How to open up difficult conversations

It’s not easy to know how to open up conversations with someone who is dying.

There is often awkwardness, embarrassment and fear, which means we tend to shy away from connecting to those who are grieving or those who are dying.

But our inability to face up to death only serves to increase the isolation and loneliness of those in distress, as well as our own. So the important gift you can give a dying person, or someone who has been bereaved, is to listen.

Some dying people chose not to talk about death, while others prefer to remain in denial.  This needs to be respected. It is their dying process, no matter how difficult it may be for you as a relative or friend.

However, the dying usually know what is happening to them.  Nevertheless, when a dying person believes relatives and friends can’t cope with the truth, it can be hard for them to talk about what they’re experiencing or ask for what they want or need. This can leave the person feeling isolated and lonely, not knowing how to reach out or say goodbye.

How can a meaningful conversation happen

Those who are dying sometimes help indirectly by throwing out ‘tester questions’ to check if you are willing to engage with them.

They might, for example, ask you ‘What do you think happens to you after you die?’  They might ask if you think there is life after death. They may ask, ’Do you think God really exists’?

On the other hand, you, yourself, may want to broach the subject of death with your relative or friend, but don’t quite know how, especially if death has never been mentioned before.

One of the easiest ways of opening up the subject is to ask your relative or friend who they would like to you contact if they became seriously ill. This conveys that you know they may not recover and are willing to talk about it. It also gives them the space to decide whether to respond or not.

If you don’t feel quite ready to have this kind of conversation and you’re in a hospital, hospice or care home setting, talk with the nursing staff so they can offer appropriate support.

Here’s a few golden rules of good listening which can open up communication, and help you to feel safer in difficult situations

Be respectful: We don’t know what this person is going through. We may have our own opinions on what they ‘should do’ or ‘ought’ to do, but it’s important not to force our viewpoint onto them. The most loving thing we can do is to listen with compassion, and not to judge.

Be honest: Often in difficult situations we tend to search for the ‘right’ or clever thing to say. Or we deny what’s happening, or make a joke of it. While such reactions are understandable – humour has its place, even in distressing situations – most people just need us to be there, and perhaps hold a hand. The act of sharing ourselves opening and honestly can be very soothing.

Engage body language: Don’t be afraid to look the person in the eye. Be alert and attentive to what they are telling you, and how they are telling you that. Listen to their tone of voice and be aware of changes to their facial colour; their willingness to engage with you; their willingness to meet your eyes.

Is what they are saying really what they mean? Are they conveying something with their body language that they are not expressing with words? If so, invite them to tell you what they really want to say.

Try to put your own thoughts aside: It’s easy for your attention to be emotionally hijacked by feelings or memories triggered by the person’s experience, of your fears for their future, or perhaps by something else that is happening in your life which is preoccupying you.

You may feel embarrased by emotional intimacy, or fearful of seeing the person cry. You may feel helpless, and even useless when confronted by their despair. Breathe slowly to calm yourself so you can be there for them.

Ground yourself by feeling your feet firmly on the floor. This will help you to be present and accepting of what the person is going through.

Don’t feel you have to fill silences: Silences can be the space where the greatest insights are gained.  Give the person room to work out what they are feeling and thinking. They will talk soon enough.

You can’t fix it: No matter how much you want to make it better, you can’t.  This is their life experience.  They will learn how to deal with it in the best way they know how.  All you can do is be there for them, and show you care.

It’s okay to cry: Crying is a natural response to emotionally charged situations.

Different types of questions and when to use them:

Sometimes it is obvious what a person wants and needs to talk about, but they don’t know how to say it. You can help them explore what they are experiencing by using different types of questions.

Open questions: How, When, Where, Who, What, and Why (although be a little careful with Why, as it can sometimes sound accusatory or intrusive). Open questions give the message that you are paying attention, and will encourage the person to talk more openly

Closed questions: There is a place for questions which prompt yes/no answers. ‘Did you?’, ‘Will you?’, ‘Can you?’ But be aware that these can also sometimes close communication.

Direct questions: Asking ‘Are you frightened?’ or ‘What are your fears?’ provides an opportunity for honest communication.

When people are dying, they may not know how to ask for help, or what to say.  You can help them by using  questions such as:

Indirect questions: A softer approach often works well. ‘I wonder whether there’s anything you want to talk to me about?’ or ‘Perhaps there’s something bothering you which you want to tell me about?’ or ‘What can I do to help you at the moment?’

This indirect approach gives the person the choice to respond, or to say no. Providing choice is empowering. They may decline initially, but will know the door is open if they want to talk later. Indirect, exploring questions give the signal that you are safe to talk to, and that you care.

Leading questions: You also can ask gently leading questions to find out how they are feeling, such as, ‘If you want to talk about what’s bothering you, who would you like to talk to?’  Again, this provides the person with the choice to respond or not.

Short statements: These can also provide comfort. You might say ‘If there ever comes a time when you want to talk about it,  please do tell me’. This gives the person permission to talk in his or her own time, without expectation.