Communication With Clients
Larry Birnbaum, PhD, FASEP, EPC
Associate Professor
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN  55811

Good communication skills are essential for any profession.  Exercise physiology is no exception.  Unfortunately, most exercise physiology students probably receive very little help with this function beyond a standard freshman level general education communication course.  Such a course provides basic communication concepts, but students pursuing a profession need more.  They will need honed skills to work directly with clients in clinical situations.  While these skills can be taught to some degree in an academic setting, honing can only be achieved with practice.

 Obviously before we can teach any skills, we need to identify them.  So, what are these client interaction skills?  Purtilo and Haddad [1] structure all aspects of effective communication around respect, not just for the client, but also for yourself, your profession, and other aspects of the provider-client interaction.  A model of communication referred to by Purtilo and Haddad [1] includes verbal and nonverbal behaviors as well as the environmental context.  The context includes the location of the interaction and the circumstances under which the conversation is occurring.  Face-to-face interactions are preferable because all the possible means of communication can be engaged [1].  The location could be a medical center (e.g., cardiac rehab), a wellness center, a fitness facility, or the client’s home.  Consider features of the site and the purpose of the visit before engaging the client in conversation.  What possible effects will the sights (e.g., medical equipment), sounds, smells, other personnel and so forth have on your client?  The client will be most at ease in her own home, which may be ideal for some purposes but not for others.

Selecting the right words is, of course, critical.  And it is not just the words, but the way they are spoken and organized as well as the tone, volume, and clarity of your voice.  Technical language may not be appropriate for many clients.  Never try to impress a client by using highly technical language.  Communication will be more effective if you interact with your clients as equals.  Always check for understanding of any instructions given by having the client repeat those instructions in his own words.  Bear in mind that he may be too embarrassed to admit he does not understand something you said.  The critical nature of tone and volume cannot be overemphasized.  Either can send a different message than the speaker may intend. 

Another variable that impacts communication is attitude [1].  Exercise physiologists must be aware of their own attitudes about characteristics of their clients and issues that may be discussed.  An attitude adjustment may be necessary.  For example, if an exercise physiologist is disgusted by obesity, she will need to change her attitude if she has to work with obese clients, especially if she expects to be successful with them.  Similarly, the emotional and mental state may require adjustment before entering into a conversation with a client.  Clients will detect anger, fear, busyness, etc., which will hinder effective communication.  The exercise physiologist must be careful to enhance rather than hinder her message with her nonverbal signals.  On the flip side, the exercise physiologist must be tuned into nonverbal cues from the client.  An attitude or mental state may be reflected in facial expressions, eye movements, gestures, posture, and proxemics [2], not to mention physical appearance.  These nonverbal signals may connote understanding or confusion, dislike or disgust (e.g., you expect me to what?), acceptance or rejection.  If the nonverbals do not agree with the client’s words, probing questions may need to be asked or illustrative examples provided to enhance understanding or to clarify an important point. 

Possibly the most important communication skill is listening [1,2].  Exercise physiologists may engage in analytical listening (looking for and categorizing specific kinds of information), directed listening (looking for answers to specific questions), or attentive listening (looking for general information) [1].  Obstacles to effective listening include a mindset that distorts meaning, trying to force an idea into a familiar context, and the rate at which incoming information can be processed [1].  To minimize these obstacles, the exercise physiologist must be cognizant of his biases and understand how they might impede his ability to truly hear what his clients are telling him.  Do not be too quick to categorize concepts into existing frames of reference.  Important aspects of the message may be lost.  Depending on the amount and level of complexity of the information, sufficient time must be allotted to enable comprehension.  Techniques that can improve listening include eye contact, clarifying, paraphrasing, and appropriate use of silence [2].  Put simply, good listening requires undivided attention.

Trust may be second only to listening as a component of effective communication.  Exercise physiologists who act superior, manipulative, and controlling tend to decrease trust, while spontaneous, empathic, and problem-oriented behaviors enhance trust [2].  A technique that may help build trust is limited self-disclosure, such as sharing a personal experience.  Using “I” rather than “you” statements may also help as “you” statements tend to sound accusatory and judgmental and may put the client on the defensive.  Additionally, the exercise physiologist must never preach to her clients.  Preaching may be interpreted as disrespectful, it turns people away, and it may create distrust.  It may be necessary for the exercise physiologist to teach the client, but teaching is not synonymous with preaching.  Teaching requires mastery of all the aforementioned communication skills.

An additional consideration regarding communication is the type of questions asked.  Open-ended questions elicit a wider range of responses while closed questions may be used to acquire specific facts.  Both are generally necessary to gain a thorough understanding of the client’s issue(s).

If this is the first time the exercise physiologist is meeting the client or considerable time has elapsed since the last meeting, the exercise physiologist should introduce himself and briefly explain what he does.  Be sure to use the client’s full name unless she gives you permission to use her first name.  Ask her how to pronounce her name if you are uncertain.  After the introductions, you can now address the nature of the client’s visit.

If the exercise physiologist is working with a group, she must be aware of forces that affect the group, how the group influences individual behavior, and the group’s stage of development at any given point in time [1].  In the first stage of development, orientation, the group needs to know the purpose or goal of the group and the time frame in which the goal is expected to be accomplished.  Since the members are very dependent on the leader at this stage, she needs to provide clear direction and structure.  In the second stage, griping is the norm, and it is typically directed at the leader.  Members are frustrated and angry with the group process.  The leader must be patient and continue to provide direction.  In the third stage, members identify with each other and the task of the group.  They come together and sense a shared purpose.  Problem-solving and cooperation to achieve the goal mark the fourth and final stage.  Different groups will vary in the manner in which they move through these stages.  Some may not make it beyond the first stage. 

This synopsis of communication skills is intended to assist exercise physiologists improve their interactions with clients.  Being brief, it merely scratches the surface of a multitude of communication issues.  There are numerous publications on communication and client interaction.  The practicing exercise physiologist and exercise physiology students are encouraged to pursue additional reading, and, if possible, training in this most crucial aspect of professionalism.

References

1.  Purtilo R., Haddad, A.  (2002).  Health Professional and Patient Interaction, 6^th ed.  Philadephia:  W.B. Saunders Co. 

2.  Grover, S.M.  (2005).  Shaping Effective Communication Skills and Therapeutic Relationships at Work:  The Foundation of Collaboration.  AAOHN Journal.  53:178-182.