Being assertive
Clare Lindsay, professional counsellor and author of Conquering Anorexia, explains why being assertive can enhance your career and gives some tips on how to put assertiveness into practice
Assertiveness has the potential to open
more career doors than any other set of
personal skills. It can boost self esteem,
build confidence, reduce personal stress levels,
and help people get as much from their
working environment as they can. With the
ability to treat colleagues positively and fairly,
assertive people gain the respect and
genuine liking of those they work with.
They feel good about themselves and their
abilities, respond well to difficult situations,
and manage their time efficiently by saying
"No" to unreasonable demands. Creating
around them a relaxed environment in
which problems can be openly discussed,
assertive people give and receive criticism
constructively, deal with negative emotions
healthily, and handle conflict effectively.
Communicating assertively can lead to happier
working conditions, lower stress levels,
and greater performances at work.
Learning to be assertive is probably of
greater relevance to medical students and
junior doctors than doctors already established
in the profession, when stubborn attitudes
and unspoken conflicts are common
practice. It helps you survive the hierarchical
system and arrogant behaviours that will
sometimes do their best to undermine you,
your abilities, and your needs.
DARLAINE HONEY/TREVILLION
What is assertiveness?
Based on principles of equality, assertiveness
involves individuals treating themselves
and others as equals and emphasises
the importance of individuals taking care of
personal rights, needs, and responsibilities.
The aim of assertive behaviour is to ensure
that the rights and needs of the self are protected
and satisfied while still equally considering
those of others.
Box 1: Fundamentals of assertiveness
- Think of and value yourself as an equal
- Recognise and protect your rights
- Identify your needs and ask for them to be met
- Take responsibility for yourself and not other people
- Express negative thoughts and feelings healthily
- Stand up for yourself
- Confront awkward people
- Give and receive criticism
- Handle conflict
- Learn to say "No"
1. Tips to being more assertive
Recognise and value yourself as an equal
Accept that your rights, needs, feelings, and
ideas deserve the same respect as everyone
else's.
2. Identify and protect personal rights
For example, to be treated with respect, to
have your needs met, not to be taken for
granted, to be allowed to make mistakes.
You have the right to have your rights
respected. Protecting your rights is your
responsibility.
3. Identify and satisfy personal needs
Having needs met does not mean you're
selfish. Having needs met is essential to
wellbeing. This is different from wants. It is
your responsibility to ensure that your
needs are met.
Acknowledge and respect the equal
rights and needs of others
Listen to what others have to say. Use
empathy to let others know you've heard
them and you appreciate their position. Use
awareness of other people's rights and
needs to ensure you treat them fairly.
4. Don't take responsibility for other people's feelings and or behaviour
Accept that you can be responsible only for
your own thoughts, feelings, and behaviours.
It's not your responsibility to protect
other people's feelings, nor is it fair to neglect
your needs in order to keep others
happy. If someone chooses to react angrily
to something you say, assuming you have
behaved fairly, the other person's anger is
their responsibility. You have no right to feel
responsible or guilty.
5. Express yourself honestly and clearly
6. Disclose feelings
You have the right to express both negative
and positive feelings. Telling others how
you feel helps them understand and appreciate
your needs.
7. Learn how to say "No"
Draw on the above skills. Use initial gut
response to judge whether you wish to do
something or not. Remember: you have the
right to say "No." If you're not sure what you
want to do, buy time and decide later. Go
with what is right for you. Saying "Yes" can
leave others feeling bad if they detect you're
feeling resentful. Remember: by saying "No"
you are rejecting the request not the person.
Own up to your feelings, share them with the
other person, and let them go. Suggest an
alternative to leave both parties feeling good.
8. Use a stock phrase technique when confronting others
Choose a stock phrase which concisely
encapsulates what the problem is and what
you want to change or to happen. Use this
to explain to the other person what you
wish to achieve. Listen to the other person,
consider their rights and needs. If your
desired outcome remains unchanged,
repeat the stock phrase until your key points
have been heard and acknowledged.
Empathise with the other person but keep
to your agenda - for example, say: "I appreciate
your point about (repeat stock
phrase)." Disclose feelings and state your
rights to strengthen your case. Feedback
honest positive feelings to the other person
- for example, say: "I really value your
opinion but (repeat stock phrase)."
Persevere until you reach an outcome or
compromise satisfactory to both parties.
Developing self esteem, confidence, and
healthy coping behaviours is also essential
for people with depression based disorders,
for example anorexia nervosa (see box 2).
You might want to pass these tips on to your
patients too.
Box 2: My experience
I had been anorexic and severely depressed for eight years when I started to write
Conquering Anorexia (see p000). I was a perfectionist and felt a failure. I had no self esteem
and I didn't believe that I'd ever be fully well again. Barely surviving from one day to the
next, I was living my life to meet the expectations of those around me and I was putting
everyone else's needs before my own. Forever terrified that other people might not like
me, the only need I had was the need to please others. I didn't think for one minute that
I had any right to be happy. Nor did I have any understanding of what it meant to be
assertive. At that time I thought that being assertive meant being aggressive and selfish.
Yet learning to be assertive completely freed me from an illness that no doctor, friend,
academic, or book ever had.
I was an expert at being passive. A natural at taking care of everyone but me, I ran from
conflict, keeping negative feelings to myself. Powerless to deal with the pressures and
stresses of young adult life, I had needed something to block out everything that I wasn't
dealing with. Not eating did the trick.
When I entered a therapy programme, I became aware for the first time that my anorexia was
not, and never had been, a problem about eating. I was able to identify and begin working
upon the real issues behind my difficulties. With the help of group therapy and assertiveness
training, I began to identify the thinking patterns and behaviours that I needed to change. I
gained self esteem and the confidence to take risks. Gradually I began to learn the skills in
assertiveness that eventually enabled me to tackle the many issues underlying my anorexia.
Others in therapy with me made similar progress as they too began to master assertiveness
- the life skill we had all lacked. Differing levels of assertiveness played an important
part for each of us in determining the development, maintenance, and conquering of our
difficulties.
Don't forget your future patients
As well as helping people with eating
disorders, learning how to be assertive can
also benefit many people suffering from
mental illnesses such as depression and anxiety.
Once you have mastered these skills
yourself, you might want to pass them on to
your future patients.
Clare Lindsay, professional counsellor and author of Conquering Anorexia
Clare has kindly agreed to correspond with anyone who wants to contact her through her publishers:
Summersdale Publishers Ltd, 46 West Street, Chichester, West Sussex. PO19 1RP
(www.summersdale.com
studentBMJ 2001;09:217-260 July ISSN 0966-6494
