Tender, not difficult … listening to problems, rather than fixing them, is more productive. Photo by Tony Anderson/Getty Images
There’s a conversation you’re avoiding. It feels important, the stakes are high, there are strong feelings involved and you are putting it off: “The time isn’t right”; “I can’t find the words”; “I don’t want to get emotional”.
But delaying doesn’t solve anything and anticipation is often far more uncomfortable than the conversation itself. Getting started might involve some awkward moments, but, after that, the situation is open for discussion and exploration.
Tried and tested approaches can help to smooth the way. Here are 10 useful tips from my experience as a psychotherapist and , developed while working in some of the highest-stakes discussions – the tender conversations taking place as people face the end of life. These principles apply whether you are chatting in person, over the phone or during a video call. You can even use them in text message conversations.
Instead of “difficult” conversations, I call them “tender” – and that attitude can make all the difference.
Invite, Don’t Insist
Make sure the conversation is a shared endeavour by starting with an invitation, rather than launching straight in. Try something like: “I’ve got something on my mind I’d like to chat about. When would be a good time for you?” or “You seem worried about something and I wondered whether you’d like to talk about it some time?” They may agree to talk there and then. If there’s a delay, check you are not leaving them anxious about the discussion. Inviting the other person allows them to consider and to prepare.
Being prepared also applies if someone catches you off-guard: it’s fine to say, “This is really important and I need some time to think before we have this conversation.”
Pace Yourself
Important conversations can go wrong if participants talk themselves to exhaustion. Plan to chat for 10 minutes, or agree to press pause at a particular point, ready to return to the conversation later. Remember, too, that sick or recently bereaved people have limited energy.
When you reach a good stopping point, say something like: “There’s lots to talk about. Shall we leave it there and chat again tomorrow/next week?”
Listen to Understand
The most effective discussions are when we listen carefully to the other person and try to understand. Instead of working out what to say next while the other person is speaking, just listen. Have you listened well enough to say it back to them? Check your understanding by repeating what you heard with empathy, starting with something like: “Have I got this right? You feel …”
Repeating their viewpoint back also helps the other person to feel heard and respected. In conversations about disagreement, try to present the most positive aspects of the other person’s view: it helps both of you to find common ground.
Be Curious, Not Opinionated
What is the person you are speaking to telling you that you didn’t know before? How do they see the situation? How are they feeling? Use your curiosity to ask questions about their ideas, hopes and fears. Teenagers, in particular, often feel misunderstood and “talked at” rather than listened-to, but demonstrating genuine curiosity can help them to explore their own experiences.
Don’t be afraid to ask whether a distressed person feels safe: this question can unlock conversations about escalating tensions at home, school or work, fear of (or actual) abuse, thoughts of self-harm, worries about a terminal illness etc. Talking about these fears won’t make them a reality, and it may also encourage someone to access more specialist support.
Give Unwelcome News Gradually
Rather than causing shock by blurting out news that is unexpected, begin by giving the background or (often better) by asking the other person to tell “the story so far”. For example, you could say: “I want to talk about Mum’s health. Tell me how you think she’s been recently … ”. That initial recap creates a space where the new, unwelcome information is less unexpected. Now you can add the bad news, beginning with: “I’m sorry to tell you … ”
Even if you are to blame in some way for the unwelcome news – such as in a breakup, for example – a stepwise approach to confessing bad behaviour or even ending a relationship gives the other person an opportunity to anticipate the information and manage their response to it.
Sit With Distress Without Trying to ‘Make It Better’
It’s not a bad thing if strong emotions are expressed during a difficult discussion: don’t try to close them down by offering reassurance or advice. Be a quiet companion to those in distress; if they cry or rage, or fall helplessly silent, stay present and validate what they feel. Useful phrases include: “It’s OK to feel like this”, “I’m sorry this is so upsetting” or “I’m glad you can talk about this with me”.
A condolence visit may involve listening to sorrows and “what-ifs”. A sick relative may want to discuss end-of-life wishes or regrets. Your attention is far more helpful than platitudes. Respect the fact that some things cannot be made better.
Don’t Interrupt the Silence
Silence is often where we do our thinking. We can support someone without interrupting their flow of thoughts by saying simple phrases that show we are maintaining attention: “Take your time”; “I’m not in a hurry”; “This needs some thought”. This is especially helpful when you can’t see each other – for example, during a phone call.
Respecting silence can be a challenge if there are several people in the conversation. You may need to be explicit, saying: “Let’s give each other time to think” or “I think we need a moment of quiet now”.
Support, Don’t ‘Fix’
We can disempower people by taking over – but if the solution was easy, they would have solved their difficulty by now. Instead of proposing ways to fix a problem, ask instead what solutions they have considered or what they would advise someone else in their situation to do. It’s surprising how often a person feeling completely stuck can tell you the great advice they would give a friend in the same position.
End on a Positive Note
Giving a time warning is helpful if you know one or other of you needs to finish the discussion soon. “Thank you” is a good note to finish on: even in a disagreement, giving thanks for their honesty and time shows appreciation and respect. Your disagreement need not become a ruptured relationship.
Look After Yourself
If you are left feeling unsettled by a conversation, remember to treat yourself kindly. Some people take five minutes to walk outdoors or to focus on their breathing. These “mindful moments” help us to recentre ourselves. Confidential debriefing with someone else can also be a helpful practice.
Don’t pick up the other person’s burden: the solution is for them to find, but compassionate conversation can help others to process their experiences. That is often help enough.
Kathryn Mannix is a retired consultant in palliative medicine.