Family Caregiver Blog

At lunch, I was telling one of my close friends about something bothering me deeply about a family member. (No specifics divulged!) She told me I should have an honest conversation ( or Tough Conversations ) and tell him/her how I was feeling. I said it would be too hard.

Happily for me, I had confided in someone who knows about effective ways to communicate. A trained mediator, my friend Susan is the Managing Director of the Program on Negotiation at Harvard Law School. And she just happened to have in her purse a copy of Difficult Conversations: How to Discuss What Matters Most written by her colleagues. “You can keep it,” she said, clearly convinced that I would need it more than once.

She’s right. I hate confrontation, or even strong differences of opinion, and will do whatever I can to avoid them. But sometimes that mousy approach is counterproductive.

When you’re a caregiver to a spouse, partner, parent, another relative or friend, there are many potential conflicts. Hiring or providing help (independence vs. dependence). Housing. Siblings. Money. Medication. Driving. Personal time. Personal feelings. And more.

Good communication improves the chances of getting your message across—and having it heard. In Tough Conversations. Mastering this skill not only helps with uncomfortable and complicated issues with a spouse or parent, but also when dealing with an unreasonable boss, say, or a worrisome teen.

Whatever you do, think about how you would feel if the proverbial shoe were on the other foot, and Mom, a friend or spouse had to have this difficult conversation with you. Would you want them telling you what to do? Or, would you like them to really listen to your needs and point of view? Be respectful—don’t interrupt--and tackle one tough topic at a time.

I’ve skimmed the book Susan gave me and will undoubtedly reread it ‘til it’s dog-eared. I’ve also talked to her and other experts. Here’s their best advice on having those tough conversations:

1. Remind them that you’re on the same side—their side. Express your love and concern and tell them that you’re their partner in caregiving, not their adversary.

2. Talk about how what’s going on impacts you. While you’re at it, use “I” statements rather than what can be perceived as an accusatory “you.” Here’s an example: “I’ve noticed that you’re less steady on your feet and I’m worried that you’re going to fall.” That’s so much better than scolding, “You should use your walker.” Or, “When you don’t talk to me about how you’re feeling, it hurts me and I don’t know how I can help you better.” That’s more effective than, “You never talk to me!”

3. Ask open-ended questions and whatever you do, listen! How do they see the situation? What do they ideally want to happen and what would be the next best step in their view? What are they worried about? Pay attention because, unless there’s a cognitive or mental health issue, they are the experts on themselves.

4. Problem solve together. What can you do so that both your goal and theirs is accomplished?

5. Pause if the conversation becomes too contentious. You might say, “This seems to be painful for you to discuss. I’m sorry. Let’s talk about it another time.” Remember, the topic is likely to be emotional and stressful. They may be reacting out of fear, loss, anger or physical pain.

6. Expect to revisit the topic. A difficult issue might take 10 tough conversations, not one. Seriously, was Rome built in one day?
7. Do your research. If you need to know how to begin the talk, turn to tried and true resources. To discuss end of life wishes and other ultra delicate subjects, for example, go to The Conversation Project, AARP or our very own Family Caregiver Council. It can be simple, such as, “I’d like to talk with you about something important. Let’s pick a time to meet when we won’t be interrupted.”

8. Find your medium. Know your “customer”—Mom or spouse—and yourself. How do they react best to delicate information and when? Is there a better time for them than another, such as after breakfast, when you are alone and there aren’t distractions like noise, TV or other people? And, is in person, on the phone or email most comfortable for you?

Professionals will inevitably say that the most effective way to have The Talk is face-to-face (even Facetime or Skype) or, when that is not possible, the telephone.

I guess I’m the exception but I find email best. Others find it cold, a cop- out and easy to misinterpret. Maybe it’s because I’m a writer, but some of my deepest emotions are shared in emails with my spouse and my kids. They read it when they want and don't have to react immediately. Often it lays the groundwork for future in-person conversations.

One more thing: realize that that difficult conversation may be a missed opportunity. So just go for it!