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Doctors at Work Podcast.

Episode #20

How to develop assertiveness. With Gareth Couch

Mat Daniel


In this episode, Gareth tells me what assertiveness is and what it isn’t. He outlines how assertiveness is more about how you see yourself, and the relationships that you have with others, rather than posture or voice. I like his idea that it’s neither passive nor aggressive, but a way to get your message across in a constructive manner that depends on the audience at the time.

Podcast Transcript

[00:00:00] Mat: Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors’ careers. Today I’m having a conversation with Gareth Couch and we’re talking about assertiveness. He tells me what that is and what it isn’t. He outlines how assertiveness is more about how you see yourself. And maybe the relationships that you have with others rather than being about your posture or your voice or how loud you are.
I particularly like his idea that it’s not being passive nor aggressive, but it’s a way to get your message across in a constructive manner that depends on the specific audience at the time. Hope that it’s useful.
Welcome, Gareth. Tell me about yourself.
[00:00:52] Gareth: Yeah, hi. I say from one coach to the other, I would say what do you want to know?
[00:00:59] Mat: I want to know how you got started in assertiveness.
[00:01:03] Gareth: And that’s an interesting story, really. So in terms of my background, I was leadership professional in retail hospitality. And then I had a big life transition, moved to Brussels from the UK, realized that retail for me wasn’t quite what I wanted anymore, but still loved working with people.
So then I went and started looking to coaching as a career. Again, working with people has always been something that comes very natural to me. I’m again, I’m an extrovert at heart. I started playing as a coach and I’m now an associate certified coach with the with the ICF. And then as I had more and more clients coming to me Over the times you start to pick up on themes.
Again, the commercial person in me was hearing and listening to what their sort of topics were, which were very much around boundary setting, being able to say no being able to speak up at work and express their opinion. And these thematics came back again and again. So then what came from that then was there’s a need here in the market for someone who can specialize in assertiveness.
Who can support people to, again, find their voice find their self expression, communicate it in a way that doesn’t…
And that’s where it came from. And now there’s a workshop, there’s a book in the making, maybe one day they’ll make a film about me, I don’t know. I don’t know the last bit, I’ve got a face for radio.
[00:02:33] Mat: Face for a podcast.
[00:02:34] Gareth: Face for a podcast, exactly. And that’s it really. And now, in addition to focusing or having my niche in assertiveness, I also train up and coming coaches to the market.
So I was at an accredited school in Belgium.
[00:02:50] Mat: What actually is assertiveness?
[00:02:53] Gareth: That’s a good question. It has evolved, if you look back over the last 100 years or so it started out very much of a skills based approach around how to how to speak in a certain way, how to communicate your needs in a certain sort of, quite like a fixed manner.
For me, what I’ve noticed in more recent times is again, assertiveness has been characterized as. This ability to, stand tall, stand proud raise your voice enunciate and all these, these are elements that kind of, yes, can contribute to a form of assertive communication.
However, I think that for me, what assertiveness is about being able to express yourself, be direct, be firm, be positive, but it’s where it comes, it’s where that comes from, which is. Almost like a sense of inner alignment that, there’s no one way to be assertive. In fact, for me, it’s inauthentic if you try to be something you’re not, quite simply.
For me, what I, in my work and what I do is working with people, supporting people to, so again, find their inner voice, to understand what’s important to them, to remove sort of some of the, beliefs they may have built up about themselves over the years, tap into this or any resources to really understand who they are, and then through that, they can then start to express themselves in a way that’s very natural to them, that also gives them gravitas, that allows, again, allows the…
Not just their voice, their opinions and their feelings to be heard. Yeah.
[00:04:20] Mat: So it’s a mixture of how other people perceive you, and it’s a mixture of how you perceive yourself? Is that, does that sound fair?
[00:04:28] Gareth: Assertiveness is always situational. It is always situational. When I say that it’s the, yes, it’s a two way thing.
So You will be communicating your message at the same time you have to be mindful of the audience and who is receiving that, you can’t just have a you can’t run a rough shot over everyone just because you, if you’re entitled to express your opinion, to share with it how you feel about the situation.
But again, it’s, you also have to take into account your audience. It’s one of my, what I call, rules of the game, which I cover in my talks.
[00:04:58] Mat: Tell me a bit more about this idea that it’s situational and that you need to take the audience into account.
[00:05:05] Gareth: For example, when you’re how can I best describe this, is that when you I think, when I think of the certainness, sometimes there’s this, or there’s Almost negative connotation, but almost be an aggression, and you have that image of the, the pointing finger.
But when you’re pointing the finger, there’s three fingers coming back at yourself. So it’s just that element of self reflection, yes, you’re speaking to somebody, but remember, the other three fingers are pointing at you, so it’s, taking, you do have to take into account your own, your own emotions, your own expression to make sure that lands coherently, but it doesn’t, I said it doesn’t unduly impact on other people it, there is a right to self expression, but it’s not to the point of aggression.
[00:05:49] Mat: So this is perhaps very different to maybe what some of us in healthcare are used to where we always used to, there’s always somebody. Who, who talks very loud and all over everybody else and is very strong in giving their opinions. Sometimes that’s me, Gareth, believe it or not, but it sounds like that’s not what you’re describing.
[00:06:11] Gareth: Again, when we look at the situation there, I would say, again, it would depend. My understanding of healthcare is very limited, so I’ll just put that there now. However, I can imagine almost like any other profession, you have moments and times where actually there are moments where how can I put it, where assertiveness might spill over into aggression, as such, or could be perceived that way, but sometimes the situation will warrant a very strong, authoritative voice.
For example, in times of emergency or when the delivery arrives late and everything in my profession and you’re trying to mobilize 40, 50 people at once. Again, it’s, again, it’s how you do it. It’s how to create that sense of urgency, for example, in that situation, how to mobilize people, but at the same time, again, it doesn’t mean you shout at them.
It’s how do you take into account, actually, because they’ve all got their lives on the go. Maybe what’s your priority isn’t necessarily theirs. It really is an art to working with people and landing your message.
[00:07:13] Mat: I might pick that up a little bit. I’m going to, I’m going to move on to maybe lack of assertiveness, whatever that is in a minute, because that’s probably much more common.
But actually, we do have an issue because there are often urgent situations or emergencies that do require healthcare professionals to speak up and be quite authoritative. What would be your tips about how does one do that in a way that lands well and constructively rather than in a way that lands in a kind of, very aggressive or very dictatorial fashion?
[00:07:48] Gareth: Yeah. For me, one of the things that my career is this approach of what I call, and again, it’s something I convey in my courses, is the, what I call the four part message, which is. And this can be done very succinctly on the spot, but it’s where you convey the situation that’s happening, how you feel about it, the effect it’s having, and what you want that person to do differently.
And it can, it does sound quite a big paragraph as such, or a soliloquy, but really it’s just a case of stop doing that. It’s making me feel X. The effect is it’s preventing me from achieving whatever it might be. I would ask you to do it differently going forward.
So there’s a sort of polite request, you’re… But again it’s focused on you as the individual you’re taking accountability for your feelings, and I think that’s one of the linchpins to assertiveness is that, yeah, it is about you, not about so maybe an example then might be, to die.
[00:08:44] Mat: I’m actually really stressed about that because the stakes are high and I need you urgently to go and do or get X, Y, and Z. And actually, as you say, that, that’s really quite quick, isn’t it?
[00:08:55] Gareth: And it also, and then again, when it comes back to a bigger piece around being on the spot about change management, how do you communicate the why, you’re telling people it’s, that’s the important bit really is if you just said in the go get whatever it is you want to get for the sake of those extras for I think three or four seconds.
Again, I’m not a healthcare professional, I would question whether that’s the difference between life and death. Maybe sometimes it is. But, it’s not maybe in the operating theatre where there’s different times and occasions where you would adapt your tone, adapt your approach, volume, even the content.
Sometimes the quick yes, no, grab this, grab that. We all do it. But it’s just, it’s more so in the everyday in terms of creating a work culture that is inclusive. Friendly, productive and engaged. That’s, this is where I’m focusing is more around is those elements you’re in the sort of the everyday rather than the sort of the more acute situations.
[00:09:52] Mat: And in actual fact, the acute situations, they don’t just come out of the blue, there’s often a preamble and then maybe in the preamble, then one can communicate the urgency, the worry, the importance, the why. And then, when you do actually need something. Urgently, then all of those things have already been communicated.
Yeah. So I like that. Yeah. I think so I think that we, that is an issue in healthcare, but often it’s we get people that that either they themselves say they struggle with assertiveness or other people say this person struggles with assertiveness. I’m interested, can you tell me a bit more about, what exactly is lack of assertiveness?
[00:10:33] Gareth: When we say lack of assertiveness, for me, the word is passive. It’s the it’s passive and it’s also you can also have a lack of assertiveness in the sense as well that you are the other extreme, which is where you have such a lack of self awareness in fact that you’re so aggressive, assertiveness is the sweet spot, as I describe it, or if you imagine a seesaw and you’ve got passive on the one end and aggressive on the other, and assertiveness sits right in the middle, if you, if it’s achieving that balance across sort of the behaviours and across the approach to, again, to land your message.
In terms of so again, passive individuals tend to generally not express their needs. They don’t tend to share with what’s important to them or communicate how they feel for fear of, again, fear comes up a lot, again, but it’s around for fear of being rejected or for fear of being thought stupid sometimes.
There’s many different reasons. It’s the mostly fear based which drives the kind of yeah, that sort of passive nature.
[00:11:29] Mat: How do people end up like that? Do you know that ?
[00:11:34] Gareth: I couldn’t give you an answer to that in the sense that every single person has a, their own unique story and own, in the sense that from the day we’re born pretty much, from the moment every single moment since we arrive.
We’ve been having impressions thrown around us from our parents, grandparents, schools, friends, colleagues. All these things will create and reinforce beliefs about ourselves, how we see ourselves in the world. And that’s what really contributes to then, again, this, our identity.
And this is again, this is where, what we’re working with is actually with the identity of people at the end of the day. And that’s how this. Either lack of assertiveness, or lack of passivity, or lack of assertiveness, or aggressiveness can form. And that’s my job then, is to, when people identify that need, that they want to communicate in a different manner.
Or even, it’s more than communication, if I just be in a different manner. That’s where I then get involved and we strip back some of the layers. To understand what’s going on there. What beliefs have they picked up over the years that are no longer serving them.
And again and understanding how it, again, through doing that, they start to explore and understand how they feel about, how it feels to them to express themselves. Initially, it’s in very safe scenarios, very safe situations coaching session or training session. And like I said, and then piece by piece, then it’s confidence building, people then.
take step by step to, find their voice and start to engage the wider world.
[00:13:10] Mat: And how do people know where they are on this aggressive versus passive or the certain sweet spot?
[00:13:18] Gareth: Do you know what, a lot of times I think people do know necessarily it’s, in fact when a lot of people arrive it’s a place of not knowing.
They, they don’t know what it is that they necessarily want sometimes. It feeds into, because someone who is a surrogate, for example, is very much in, like I said, aligned in terms of what’s important to them and what they want and what they need from others and from themselves. So it’s more actually a place of, yeah, this sort of not knowing space that people arrive.
And again, it can come from, like I said, from any other angle of space around assertiveness. And I suppose what I do is quietly welcome them in to the circle again, step by step. And that’s the joy of the work. Some people take a lot of steps. Some people can jump straight in depends on the individual, depends on that whole beautiful life experience they’ve had before that will undoubtedly inform who they are.
[00:14:14] Mat: And I guess arriving Uncertainty. I think when all of us as healthcare professionals, if we think I’m not really quite sure how I am or who I am or what impact I have on others, and I want to spend some time thinking about it, that’s quite a good place to be, I think.
[00:14:31] Gareth: Yeah. You think about, a place of not knowing is a place of curiosity. It’s very childlike in that sense. I miss my childhood, I don’t know about you, but I it was definitely a, a joyous time. I think I think there’s a genuine fear.
Sometimes people don’t enjoy not knowing this and that, they want to be in control. They like to have some sort of sense of where they’re going. But more often than not on the journey, when people then accept the fact that actually I don’t know. That’s where then this is one, one of the turning points where then they start to really find out who they are, really find out.
what it is they want. And again, and then within that, how they want to express that.
[00:15:13] Mat: I think the not knowing, I can see that also translates into clinical practice because one of the things I’ve noticed is as I’ve gotten older and more experienced, I’m much more likely to say, I have no idea. Then perhaps I was early on in my career When it constantly I felt that I did have to have all the answers and if I didn’t I was somehow a failure.
You, you mentioned earlier that in order to change that it’s about identity, it’s about how people see themselves. I’m interested how do people change how they see themselves?
[00:15:43] Gareth: I should put a caveat here.
Not everyone will do, and again, in terms of the journey people go on, some people will potentially reach that level of exploration. Some people say, actually, and this, and again I don’t force my agenda on people, but some people would just be actually happy or content. Their aim is to actually get some sort of what I call assertiveness skills.
More so like what I call it the. Entryway into a certainness. Again, it will depend on the individual but really this how they arrive there is when they start to, what I call deep dive and explore again, 20 years ago or 10 years ago, maybe even 10 months ago for some people, so it’s very much around yeah, working with, again, this sort of sense of discovery and exploration not knowing, what it is that is important to them in life.
Not knowing when they arrive around, how can I put it, the, or not knowing there’s another way to see the world sometimes, it depends on, we can really have, it depends on our exposure to the wider world that we can really build up some very strong viewpoints about ourselves and about other people around us.
And it’s just, again, I say this in my course, it’s just A truth. It’s not B truth, and that’s one of the beauties of. When you go into sort of a personal development course like this, or when you work with a coach is that if that other perspective is what we call that mirror, someone to hold up and say, actually what are you seeing right now?
And if I hold it here from this other angle, what do you see there? It really is about again, thriving and bringing about this sense of, or an increased sense of self awareness. And through that’s then how people arrive because again, they see themselves from many different angles.
Many different positions over a course of time and then that’s them where they will or won’t decide to, call it a change. Or maybe they might even do it unconsciously sometimes. Yeah.
[00:17:35] Mat: Yeah. I like how you talk about assertiveness coming from the inside and you, how you see yourself, the relationship you have with yourself.
And all of the stuff that, people read about, standing tall and, and using a loud voice that’s. That’s superficial stuff, which, which may or may not work for some people but even if it does work it’s superficial behaviour. Whereas what you’re saying is what really needs to happen is there needs to be a healthy relationship with yourself and an understanding of how you impact other people.
And that’s where high quality assertiveness rather than aggression or passive behaviour than sits. Yeah, I think,
[00:18:15] Gareth: If I give myself as an example here, so I’m, what continental 193, six foot, six foot two in, in UK measurements I’m not a big guy. So for me, if I was saying standard, as we said, this kind of tall shoulders back approach is probably quite intimidating for some people.
So invariably I’ll find myself in most forms of communication, actually. Lowering myself in some respect, whether it’s leaning on a table these things that, again, they’re not free thought, they just they happen naturally, and I noticed myself doing it. But yeah, listen so if, likewise, that said, if somebody is, of a different stature to me, then maybe for them standing up tall and shoulders back will be an alignment with who they are.
But I know for me, in terms of who I am and what’s important to me is that I would never want to intimidate somebody. In fact, I, I want somebody to, I’m very much all about building trust and creating a sense of safety with whoever I work with, whether it’s as a coach now or… in my previous career as a, in leadership.
Yeah, I think, it’s just, it’s this notion of one size fits all. For me that’s where my kind of that’s my point of difference, although, it’s there are a lot of courses out there in the market that say otherwise, but for me, it’s important that we work with the, again, the head, the heart and the body, it’s all got to come together for an authentic assertive expression.
[00:19:36] Mat: If I think of our medical students or very early career doctors, what, what can senior doctors do to help develop assertiveness in people that are at the beginning of their career journey?
[00:19:50] Gareth: As soon as you asked me that question, I just thought the word is two, two words, same letters listen and silent.
Just listening for me is you can be the quietest person in the room and be completely assertive. It’s how do you, again, if, and I mean that for the senior doctors, but likewise also for the juniors coming through, it’s not about making your voice heard or being the loudest or the proudest, it’s about this element of congruence and just Being present, actually in the womb as well, it’s this notion so that actually, like you said earlier on, so that you can be fearless rather than fearful, that you can I always love the term when I talk about vulnerability and strength, for me, they’re so closely aligned that you can be vulnerable and say I don’t know, I’m not sure what’s going on and that comes about though through this concept of safety that’s, that is generated, that’s, that, that requires assertiveness.
Because of certainness in its truest sense is that it requires great listening skills and not just listening to the sort of the words, but it’s actually when somebody walks into work or they walk into the meeting and take into account their whole presence, their whole body. How are they? I’m aware of, I’ve, had a lot of friends over the years who’ve worked in the NHS and I’ve seen the toll it takes on them.
And, but they would never complain. But physically, I think back now to how they would show up to a after work drink, always later than the rest of us. Yeah, so I think that’s really it. Be aware listen, be silent, invites them into the room almost, and lead by example, that’s the thing we, model the, as Gandhi said, be the change you want to see in the world, model what it is. To be assertive, not aggressive.
[00:21:39] Mat: You, you used the phrase that people being present. What do you mean by being present? Or what is that?
And what does that look like? And how did you get there?
[00:21:48] Gareth: No, it’s actually my, my, my other favourite topic. Being present is, it’s more than just being there. If that makes sense. It’s, you can be in a room, talking to someone and be completely non present or, so presence for me is about again, it speaks to this notion of alignment, but it’s, and it speaks to the partnership or the relationship that’s actually happening at that time.
In, at least in my world two people both need to really be present for it to exist, presence is about, again, it’s about listening about. giving space, creating time to the other person. If I could put it in a sentence to be more clear, I would say it’s about it’s about speaking but not, how can I say?
Or when you’re listening to the other person. Not just to come back with something else to say, so you’re actually taking in the whole of the person you’re again, it’s this notion of really hearing everything about them from, again, from not just what they’re saying, how they’re saying it what their bodies say when they’re saying it just.
You really give it full attention, and I suppose that’s the easiest way to say presence. Technically, there’s a lot more elements I could drill down into around what makes certain executives more present or what makes coaches more present, but for me, that’s it really.
It’s about the Intention of giving your attention to somebody else.
[00:23:09] Mat: I, I have a vision of people in meetings signing their letters or online meetings and, people are dealing with their emails or people are on their phones. So they’re all the kind of things that happen all the time and they sound like they’re exactly the opposite of what your suggestion would be a better way of being.
[00:23:26] Gareth: It is, but I think I was reading recently about Novak Djokovic, and he was saying in his, what’s it now, 23, 24 Grand Slams how actually it’s not about being constantly present, because his argument is, it’s an impossible thing, you can’t be constantly in the game, out of your head and into your body all the time, but what he does touch upon is that it’s actually how you come back, so yes, we all will.
grab the phone send an email when we should be listening to what the other person’s saying. We’re human, but it’s how it is when you, it’s that moment when you catch yourself and you say, ah, yeah, I wasn’t listening. Come back to the room. And that’s really, for me, how that’s one element to how we start to build our presence more and more is.
Again, it comes back to self awareness, being aware of what you’re doing and who you are in that moment and aware that, again, you’re not giving yourself fully to the other person or persons in the room.
[00:24:24] Mat: And then my final question, when it comes to assertiveness, what would be your top tips for doctors at work?
[00:24:31] Gareth: So I’ve already shared the for me, if you’re trying to create a culture of assertiveness and for one of almost like fearlessness where people’s voices can be heard and where people can be expressed, it all begins with listening. And like I said, giving time, giving space to other voices.
The other tips that I would say is very much around knowing yourself, starting to actually look inwards, actually, to what’s important to you, so that, and to understand, just start to understand yourself more, because the more you understand yourself, then the more aligned you’ll become, so what’s important to you and what you hold to be true you’ll, Create this sense of sort of inner congruence that then when you do speak, when you do express your messages, they’re very authentic.
And authenticity as well is key to being assertive. In fact, when somebody is 100 percent authentic, I can pretty much probably guarantee that in that room they will also be probably the most assertive person because people will gravitate towards them. People will be interested because that person is interested in what they’re actually saying.
They’re not saying what they think they should say. There’s no sort of ego in the background trying to project this kind of image of a, as a certain type of doctor or a certain type of surgeon or, it’s very much yeah. Be authentic, know yourself, but we’re using some lovely books, so Gandhi and now no, that’s not, that’s Plato, is that?
I don’t know where this is coming from. Your podcast is bringing out some of my things I didn’t know I had in my brain. Thank you. That’s wonderful.
[00:26:00] Mat: Thank you very much, Gareth .
[00:26:01] Gareth: Oh, thank you. Pleasure.

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