What I Wish I Knew - The Art of Difficult Conversations

Maria Blaze, PharmD, BCPP

Dr. Maria Blaze is a Board-Certified Psychiatric Pharmacist and Mental Health Clinical Pharmacy Practitioner at the Memphis VA Medical Center. She is passionate about resident education, leadership development, and strengthening communication across healthcare teams. As a trained Crucial Conversations facilitator, Dr. Blaze helps clinicians build confidence in navigating high-stakes conversations that support collaboration, psychological safety, and professional growth. Her work reflects a deep commitment to improving both mental health services and workplace culture in healthcare.

Have you ever left a conversation thinking “what just happened,” “that was intense,” or “that conversation didn’t go as planned”? Most likely you engaged in a high-stakes conversations and may not have realized it. Difficult conversations are defined as “subject matters that may provoke strong emotions and outcomes that significantly affect relationships, careers, or important decisions.” Throughout one’s career (& life) a person will encounter conversations like these more often than they may realize. 

Earlier in my career, I experienced and witnessed that often people try to avoid difficult conversations at all costs. Why? Because they are uncomfortable and/or have misplaced assumptions about the other person. What I’ve learned is that having these difficult conversations can strengthen relationships, build accountability and trust, and increase productivity. On the contrary, avoiding difficult conversations can lead to stress, reduced engagement, and low morale.

As a crucial conversation facilitator, I have found that there are two common pitfalls that occur in relation to these conversations.

1. Thinking that the skills used are common sense. While that may be true, it has been proven in role playing simulations in training classes that common sense goes out the window when tasked with having these conversations.
2. Lack of preparation. There is a lot of prework that goes into making these difficult conversations successful.

The good news is there are multiple tips and tricks for navigating these conversations. Below are just a few.

Tip 1: Preparation is key.

There are two skills that consistently set the stage for productive conversations: focusing on yourself and establishing the facts.

Focus on self: When you are focusing on yourself it is important to recognize that your viewpoint is shaped by past experiences, information sources, and personal rules, which may not reflect the whole truth. A good rule of thumb is to reflect on your purpose for engaging in dialogue. Some questions that you may ask yourself are: Am I trying to prove myself right? Prove them wrong? What do I want to accomplish from the conversation?  

Establish the facts: Understand that facts are observable data vs. assumptions which is typically a perception of what you think you know. It is important that you gather your facts prior to the difficult conversation. Using factual statements helps you communicate observations without bias, making information clear and reliable. Factual statements sound like; “What I’ve observed is…,” “Here’s what I directly noticed…,” “What I saw/heard was…,” “On [date], the following happened….”           

Moving on to the conversation phase is where we find our next skills.

Tip 2: Utilize effective communication strategies.

In this phase we focus on skills such as active listening and emotional control. In my experience, the most productive conversations usually follow this rhythm:

• Express – Share your truth, your assessment of the situation, your examples, your reasoning, your goals, and your suggestions. Speak first person. Use “I.” Avoid using “you,” “we,” and “it.”
• Ask – Inquire openly, with curiosity, trying to understand why your counterpart thinks what he or she thinks.
• Listen - Listen quietly, with no interruption, trying to see the world from the other’s perspective.
• Summarize – Let the other person know that you heard what he or she said and ask them if you understand it correctly.
• Validate – Acknowledge that what your counterpart said is reasonable even if you interpret things differently.

In a perfect world, these conversations would go seamlessly, right? Even when you prepare and go into the conversation with the best intentions, conversations can still derail. Now what!? That’s ok, there are tips to control your emotions and get the conversation back on track.

1. Revisit your assumptions: Emotions don’t come directly from what people say or do — they come from the assumptions we tell ourselves about those actions. Example: Fact: “He hasn’t responded to my emails for two days.” assumption: “He doesn’t respect me.” (this is where emotions explode). To combat these assumptions, it is important to get back to your purpose. Some questions that you may ask yourself: What do I want for me? What do I want for them? What do I want for the relationship?
2. Reestablish psychological safety: The entire conversation rests on safety — when people feel unsafe, the breakdown of the conversation typically follows. An important skill to promote psychological safety is to seek or restate shared goals and ask for their side of the story. Statements you may say are “Can I share my intention before I continue?” and “I want to understand your perspective.”

The good news is that these conversations become easier with practice — and each one strengthens your confidence as a professional. Currently, this is a highly relevant topic in today’s culture. There are many resources that can assist you in navigating these types of conversations. My personal favorite is the crucial conversation training course due to its real-life practicality. If you don’t have     access to the Crucial Conversations curriculum, a quick Google search on “difficult conversations” or “high-stakes conversations” will yield a plethora of results. I will provide some great resources in the references.