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Q&A with Martin Richards

Hello Martin and thank you for having this conversation with us. Can we perhaps start by introducing you to our readers? Your professional background and experience?

I have over twenty-five years’ experience as a hostage and crisis negotiator and crisis management.

 I am a crisis management professional, who specialises in working with public sector and corporate business clients on crisis preparation, post event management, training, exercises, crisis plan preparation and assisting clients manage live crisis situations, including kidnap. I have spent time in senior leadership roles both in the public and private sector.

I spent 30 years in the UK Metropolitan Police with command responsibility over a series of high-profile major incidents. I achieved the rank of Chief Superintendent and retired after thirty years of exemplary service.  I was head of all management and leadership development for supervisors and worked on secondment to the Home Office, National Police Powers and Policy Unit and concluded as UK Director of strategic police command firearms training.

Throughout my career I was an international hostage and crisis negotiator, being responsible for the 24/7 deployment of negotiators and formulating negotiation strategies, incidents including, suicide interventions, armed sieges, protesters and gang related kidnaps.  I was also deployed to negotiate the release of UK citizens throughout the globe including into the war zones of Afghanistan and Iraq.

I have created my own crisis management company, where I created products that bring the world of hostage and crisis negotiations into the world of business, I am also currently employed as a kidnap and extortion senior management response consultant that has managed over 100 cases and debriefed over 100 hostages. 

People may wonder what a Hostage Negotiator and ex- Chief Superintendent of Scotland Yard has to do with care. Indeed, the connection may not be apparent at first glance. So how can your particular skill-set be of help and support to family members and caregivers who offer daily care and support to a loved one in need of care?

Communicating with people in a crises, negotiating with difficlt people and communicating with victims of serious crime use skills that can be used in all conversations.  Particularly difficult conversations, those that are emotional and where people are stressed.

At IDEA Care we strive for excellence in everyting we do, and that means not just in WHAT we deliver, but HOW we go about it. Very often, family members have a cruical role in delivering care to older persons or those with disability, dementia or other support needs. Unfortunately, too many of them take on so much that it takes a toll on their own physical and mental health. We are here today to offer a few tips for family members of vulnerable persons to help make communication easier.

 

  1. Sometimes a family member may need to make a difficult decision which their loved one is not too pleased with.  Introducing a live-in carer may be one such decision.  The guilt and self-recremination can be overwhelming, as can be those recurring questions that make you doubt whether you have made the right choice.  How should we deal with these situations?

It is my experience that the first step comes from recognising that our loved ones probably feel out of control, have little certainty and are feeling vulnerable, probably in contrast to the days when they were breadwinners, decision-makers, athletes, or successful professionals.

Making a connection and good communication requires  ensuring that a rapport is there, earning you the right to advice and reach a stage of  collaboration. The focus should be on working together rather than on their behalf. The patient needs to feel a sense of belonging and ownership of the whole process.

Empathy is really important, especially when you’re engaging with someone who may not want to hear what you have to say. Making that emotional connection will help to ease the way when you come to talk about a subject which may be sensitive or painful for them to hear about.

You could then steer the conversation to give a new perspective on how it could help them going forward.

Firstly you will need to manage stress – to pick up on it and identify their needs from their point of view, not yours.

The person will probably be feeling stressed because they sense that they have no certainty about what will happen – am I a burden to you?  Will you see fit to send me to a retirement home?  Will I lose contact with the neighbours I’ve known for so many years?  What about my cat – what will happen to it?

They most probably feel a lack of control over their own future which tends to make people feel unsafe or insecure.  To address these three areas choose words that address them. (e.g. its normal to feel unsure of what is about to happen….; this is unsurprising as its lot to deal with at one go…)  

Think, how can I make them feel as though they do have some control over the process, how can you make them feel safe. Try and give them some control over what will happen (e.g. select the home carer together; discuss best timings for their daily structure; give them choices over meal selection, clothing etc.)

You need to highlight the positives and the improvements it can make to their quality of life, rather than focus on approaches that haven’t worked in the past – to make it easier for people to say ‘yes’  (e.g. Having a carer at home will give me time to spend chatting with you and doing things we always loved to do together, like playing scrabble or listening to music; wouldn’t you prefer to enjoy or time together rather than me rushing from one thing to the next to take care of the practical stuff?)

You also need to manage your own stress and frustration with the barriers and challenges you face. Are you in a bad mood, too many demands in the workplace, have you the mental capacity to empathize? It takes effort! – so take the time to be in touch with your own needs – be honest and realistic about what you can deal with, and get a good support system around you – be it other family members, friends or professional persons.

Remember when people feel vulnerable it’s easy for them to become overwhelmed with information, so deliver your information in small chunks, allow them time to digest each piece of information before moving on.  Summarising or asking them to summarise what they understood can also be an excellent strategy to make sure that the information shared has indeed been understood.

Slow the pace of your conversation and be patient.

It’s important never to interrupt, this disempowers people and suggests only short answers are required by them and avoid asking, too many questions too quickly, then it may feel threatening – like a test or an interrogation. Vulnerable people may be particularly compliant in that they will try to be helpful by going along with much of what they believe you ‘want to hear’.

Summarising the outcome of your conversation is always a good idea, especially if some important decisions have been made which are likely to affect them deeply.  Always make sure you speak about the ‘how’ in addition to the decision made.  (e.g. we decided that we will bring in a carer during the time when I am at work as this will allow me to focus on work and not worry about you.  So I will be calling some service providers tomorrow morning and together you and I will review them tomorrow evening so we can choose the best one for you.)

 This allows the person to check your recall of what they have said for accuracy and prepare them for how the decision is going to affect them practically-speaking.

Don’t forget to check on the emotional state of the person before you leave them!

This is a difficult conversation so:

They must be convinced that your advice/proposal is to their advantage

Praise their ability to make tough and realistic decisions, e.g.  ‘It takes courage to raise / discuss this

It was brave of you to mention you need help, Not everyone is so self-aware, You are to be admired

You show strength by wanting to improve your health’

Keep ego in mind, their need to feel in charge: e.g. ‘You make the decision as to what assistance you require, You decide what you want to discuss, You can stop the discussion at any time – we can always continue later’

And finally, help them to save face:  (e.g. I realise that your personal space and privacy are important to you, so we will find a person who will assist you discreetly so that you can continue to feel independent and in control.)

  1. At other times, it may be necessary to draw some boundaries for the person you love so much. You may need your quiet time to spend with your own family, or you may need to go abroad for a few days. How do you communicate this in a firm but kind way – even if it is tearing you up inside?
  • Be honest about how you are being affected – emotionally and in a practical way (e.g. you are constantly worrying about their safety while you are at work and I seem to be making a lot of mistakes as I am distracted a lot of the time)
  • Wait for a response and give them the space and freedom to react naturallyir
  • Reflect back their response – (e.g. it sounds like you are surprised by what I told you/ sounds like you feel guilty for putting pressure…) – it’s ok if you call it out wrongly. Let them confirm or correct you.
  • State how you would like things to change – if possible, present more than one solution that could make this happen.
  • Mention the consequences if you are not allowed a break (poor health, leading to poor care) – be careful not to make this sound like a threat, but more like a logical consequence which you both would wish to avoid.
  1. Sometimes having a conversation with your loved one’s professional caregiver or doctor can be a challenge. There are so many questions to ask, and so little time.  It may already be an exhausting and overwhelming time for you, and sometimes it feels like these people just use technical jargon that simply go over your head.  Is this normal?  And how can you control it?
  • Slow down your speech and tone of voice. It will encourage the other person to do the same
  • Use silence after you have received information to give you time to process
  • Ask questions where you don’t understand – or summarise what you’ve understood and let them correct you or elaborate.
  • Don’t rush into agreement. If it’s an emergency situation where a decision is required immediately, then they will let you know.
  • Recognise your own emotions and label them.
  • Validate your own emotions – it’s ok to feel this way.
  • Breathe slowly and consciously to help you activate your parasympathetic system.
  • Summarise what you’ve understood to check for any misunderstandings
  • Ask for a plan of action (e.g. what’s the next step? Do I need to do anything?)
  • Recognise that there will probably be more questions that will pop up over the next few days. Ask for a name and telephone number where you can contact the professional with any queries or concerns that may arise
 
  1. Sometimes it seems like communicating with a loved one who is ill is a futile attempt at communication. Do they even understand what you’re saying?  And if they do, will they remember what was said?  Are there any tips you can share with us that will help?
  • Plan the conversation what are your objective?.
  • Speak clearly and slowly. Make sure they hear, listen, understand and feel ready to react.
  • Maintain eye contact. Don’t multitask! Give your full and undivided attention.
  • Be patient. Make sure you have enough time before you start the conversation.  Don’t be afraid of silence – give them time to react and reply.
  • Body language- be aware of what you are stating with your body. Turn towards your relative.  Be relaxed and open.
  • Use reminiscance especially with persons with dementia. This will help them feel comfortable and brighten their mood! Try remembering past events you enjoyed together, or a holiday you had together many years ago.
  • Limit distractions around you – strong sunlight, the phone, the TV/radio, people going in/out of the room can all be huge distractions. Also make sure that your relative is physically comfortable (s/he has eaten, drunk and gone to the bathroom)
  • Simplify choices
  • Empathise and validate feelings – you may be in a hurry to go to work, but to your relative, this is probably the most important conversation they have had all day. If you can’t stretch the time, close it off but make sure you have a set date/time for the discusssion to be resumed and stick to it!
  • Repeat important information as many times as necessary.
  • Use visual, auditory and other memory aides (e.g. flashcards, photos, recordings etc) especially for persons with autism, dementia or challenges in communication.
  • Encourage them to ask questions.
  • They should not be made to feel that their answers are inadequate in any way.

We should never say I understand.  Rather we should use the term, “help me to understand what you are feeling/ thinking.”

Head nodding along with minimal encouragers are nice nudges,  such as, ‘uh huh, I see, ok, right.’ Along with with open gestures, good eye contact and leaning forward. Merely passive expression with no movement or encouragers may suggest a lack of interest or engagement.

Finally, can you summarise some top tips to remember?

For all conversations to be successful they should incorporate three elements:

Empathy:  “Make them feel” 

Create a positive emotional connection between you and the patient.
You have to appeal to people on a human level

Reassurance: “Make them trust you” 

Make the person believe their issue is important to you.
Let them know you care

Authenticity: “Make them believe you”

Say something you mean rather than for the sake of it

 Remember:  you have to earn the right to advice or problem solve.  That means build rapport and listen before you attempt this.   Do the hard work first.  The person is then more likely to take your advice. 

 

Thank you Martin. It was a pleasure sitting down with you for this interview. I’m sure your input will mean a lot to many who are struggling with the reality of caregiving on a daily basis.

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