[No CEs] Emotionally difficult or painful conversations are very common in health care, so it is quite remarkable that health care training programs do not spend more time teaching students emotional and relational skills that are often required in these kinds of patient-provider interactions.

This presentation will discuss the architecture of the painful conversation by examining its effect on the professional's sense of self and especially his or her need to preserve self-esteem, the critical role of feelings and emotions, and the nature and value of empathy. The latter half of the presentation will consist of various strategic and practical recommendations so that emotionally challenging conversations might be conducted artfully. We will particularly examine the nature of the human propensity to label certain people, patients or family members as "difficult" or Impossible; the nature of the health professional's defenses when the professional is confronted with assaults to his or her self-esteem; the need to understand the difficult patient rather than succumbing to the temptation to emotionally react; and numerous "what to say" responses, especially when the communication seems strained or uncomfortable. This presentation does not aim at teaching psychotherapy, but rather simple communication techniques that build rapport.

At the completion of this presentation, learners will be able to:

• Relate emotionally disturbing conversations to the health professional's construction and understanding of his or her professional "self";
• Explain how an ability to control one's feelings can influence the success or failure of an emotionally difficult conversation;
• Explain how one's psychological defenses might compromise his pr her rapport with challenging patients;
• Describe common characteristics of relationally difficult patients;
• List a number of empathic responses that are useful in conduction difficult conversations.