Conflict and overcoming it in discussion
There are many internal and
external irritating areas that can lead to conflict between a doctor
and his patient. If they are not resolved, they can lead to a stressful
doctor-patient relationship and usually hinder successful communication
because anxieties and aggression are released. Resolving
these sorts of conflict is usually difficult, less often because the parties
in conflict are not prepared to find a solution, but because the situation
of conflict makes them helpless. Discussion is the best way of overcoming
the conflict. This chapter attempts to show how to best solve interpersonal
conflicts rather than "interpersonal" conflicts.
All definitions of "conflict"
include irreconcilability of ways of acting, motives or ways of behaviour
as the general but essential characteristics. Mack and Snyder described
interpersonal conflict as being characterized by values which were non-complementary,
irreconcilable or opposed. Rüttinger's definition includes the qualification
of "apparently or actually incompatible plans for therapy". Birkenbihl
called conflict "every tension which can be characterized by hidden or
open antagonism". It is then the irreconcilability between two tendencies
to behaviour which, by definition, is the distinctive feature of conflict
(Seibt). In itself, because of its very nature, conflict is not solvable.
The only possibility of solution rests in transforming conflict into a
framework of problems, as problems are potentially solvable,
whereas conflict is not (Seibt).
Approaches to a solution
The transformation of conflict
into the theoretically solvable structure of a problem involves metacommunication
in discussion. By referring to the conflict in the sense of metacommunication,
both parties should be made aware of the irreconcilability of the way in
which they are dealing with one another or tend to behave. Only then is
it possible to find a common explanation and/or change the situation. At
that point there is no longer conflict, but a problem. The result of this
metacommunication is that "both have agreed to disagree".
If this situation can be
attained, not only is the path smoothed towards the solution of the conflict,
but productive or creative forces can be released.
This principle has been used
by the church in canonization procedures in which the devil's advocate
was expected to take a contrary position, in order that men should not
make incorrect decisions. Certain techniques depend on somebody deliberately
creating an opposing position, a procedure which is said to be used in
meetings of the American cabinet.
Every attempt to change
a situation of conflict depends on two conditions:
of the conflict situation and
to attain a conflict-free situation.
Attempts at solution consist
in trying to overcome the initial situation (conflict, which is
characterized by an irreconcilable behaviour pattern) and to attain the
objective (problem which is characterized by patterns of behaviour
which can be reconciled). Attempts for resolution are of the first and
In the first order attempt,
both parties remain at the level of the conflict. It is not possible to
attain a real solution. This can be shown by a common example of inability
to escape from this level of conflict:
A says to B: "I have
to nag all the time, because you are always smoking."
B says to A: "I have to
smoke all the time, because you are always nagging."
A says: "I only carry on
talking, since nobody listens to me."
B says: "I can't listen
to you any more, because you talk so much."
If these people continue
to insist on their positions at this level, no solution is possible.
Second order attempts to
solve the situation reside in moves to change the system from the "conflict"
structure into the "problem" metastructure. This is only possible when
there is an awareness of the conflict and when those involved in the conflict
have a high degree of flexibility and discernment of "the relative and
unique construction of actual internal drives" (Berkel). Put another way,
the relativity of one's own reality is the first step in the second
order of conflict management.
It also has to be recognized
that many apparently content-related conflicts are in fact
conflicts on the level of relationship. If in fact polarization
is purely a matter of facts or content, both are usually aware of
the differences. If the relationship is intact there is a good chance of
reconciliation. However conflicts in relationships are often hidden under
other differences. "These points of argument change from situation to situation,
and rather than being objects of conflict, they are only symptoms of conflict"
(Seibt). Both parties are surprised to find themselves conflicting again
and again, and do not realize that behind these more superficial conflicts,
conflicts are present in the relationship itself. Watzlawick says: "Both
parties experience each of these controversies as a completely new event,
a crisis that they have never had before as the substance of the conflict
is always different, but neither recognizes the persistent unresolved structure
of the relationship."
The only chance which promises
success to resolve conflicts in relationships is to make the structure
of their relationship clear to both, regardless of the actual substance
of the conflict. This is most likely to succeed through the intervention
of an external uninvolved person. It must however be emphasized once again
that the first and decisive step towards resolving conflict is to make
it known to both of those involved that there is really a disorder in the
relationship rather than just a divergence of opinions. Seibt explains:
"The major handicap in relational conflicts resides in the fact that the
people involved are not aware of their disturbed relationship or of their
part in it, but tend to unconsciously transfer their conflict onto any
old subject with the illusion that the discussion is objective and "serving
the cause". For example, in the case of marked conflict at the relationship
level, those involved in it can take part in conferences or discussions
which appear to be based on "completely factual" arguments about the budget
or introduction of permanent posts, but which are in fact marked by power
struggles, fawning or attempts to conceal incompetence.
Most possible solutions fall
at the first gate, as the aggression which is released by the conflict
(usually as an expression of anxiety) leads to a more or less complete
hardening of the positions. This means that the first step in a
conflict situation is to accept the aggression (Salewski). Accepting
aggression avoids the danger of blocking conflict management from the very
beginning. A further step is required, which attempts to reveal the problem
at the base of the conflict. This is done by considering whether there
is a conflict of substance or if the conflict is really due to a
relationship. A basic requisite here again is the ability to grasp
the reality of the other, and to strive towards a common reality, within
and through awareness of the conflict, to make a solution as likely as
possible as it comes to be seen as a problem. Salewski called this form
of overcoming conflict the APO method:
||Bring the Problem
to a conscious level
to hear the arguments of the other.
It is usually useless
to argue in a conflict situation. This leads to continual escalation
with new arguments and counterarguments, which bring no new facts to light.
It is more promising when one person is prepared to take a step: for example
if B were to say to A: "If you think that you only nag because I smoke
all the time, I won't smoke for 24 hours" (if A carries on nagging, that
proves that this behaviour does not depend on the fact that B smokes).
This first step should not be interpreted as simply "giving in", as its
actual objective is to attempt to leave the closed system of conflict in
which there is only unreconcilable behaviour or ways of acting.
The solution is most difficult
when the conflict is really not based on the facts, but rather due to conflicts
in the relationship. The possibility of resolution is usually afforded
in these cases by the intervention of a person external to the situation.
It is particularly important
to listen actively to the other person in a conflict situation,
to let him "have his say", even when he is critical. It is also
particularly difficult to leave time for the pauses which are necessary.
However it is only by doing this that there is a chance of determining
what are the real motives, expectations and points of view of the other.
There are three reactions,
commonly used by conflicting parties, which should be avoided, because
they do not serve the objective of resolving the conflict: appeasement,
evasion and confrontation. These techniques either put conflict material
"back under the carpet", "off until another day" or increase the conflict.
It also does not solve conflict to strive for harmony "at all cost".
Putting a name on the contents
of the conflict can have a clarifying function, as it defines the positions
and possibly achieves the first step in the direction of transforming conflict
into a problem. In addition everything should be avoided that would unnecessarily
extend the conflict further or lead it to go on endlessly. Even when disordered
relationships are at the bottom of a conflict, it would be wrong to question
the whole of the relationship ("... you probably don't think much of my
whole treatment"). It is much more important to define the limits of
the conflict, and to go into only that which relates to the actual
conflict material. A compromise (that those involved in the conflict
come together and each concedes something) is always better than an unresolved
conflict. It is also legitimate to mutually agree that the conflict
cannot be solved immediately, and that both should have time to think about
for overcoming a conflict situation
of the divergence (content) - ("We have agreed to disagree")
||Decide on the
level of the conflict (content, relationship)
order solutions have a chance of success - (transformation of the insolvable
conflict into a theoretically solvable problem)
define the contents
||Attempt to define
the disorder of the relationship - (perhaps with the help of a third
||Take the first
Geisler: Doctor and patient - a partnership through dialogue
Pharma Verlag Frankfurt/Germany, 1991
of this page: http://www.linus-geisler.de/dp/dp17_conflict.html