In a clinical setting as an OT, it’s really important to be able to give feedback to a client. This might be about the outcomes of an assessment where we need to share with them the findings of that assessment and what we found (and importantly what we’re going to do about that). We might need to give feedback (and not merely instruction) about a task we want them to do in rehabilitation so that they can learn how to do that better; both to achieve a desired outcome but also as a way for them to understand what they did and how they did it, so they can make changes to that. This is really critical in many aspects of one of my clinical areas of practice, neurological rehabilitation, where we are retraining movements of the body, trying to tap in to alternate brain pathways to achieve an outcome. We know we need repetitions, but we also know that we wont build strength and capacity to move, unless we give feedback about how the person is moving and how we want them to move to complete an exercise or task in order to get the best movement outcome and result. We deliver feedback in cognitive rehabilitation approaches but also encourage self reflection about performance to build insight; but again, to drive growth in order to do a task better- more efficiently, more effectively, with less errors. This is absolutely critical in my other field of driving assessment and rehabilitation; we need good drivers on the road and if they don’t know they made an error or mistake and if they aren’t given that feedback along with opportunity to improve and learn then they will continue to make mistakes and potentially experience serious consequences. Feedback is essential for growth and development in so many ways. If we don’t give feedback, then someone cannot change what they do and that can limit potential for improvement and optimal performance of tasks and activities.
So if we accept that feedback is important and indeed essential for growth, we also need to think about this in terms of ourselves as professionals. As an employee but also as a therapist, I’m not going to be able to improve or do better, if I’m never given feedback about how I’m doing. I think this means actually also seeking feedback and actively evaluating my practice. I think good therapists want to do this because we know that we don’t know everything (!) and we really want to keep developing our skills as a therapist so that we can help our clients more, so they can have a better outcome, a better recovery and a more effective service.
As a supervisor and mentor, this is what people are often actually seeking; yes, they may want some advice or information or pointing in the right direction. But it’s driven by a desire to know how they are doing (am I on the right track here? Am I thinking about this in the correct way?) and to do better (should I do it like this? Is there a better way? I find it hard to do this- what do you think?) i.e. it’s about learning but not just learning knowledge or learning skill, it’s also about growing self awareness and insight that drives growth. There’s that expression “You don’t know what you don’t know” which makes the point, that if you don’t know then you cant grow or improve but when you know more, you can do more and you can do better. And when you grow self awareness as well, then you become acutely aware sometimes of how little you actually know and definitely know where you need to grow!
I think that most people probably accept that learning and growing is important and probably also accept that feedback is part of that. I think the challenge is that there are situations and circumstances when feedback can also be really really uncomfortable! Because it might shine a light on areas of weakness or lack of skill, knowledge or ability. In theory, that’s actually good because then we might be able to grow in those areas. But I think that sometimes (maybe even often), it doesn’t feel good. I think there’s a few reasons for this
- When feedback was provided unexpectedly or unsought.
I think this is a funny one but to me it feels like I feel much more comfortable when I seek feedback and receive it than when out of the blue, you’re suddenly given some feedback by someone. I don’t know if there’s an element of “bracing yourself” when you know you’ll be provided with feedback so there’s an element of self protection that you’ve lined up but there’s definitely something uncomfortable about the unexpected and unsought feedback. I think sometimes it’s also because when we’ve sought feedback, we probably have asked someone whose opinion we really care about and hopefully someone who we trust will be kind with us and deliver feedback in a way we can handle. Sometimes that unsought feedback can also come from a less “safe” source (see point 6 further below about psychological safety).
- When feedback is a surprise because it doesn’t match what we think, know or feel about ourselves.
I think many of us probably have a picture in our head of how we come across and what things we’re good at and probably even things that we don’t think we’re very good at; our areas needing growth. For example, I feel fairly confident with thinking that I’m a fairly warm person and I hope and aim to be kind. So when I was given feedback recently that said I was “very kind and patient”, it made me feel good; someone had seen those things in me and it was like getting a gold star- yep you’re on track. But when I was given feedback in a previous role, that I was unapproachable and unresponsive, it felt really uncomfortable and unpleasant. Because, I never wanted to come across that way and I felt I had been responsive; so the feedback didn’t fit with what I felt about myself and also who I wanted/hoped to be. I wanted to be given examples! Times! Dates! Circumstances! I wanted to be able to explain and justify myself. I wanted to respond and say that it was never my intention to come across like that and I was sorry that I had and I wanted to fix it and make it better for that person. Recently some feedback implied that I/we were trying to “trick” someone and my gut initial response was to feel so hurt and almost offended because it would never have been my plan or intention to trick or deceive anyone; in fact, I really value integrity and try really hard to be fair (see, look at me wanting to defend!). So that mismatch between how we are perceived and what we know or feel about ourselves can really make feedback hurt.
- When feedback provided feels unfair or harsh, including when there is potentially a limited understanding of context and situations
Within my university role, I was given some feedback about being disorganised. Now, there is an element of that I’m perfectly willing to accept because I freely admit, there were times that I was less organised than I wanted to be and than I felt I should be. But, (of course there’s a but) there is totally context for that! I’ve been working 2 part time roles this year and felt extremely stretched between them. It was a subject that I hadn’t taught before, it was a complex subject, there were lots of moving parts, it was a non semester topic so I had less time to prepare, there were timetabling issues, there were personnel issues etc etc. So it feels again like I want to defend and explain and rationalise because it feels like if they would just understand the situation then they would give me a break and it would feel more fair! In other circumstances, I feel like this has happened before when I ran a survey with a team of OTs and got absolutely slammed for staffing issues that were absolutely out of my ability to control and which were far more complex at an organisational level than I understood or could describe to my team; and I desperately wanted to say (just like my little boy) “It’s not my fault!”. But of course, to them, I was in a leadership position so it probably seemed to be within my remit and responsibility. I think it’s a real human need to be understood and so when we feel misunderstood or allowances aren’t made for the situation and context at the time things take place, then we can feel that feedback isn’t fair and we can become defensive.
- When feedback triggers shame
Some definitions of shame discuss feelings of being embarrassed or humiliated as well as being judged and also link shame to becoming conscious of having done something wrong (guilt), falling short or behaving immorally or improperly (not following social norms). I think it’s probably fairly obvious that some feedback would definitely cause us to feel shame in that sense for sure but I think what I mean here is when feedback triggers shame how Brene Brown describes it “as the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love or belonging” (https://brenebrown.com/articles/2013/01/15/shame-v-guilt/) I think that we can self internalise feedback and it goes from being about behaviours or things we did- in to who we are. Again, the question of intent can come in to that here. We might intend for something we say to mean something but it can be taken another way and when we’re given feedback about it, it feels uncomfortable because that’s not who we are; we know that and we want them to understand that. Sometimes, feedback can hit us hard because it can feel like that criticism of who we are as a person. Or if the feedback is about something we did, we can take it to mean that we are therefore a bad person. For example, “if I’m disorganised as a lecturer then that’s terrible, that’s an awful trait. I must be a terrible lecturer then, I’m so ashamed of myself, the university is going to know that I’m awful at my job and probably fire me which is fair enough because I don’t deserve this role anyway”. There’s probably a bit of catastrophising thrown in there too! But nonetheless, feedback can certainly trigger us to feel ashamed about who we are. Brene Brown (who I’m sure many people know as being just amazing) talks about how guilt is uncomfortable, but actually also adaptive and helpful whereas shame is deeply destructive. She has so much more on this which is worth exploring (e.g. her classic TED talk) but I think that inner self critic is already rampant in many health professionals I know and feedback can definitely trigger a shame spiral.
- How feedback is delivered
We’ve probably all been in the boat of someone who just doesn’t deliver feedback well (I am going to write a whole post about giving feedback one day) and it hurts. It just does. Words can really hurt and be really cutting. I think anonymity and online settings can be pretty rough for this; so things like online surveys and questionnaires for feedback. I cant remember where I read this, but someone wrote once, that we would never say things that we say online to someone’s face if we were in a room with them. That feedback survey I talked earlier about was an anonymous online one because I thought people might be more honest and open if it was anonymous. But some of the feedback me and my leadership team got was absolutely brutal. And it’s hard because the people giving feedback also risk being misunderstood. They cant be questioned about what they really meant or give further details or examples themselves so sometimes we cant really get the full picture or meaning; you also cant pick up tone or language when reading- we hear it in our own voice in our head, how we might say it. But beyond that, I think that there’s a distance that online settings create where the person/people that you’re giving feedback about are removed. They seem less like actual people and maybe can become bigger ogres in our mind and we can feel perhaps braver to be brutally honest with our words (like giving a bad review for a restaurant with poor service) and use the forum for venting and expressing frustration; forgetting that an actual human person will read that and even behind businesses there’s real, actual people who may very well be trying to do their best. Even outside the online setting, delivering effective and constructive feedback is a skill that needs to be learnt or the risk is that someone will be too hurt to actually learn from it.
- When feedback carries a heavy weight
Some workplaces take feedback really really seriously and place a lot of value on feedback from clients and referrers. In one of my former workplaces, you were highly valued if referrers liked you because of course that meant more referrals but if they didn’t like you, criticised you or gave feedback to your boss about you, then you knew you were in trouble (even if you’d done nothing “wrong”). There was a lot of people pleasing in that organisation! Amy Edmondson (find her on LinkedIn and her wonderful course here) has done a lot of work on psychological safety within the workplaces which is the idea of creating a culture where you wont be punished or humiliated about mistakes (or ideas, questions, concerns). I think this is like creating a “growth mindset” within an organisation; where the goal is learning and growing. But of course, not all spaces are like that. Some organisations use feedback metrics (client satisfaction or evaluations) as part of individual performance appraisals. So I think in these contexts, that additional weight of what the feedback means for you personally, can add discomfort. We need to feel safe at work to make mistakes and try new things and be OK if that doesn’t work out or land as well as we had hoped. But if the feedback is taken so seriously that this constrains our ability to do this and to feel safe about our learning and growth, then any feedback is probably going to feel more like criticism than a learning opportunity.
The challenge with all feedback is what we do with it. There’s a choice to
- Take it all on board personally. All feedback is right. The customer is always right. Therefore, I am wrong, I screwed up, I have to do better.
- Dismiss it. Fuck it. They’re idiots. Screw them, what would they know?
- Defend. It’s not my fault. It’s the situation/circumstance. (I don’t hold a hose).
- Somewhere in between that might actually look a little like
- Reflecting and considering the feedback. Taking it seriously but not personally. And maybe not staying in the reflective mode for too long.
- Sitting with the discomfort and even the guilt, but not letting my inner critic get too loud. My therapist encouraged me to actually talk to my inner critic and thank her for trying to help me grow but to also talk when she needs to be quiet (I know it sounds a little nutty- but it works sometimes!)
- Talking through the feedback with a safe trusted colleague; this can allow a little bit of venting and defending and justifying and debriefing and then also moving towards something more helpful.
- Accepting that I make mistakes and I’m human- and that’s OK. I actually find this last part really hard. I hate making mistakes and getting things wrong. I have no problem with accepting that I make mistakes. I just really hate that I do. I think this is where I can fall in to the shame trap and think that a mistake = being a bad person.
- Taking responsibility for things that I can control and where I feel I could potentially improve or do better.
- Not taking responsibility for someone’s feelings or for everything; and desperately trying to not overthink it because not everything about someone’s experience sit with me.
- Accepting that I cannot actually please everyone or be liked by everyone no matter how hard I try (even though I think I’m a really nice person who everyone should like ha ha)
- Accepting that people may misunderstand my intentions and sometimes the best intentions still result in a poor outcome (and it’s OK to be given feedback on that)
- Talking it through with a supervisor or mentor. I think it can help to “test” it sometimes: does this fit? Does this seem fair and like feedback I should take on board? What do you think this means? What can I do about it? How do you think I can go about improving this area of my practice?
- Taking some kind of proactive action to “make it better”
- Kind of like what I teach my kids when they’re naughty
- Accept responsibility
- Say sorry and acknowledge what you did
- Describe what you’ll do differently next time
- Make amends (What can I do to make this right? What can I do to help you feel better?)
- Do better next time
- Kind of like what I teach my kids when they’re naughty
- Making some kind of personal or professional development plan to continue with my growth and learning. So for me with my organisational abilities, I already had some great advice and support about how to be about 2 weeks ahead of the university semester at all times and I’ve started using tasks and reminders in my diary in a colour coded way based on observations of a colleague. In my EncourageOT world, I have engaged an admin assistant for some additional organisational support.
Anyway, that’s about all I have for the world’s longest brain dump about feedback!
What is your experience? Feel free to comment on Facebook or Instagram any of your thoughts about receiving feedback and by all means, feel free to give me some feedback about this post!
