do is…”, „First, you will feel cold, then there will be a sensation of distension… it is natural… this way, I can help you and ensure that…”, „The procedure will involve… at the beginning… then… at the end…”, „The examination consists of 3 stages… the first one is … the second one is … finally, the third one… is one that may cause pain – for this reason, I suggest that…”, „I will now have to have a look at…, touch… I know it may be embarrassing… it will only take a moment…”, „Before we start the procedure, I would like to tell you exactly what I will do… during the procedure, you may feel… this is a completely natural… please, let me know if you start to feel tingling or itching.…”, „Before the examination, I will need your cooperation… at the beginning, I will ask you to… then… please, also let me know if the pain increases – I will change then…”, „I will warn you before pricking your skin…”

Avoid silent performance of individual operations and medical procedures. Most of us feel anxiety, fear, shame and sometimes anger in such circumstances.

Try to say all the questions, paraphrases, explanations and instructions while maintaining good eye contact with the patient. When he/she is lying on his/her stomach on a bed and you are standing behind his/her back, it is a lot harder to focus attention and maintain a longer conversation. If you are going to force the patient to do so, he/she will mostly feel disrespected, humiliated and ashamed.


55

Formulating the solution or performing the procedure

„In this situation, sir/madam, I would suggest…” „The best solution would be to…”, „What I can to in this situation is that…”, „As I have said before, now I will ask you…”, „Watch out… a jab…”, „I understand… it hurts… I am already changing the route of administration of the medication.”, „Please, tell me where exactly it hurts… I need to know to be able to…”, „The possible consequences of this treatment include… the risk does not exceed 10%…  the decision is yours, sir/madam…”

When formulating the solution, name the objective that you want to achieve. This makes it easier for the patient to focus on the future and helps him/her endure the pain and suffering associated with various medical procedures.

„It is all about your health, sir/madam. This procedure will make your arm regain its full range of movement…”, „Your heart needs to rest. It needs time to regenerate and recover – the stay in the rehabilitation centre is necessary in order to…”, „You will be able to walk again – that is the purpose of what I am suggesting to you… the rehabilitation process will take… therefore, I suggest that … 95% of patients recover…”, „This examination will allow us to determine precisely what needs to be done for you to stop feeling the pain…”, „In this situation, to restore your health, you will need to…”, (to a child) „What do you like doing in the playground?… I see – you would like to play ball/throw snowballs/go sledding/cycling… Well… if this is to be possible, now you need to…”, (to a child) „I understand that you really want to be able to go to your friend’s birthday in a week’s time. In this situation, I suggest … I think that if you… you have a very high chance to meet with your friends”, (to a child) „After the treatment, you will be able to… it will be possible for you to… you said to me that your really care about… I know about this and I remember… this will make you…”

Avoid silence or using incomprehensible medical terms. The patient needs to be sure you understand his/her needs, what is important to him/her and what he/she cares about. He/she needs to know and understand that you will do everything that is possible to help him/her restore health to him/her and his/her relatives.

66

Closing the visits with specific arrangements

At the end of the visit, discuss specific steps of the planned treatment and the decisions taken. Repeat the most important facts, numbers and dates.

„In 7 days, please report for a check-up. On that day, I will be available from 10:00 a.m. in room no. 26. I will write this down for you”, „Registration will begin on 26 October at 7:00 a.m. Please, bring along…”, „Today, we have performed the 4th procedure – there are still ten to go. I suggest that the next one be performed on 10 May. Please, determine the specific time of the visit at the registration desk.”, „Take 2 tablets of this medication every other day for 10 days, i.e. you need to take this medication on Wednesday, Friday, Sunday, Tuesday and Thursday. I am writing this down right now. Please, remember that you will only feel better if you continue to take the medication like I said.”, „Summing up, we agree that on 10 March, then on 18 March,… and finally on 3 April…”, „You will need 5 additional procedures… I suggest that the first one be performed on Tuesday at 10:00 a.m.; please, report to Tom in room no. 34”

Avoid general words and phrases: „As soon as possible” (determine exactly when), „a few, many, several, a lot, a small amount (determine the exact amount).

If possible, write down the most important information on a piece of paper.


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Work organisation

Arrangement

Work organization

calendar, flexible task lists, contexts and activities, projects and tasks

Part A. List – my objectives, tasks and obligations.

The first part of the exercise is to prepare a list of all uncompleted, unfinished or planned objectives, tasks and obligations. You should not consider whether they are more or less important; professional or personal; short-term or long-term; general or detailed: the task is to record them in the order and form that appear in your mind. By default, the to-do list in this exercise should not be systematised or organised. The creation of the list ends when you are unable to remember or formulate any valid objective, matter, task or obligation important to you that you have not already recorded. Reading through the following categories of objectives, matters, tasks and obligations may prove useful:

 

  1. Financial matters and legal documents: banks, accounts, invoices, balance sheets, budgets, declarations, fees, rents, bills, purchases, credits, taxes, insurance, savings, deposits, funds, policies, insurance, statistics, reports, contracts;
  2. Infrastructure: real estate, roof, flues, heating and air conditioning, electricity, plumbing, walls, floors, ceilings, decorations, finishes, equipment, furniture, electrical goods, archives, storage, garage, garden, building surroundings, lighting, new buildings, cars, motorbikes, bicycles, technologies, machines, devices, computers, telephones, software, the Internet;
  3. Personal matters: schools and universities, studies, training, courses, languages, diplomas, certificates, degrees, libraries, books, articles, educational materials, playing an instrument, sport and physical activity, weight and diet, sleep, diseases, medications, doctors, clothing, cosmetics, appearance, projects, results, decisions, travels, new projects, plans, initiatives, new products, services, concepts, visions, strategies;
  4. Professional relationships: telephones, emails, letters, faxes, memos, responses, meetings, invitations, obligations, promises, superiors, co-workers, subordinates, customers, partners, investors, competitors, sales, marketing, logistics, distribution;
  5. Family and friends: telephones, emails, letters, meetings, invitations, responses, promises, husband/wife, children, parents, friends, colleagues, acquaintances, neighbours, toys, health, clothing, hygiene, education, development, name days, birthdays, anniversaries, celebrations, travels, holidays, gifts, photos; cat, dog, fish, birds, etc.
  6. Activities: cleaning, throwing away, cleaning, organising and sorting, installing, starting up, laying, analysing, writing, learning, teaching, resting, treating, repairing, maintaining, replacing, training, giving up, ceasing, refusing, buying, designing, nurturing, decorating, altering, improving, developing, building, limiting, being together, celebrating, investing, producing, supplying, selling, promoting, moving.

 

Part B. Development of a system of work organisation

Step 1. For each of the objectives, tasks or obligations recorded on the list, define:

  1. The nearest and simplest action that starts its implementation, and add it to your list, e.g. in case of the task: replacement of tyres for winter, the first action may be: find the phone number to a tyre service on the Internet. Do not determine the nearest and simplest actions for the objectives, targets or obligations that cannot be broken down into smaller meaningful wholes;
  2. That have 90% sure and strictly specified dates (if any); that are related to individual objectives, tasks or obligations. A 90% sure date is one that is precisely defined in time and results from circumstances that are difficult to change, e.g.
    • Finish the Z report by 21 May at noon – this date has been included in the contract with the customer and if exceeded, may result in liquidated damages or breaking off the agreement,
    • Duration of production meetings, participated by the Management Board and key managers, taking place regularly on Mondays from 9:00 a.m. to 10:30 a.m.

Important! Do not plan the time or dates for objectives, tasks or obligations whose implementation is not or cannot be strictly defined in time, e.g. do not enter the task: replacement of tyres for winter in the calendar until you obtain the information from the tyre service when exactly it will be possible. The most common mistake of work organisation is to fill in the entire calendar and plan time of completion of most objectives, targets and obligations. Due to changes in circumstances, the implementation of such plans is never possible and your assumptions prove infeasible.

Step 2. In your calendar, record the tasks, objectives and obligations associated with 90% sure and strictly defined dates (day, time). Do not write anything else in the calendar. Place other matters on flexible to-do lists.

Step 3. Review all the objectives, tasks and obligations one by one and mark those that comprise the nearest and simplest action in respect of others. These will be contextual actions and will be ordered according to the context necessary for their implementation. The remaining unmarked and more complex tasks will be referred to as systemic tasks, and will be arranged into categories according to whom or what they refer to.

Step 4. Develop 5 flexible contextual to-do lists, ordering them into the following categories: Telephones, emails, computer, shopping, TO-DOs – in case of free time . The flexibility of each list is about not determining any specific date for each specific contextual objective, task or obligation.

Step 5. Develop 5 flexible systemic to-do lists, ordering them into the following categories: Personal, family, home, work, maybe/one day. The flexibility of each list is about not determining any specific date for each specific systemic objective, task or obligation.

Step 6. This way, enter your to-do lists into a mobile device that enables you to browse them daily and set reminders. Important: Set the reminders only for contextual tasks. Systemic tasks enable to manage the general scope and direction of our objectives, targets and obligations. After a few days, adapt the system to your life: if necessary, modify the quantity and nature of accepted categories and how to use the reminders.

 

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Listen, breathe

Minfulness training

Listen, breathe

fatigue, exhaustion, depression, outbursts of anger, silence

Too many memories, thoughts, objectives and plans create the most common trap for your mind. They continually move you backwards or forwards in time. They hinder or even prevent you from maintaining the present mode. You do not see:

  • changes,
  • opportunities for development,
  • business opportunities,
  • needs of other people,
  • yourself.

You live in an unmindful manner. You are upset because something happened once or you are worrying about the future, planning, organising and finishing. You burn out and become exhausted. The mindfulness training, developed by Jon Kabat-Zinn, has been helping people for more than 25 years to deal with daily difficulties and troubles. The effectiveness of this programme has been confirmed in a meta-analysis of 209 studies participated by 12 145 people. This method supports building and protecting your personal energy, motivation, involvement, and counteracts effects of stress, exhaustion and burnout. We have prepared breathing exercise for you, inspired by the work of this author. Try and see how it works.

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My narratives

Therapeutic exercise

My narratives

bad stories, exceptions, strengths and opportunities, optimism, mental resistance

11

Getting lost and giving up

„My life is pointless. It is full of contradictions and absurdities. I have no dreams. I do not believe that it is worth it. I cannot say what I care about. I have no strength. I cannot find the motivation to act. I do not know what to do. Is it too late.”

 

22

Being worse

„I am a worse version of the man. Others have the knowledge, skills and success – they are stronger and better. I am afraid – I take no risks – I can only make fool of myself. I choose only the simplest tasks – I say I like it – I want to hide who I really am so much.”

 

33

Anger and guilt

„I am a bad person – I have no control over my anger – I can only scream – everything annoys and bothers me – I deserve nothing – others go through hell with me – they need someone much better than me. It is ridiculous and pathetic to think I could be someone good and valuable. Others know what I am.”

 

44

Loneliness

„I am lonely. Others move away from me. They avoid me. They do not like. I lost even those with whom I used to be close friends. Who is the person they are all leaving?”

 

Exercise

 

If you want to, you can now perform an exercise that reduces the strength of such negative stories about yourself and helps you liberate from their impact. Objectives of this method derive from the narrative therapy practised by Michel White and David Epston . You will need about 45 minutes of your time to start working on your own story. You can do this exercise alone or together with a close person that you trust and that has known you for a long time.

 

Such and similar stories sometimes lead you through your life. They hide right under your daily stress, fatigue and preoccupation with meaningless information. They come back to you when you are making plans, dreaming, trying to enjoy what happens to you here and now. They harshly mark the boundaries of a possible fate. They serve destiny up to the standards of their malice. Living in their shadow means torment and suffering.

 

Step1. My difficult story.

The first part of the exercise is difficult. You can continue for up to 7 minutes. If you extend the exercise, it will not produce the expected results: you will plunge into pessimism and hopelessness even more. Your first task is to write down several sentences of the story that bothers or limits you, associated with shame, guilt or suffering. Write one short story similar to the four quoted at the beginning. Do not write more! Remember: 7 minutes! Focusing on these few sentences for a longer time will be like losing your time on watching the starters instead of enjoying the main dish: you will leave hungry and angry. If you are doing the exercise with somebody else, ask him/her to check the time. Do not let him/her help you build the story or review it. At this stage, his/her biggest favour is to pay attention to the time.

 

Step 2. Exceptions – what events contradict my difficult history?

The second part of the exercise is to find exceptions, i.e. specific situations and facts that contradict the story told just a moment ago. It is not about comforting yourself, positive thinking or giving good advice and tips to yourself or others. The second task is only a reminder; it is about writing down and analysing facts and events that are difficult to reconcile with the story you have just written down. Try acting like a disciplined detective who investigates even the slightest inconsistencies or discrepancies. Do not twist the meaning of events. Do not cheat yourself. Write down only what you cannot explain using the bad story. When you recall such a situation, answer the two sets of questions:

Where were you when this happened? Were you there alone or was there anyone else with you? Who was that? When exactly happened? How long did it last? What happened before and right after?
What, in your opinion, does the situation you have written down tell about what is important for you in your life and what you care about? Could you name the values that you followed then? Could you describe the relationship between the main characters of the story? What knowledge, skills and abilities did you use in this situation? What was necessary to do this? What did you want to achieve in your life by taking such action? What does that say about your plans then? What person would take such an action? What does that say about you as a man that you have decided to take such an action?

If you are doing the exercise with somebody else, ask him/her for help now. Use his/her memory of the events and facts; ask more about those that do not fit the image that you have presented in the bad story; ask him/her to respond to the above questions and specify your beliefs, preferences, values, objectives, motives, knowledge and skills in his/her opinion. Write them down and analyse at least 5 facts, events and situation important for you!
 

11

Crisis and change

„7 years ago, I changed everything in my life for my wife and son. I took a risk of changing a job, place of residence, losing everything I had had, losing the respect of the people I had know and the sense of security. Over the next few years, I worked using the simplest activities and tasks not fitting my professional qualifications. I would go to work at 5:00 a.m. and commute more than 80 km almost every day. I did it for them. I think this shows that family is the most important thing for me; that I love them very much; that I can overcome a lot of obstacles for their welfare; that I provided them with as much happiness as I could; that I cannot be a completely bad person. I did not run away from a difficult situation; I did not give up; I did not break down”

 

22

Care for loved ones

„4 years ago, my father-in-law became very ill. He was 65 at the time. He was at risk of an extensive stroke. There was a great risk he would be unable to walk and would require a 24-hour care. Together with my wife, we invited him to our home; I made up my mind regarding all the related consequences. I knew that if his health deteriorated, my life and life of my family would change very much; I was afraid that it would be more difficult. My father-in-law lived with us for over a year; he gave us support and joy. When he felt better, he returned home. I was able to take a risk: I did not know he would recover. This shows that I care about others; that in situations of crisis, I am a real support for them. I do not think only of myself.”

 

33

Determination

„I graduated 4 years ago. I had to study, work and deal with my family responsibilities. Sometimes, it was really hard. For 3 years, I read, wrote and did complex calculations almost every evening. Many times, I had no strength; I was tired by the number of issues and tasks I had to do. I did not break down; I made it. I graduated on time. I think that this whole effort proves I can consistently strive for a goal; that, after all, I am very capable; I can quickly and effectively learn.”

 

44

Being needed

„For 5 years now, my everyday companion is Scarf, my beloved dog. He really needs me. He has nobody else in the world. If I was gone, no-one would care about him. Maybe it is funny, but, at the moment, he is the only sensible reason of my life. People have left – a beloved person has left me. However, I must live for Scarf; I will not leave him here at the mercy of fate; he needs me. I think that I care greatly for someone to need me; that I want whatever I do to have value for others. I cannot be such a recluse if I am pleased so much by being needed by others.”

 

55

For the daughter

„6 years ago, I helped my daughter buy a house. I have worked many years to be able to support her then. I could give up many things, sometimes wait for what I needed, share what I had, and did not think of myself. What I did shows that I love my child very much; that I am able to love; that there are people in my life whose happiness is more important than me; that I am a good person.”

 

66

Hope

„3 years ago, my son was going through a breakdown and crisis. I greatly sympathised with him. Despite his difficult situation, he often visited me. I could not help him financially. When he felt better, he said that conversations with me were really important for him; that I am one of a few people who believe in him; that I am someone who is not surprised by his strength, determination and ability to cope; that I help him think well of himself and have hope that everything will be all right. I will remember what he said forever.”

 

Step 3. My complex history.

The third part of the exercises is to write down a new short story. Try to use the expressions:

– Because this happened…,
– and in these situations I did…
– my bad story was too simple for me to treat it seriously
– my life is much more complex and …,
– I am cable of…
– I am able to…
– I can…

 

Step 4. Help others and end

The last fourth part of the exercise is the answer to two simple questions and a few conversations with important people:

Who would be the least surprised with your new history?

What would make these people least surprised?

If possible, meet them and let them talk about you: about their feelings and perceptions.

In a situation when you are struggling with a story that bothers, torments and limits you, repeat the search for and analysis of exceptions many times. At some point, your image of yourself will become more complex, and the bad story will turn out to be uncertain, partial and biased, and will cease to be the dominant and current version of you.

 

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