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  • Amina Aitsi-Selmi

Why you might really be a barbarian (even if you’re working in the NHS)

Have you every wondered why relationships, whether at work or personal life, are so complicated?

It’s estimated that 50% of us have dysfunctional attachment patterns. Whether you belong to the healthy half or the unhealthy half (the 20% anxious, the 25% avoidant or the 5% mixed), you’ll have probably come across “weird” behaviour in your time.

Being highly educated or working in a healthcare setting is no protection either…

I’ve worked in some of the most excellent health organisations and hospitals (e.g. in Cambridge, London, Switzerland) and find that IQ is poorly correlated with EQ (emotional intelligence) - and I'm as guilty as the next doctor…

Most patient complaints are related to bad communication that could have been addressed with a simple apology. But so much communication in hospitals and high pressure environments is aggressive.

For staff, aggressive communication leads to more aggression, rebellion or stress in those who try to tolerate the barbarian aggression until something gives.

At the heart of dysfunctional relationship (and communication) patterns is the inability to know and express our own feelings and needs.

Experts in communication, including non-violent communication like Marshall Rosenberg, make it clear that in the West, we simply can’t tell our feelings from our elbows, let alone identify our real needs or articulate reasonable requests. We all speak “jackal”, his term for barbaric communication.

I feel passionate about this, as in career and leadership coaching, a certain element involves developing assertiveness and communication skills, particularly for women as they’re taught to be the “nurturers” and put their needs (for expression or other) second. You can see this in gender-balanced meetings where men tend to take up 75% of conversation airtime, yet perceive women to dominate if they try to speak up!

If you’re afraid that speaking up or carving space for your needs will take opportunities away from you, think again! If nothing else, you need to function optimally to deliver on your work and go the distance in your career.

As an example from my own experience, in the final stages of my Junior Doctor career, I worked with a boss who was completely dedicated to her work, literally 24/7. At first, this was really exciting and the work was great but I eventually had to admit that I couldn’t keep up!

In fact, I was growing resentful at the endless opportunities! I had other things I needed to focus on, including working out my next steps in work and life. So part of my energy and thought processes had to be devoted to that, along with basic self-care like exercising, sleeping and eating which my boss didn’t seem to need much of!

I could see the negative impact on my but worried about missing opportunities and disappointing my boss (note the sabotage from the inner – people pleaser) if I said something. I plucked up the courage to speak up and honour my needs. I drew some boundaries and made requests for what I needed e.g. time off, no regular weekend work leaving at a decent hour, more clarity in work assignments and work assignments that were the best possible match to my skills or skills I wanted to develop.

Interestingly, this helped to improve our work together. You’ll be amazed how being comfortable enables you to deliver on your responsibilities and perform better as well as improve your relationship with the person you are affirming a boundary with. Sure, I missed a few opportunities but the ones I took up were the right fit and helped me progress. I was even able to take up my first consultant post continuing the projects we were working on and increase my experience and exposure to global health beyond anything I could have imagined.

I know that hadn’t I expressed my needs and placed boundaries to support me, I would have burned out and left the job, missing out on great opportunities. In fact, colleagues commented on how well I was doing! Bottom line: honouring your needs is healthy and productive. Communicating them in the right language makes it much more likely that you will thrive in your work. Of course, if the environment you’re in is toxic, you may have to take drastic action to honour your needs (see previous post Should you change job if your work environment is toxic: lessons from the NHS.)

How can you drop the barbarian and speak Roman?

Understand that your feelings connect you to your needs. Your needs connect you to healthy living and ultimately enable healthy relating. Not owning your feelings or having the skills to express them appropriately will keep you trapped in destructive cycles. Translating your feeling into a concrete need is the next step. It makes your interlocutor less defensive and more likely to want to help you.

So here is a communication sequence when someone does something that causes you stress:

1) Identify the behaviour that bothers you without judgment: Many of us comment on things people do that annoy us in a judgmental way that involves criticising the other person. Practise identifying specific behaviours e.g. being asked to complete job X without clear guidelines or a reasonable amount of time in which to complete it.

2) Identify your feelings:At any one moment, can you tell how you are feeling? (fear, anger, shame, sadness, etc?) If you’ve grown up in Western culture, you’re likely to require a good amount of training in reconnecting to your feelings. Beware of nouns that hide a moralistic judgment e.g. feeling "disrespected" is not a feeling but includes a moral on what the person is doing.

3) Identify a need: If you’re angry, perhaps you have a need to be given more time to complete a task or be given clearer instructions (a form of needing safety). You have a right to this need regardless of what others may try to tell you. Be clear about this. Ultimately, there are a limited number of core human needs (safety, variety, significance, connection, growth and contribution c.f. Maslow’s hierarchy of needs). But there are endless ways of meeting these needs (healthy and unhealthy). Understanding in depth how you like to meet them and who can help you meet them is crucial to living a happy life.

4) Articulate a request: What is it that would help you meet that need? If it is a need for safety in being given more time or clearer instructions to do job X, say so. The other person can disagree and you may have to persist but it doesn’t take away from the fact that it is your need and that you have a right to it. Speaking from this place of assertiveness alone can shift things.The end result is that you communicate more clearly and assertively.

Over time you eliminate a lot of clutter, resentment and confusion and make it more likely that you will get what you need. Remember to always use clean language that is free of judgment: never tell someone that they “made you" feel or do something but rather that: when they did X, you felt Y and you would like it if they could do Z.

And that’s how barbaric communication might one day truly become a thing of the past…

Until next week,


Do you want to become more assertive and be seen as a leader at work? Do you have brilliant ideas and do great work but hate speaking up while others take the credit? Book a free conversation to find out if Transformational Coaching can help, here: Questions, comments or interest in Transformational Coaching? Email me on

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