March 2022 Communication Tip

Attunement

This month, I’d like to focus on the powerful skill of “attunement.”  A basic concept in human development and psychology, attunement is the basis for meaningful relationships and is a clinical skill that we all can improve through practice.

Attunement is the process of understanding and responding to another’s spoken and unspoken needs.  For example, when new parents begin to understand what their newborn’s behaviors and cries indicate (hunger, pain, etc) , they are attuning to the child.  Needs are met and trust develops. When someone attunes to us, we feel seen and heard.  Attunement involves knowing what is important and figuring out what needs further exploration and what should wait for later to discuss.

Empathy (understanding and responding to another’s feelings) is part of attunement.  But attunement goes beyond just feelings and involves understanding and responding to another’s physical, cognitive, and relationship needs, as well as emotional needs.

In a recent paper by Juliet Jacobson and colleagues (Jacobson, J of Palliat Med, 2021;24;1737), attunement in the face of serious illness is described as being made up of 3 skills: asking, repairing disconnections, and offering containment. 

Asking:  Checking-in with a patient is the first skill in attunement.  Finding out what the patient needs, what is too much for them, monitoring how they are doing with the amount and cadence of information.  Additionally, the clinicians must be attuned to the needs of the patient, but also to the needs of the illness (the cadence, the seriousness, the natural history)

Repairing Disconnections:  We don’t always meet the needs of another perfectly.  Misunderstandings and disconnections are common.  We can misunderstand what a patient is feeling, or, we can understand correctly, but miscalculate what a patient is ready to discuss.  As Jacobsen writes, “Attunement does not require perfection but rather a willingness to learn from times of disconnection and a desire to continue to work toward deeper connection.”  Relationships take real effort, including the effort to repair things that aren’t working.   Usually, repairing disconnections requires acknowledgement of the moment, often an apology, and a restatement of an interest to make things better.  Patients generally appreciate the efforts to repair as they communicate caring and commitment.  It’s been said, “It’s about connection, not perfection.”

Offering Containment: Sometimes, being attuned means understanding (or figuring out) when strong emotions should be contained or simply dealt with later.  A clinician may say: “There are times when it can be too much to think about the future. Let’s switch topics and focus on your pain. Does that sound ok?”  Such communication may allow patients to maintain a sense of emotional control.

In the face of serious illness, clinician attunement to patients means recognizing when to push into difficult topics and when to back off.   Attunement allows clinicians to serve as a trusted guide to patients.  As Jacobson concludes, the “clinician is keeping an eye out to let the patient know when to worry and when to rest, so that the patient is not left alone to navigate the illness.”

Best,

Mike