Communication is the linchpin of the work that we do within Crestwood, and it is a primary means for conveying our Crestwood values of Compassion, Commitment, Family, Enthusiasm, Flexibility and Character. As we strive to become more trauma-informed and committed to conveying an unconditional positive regard for those we serve, the words we choose and how we convey them become ever more important as they are the vehicles with which we convey our attitudes, perceptions, and beliefs.

Sometimes, even with the very best intentions, we choose words or say something in a certain way that is received as offensive by another. There are layers of cultural, ideological, identity, and historical dynamics that contribute to this. It is therefore crucial that we become educated about and sensitive to the individual triggers of those that we serve, those of our colleagues, as well as our own.  At Crestwood Treatment Center in Fremont, we practice a method of communication that we call “Non-Aversive Communication.” Essentially, we avoid using language or communication styles that are perceived as triggering with our residents. 

Common to the experience of those we serve at our Crestwood campuses, is a loss of independence. Whether it’s a short stay at one of our PHFs or a long-term placement at one of our SNFs, within our programs the people we serve do not have the full breadth of their prior independence. It is thus fair to assume that a primary trigger is any circumstance or interaction that indicates that the resident is not in control. We run the risk of communicating this when our actions or words suggest that we are in control when we don’t create space for choice or voice and when we suggest that we know what is right for that individual. 

This is the difference between telling a resident who has a limited income and whose goal is to obtain their own apartment, “That’s nice, but let’s find a goal that’s more realistic for you,” and instead saying, “That’s an admirable goal. Tell me a little bit about why this is important to you.” It is the difference between telling a resident with severe dementia who has had an episode of incontinence, “You’re wet,” and instead saying, “Here’s something nice for you to wear.” It is the difference between telling a resident who is in acute distress and agitated, “You need to calm down,” and instead approaching that person and saying, “My office is open, I’m here to listen.” It is the difference between saying “That’s breaking a rule of your program,” and instead saying, “You’re usually really on top of your goals. What’s different for you today?” It is the difference between saying, “No,” and instead saying, “This seems important to you, tell me more.”

There is a power dynamic inherent to the roles we hold with those we serve. Communicating transparency about this power dynamic further conveys respect, validation, and compassion. The intention of each of the latter of the previous statements is the same. It is an intention to acknowledge the individual by conveying respect that their experience, opinions, and choices may be different than our own, but are equally valued.  It is conveying that each individual’s aspirations are valued and worthy of dignity and that they are deserving and have very real and important thoughts and feelings. It is through such conveyance that trust, and therapeutic relationships are built. 

It is our privilege to accompany those we serve as they work towards recovery and wellness. It is our responsibility to clear the driver’s seat for them on that journey. The driver’s seat does not mean that the people we serve know how to drive yet or where and how they will reach their destination. But making the driver’s seat available, ensures that we are not creating additional barriers to getting in that seat. It means that we communicate our belief in the driver’s ability to get there and on the road that they choose. 

Contributed by: Karen Scott, Program Director, Crestwood Treatment Center, Fremont