How to Discuss Frightening Topics

Difficult Conversations
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Few people look forward to discussing anything frightening. Coping with a chronic illness or the possibility of dying is one of the most frightening. What’s difficult for caregivers is when the time is right to begin discussions of disability, a new identity, a changing lifestyle, difficult treatment options, and end-of-life issues.

Don’t Force It

Jim was told by his doctor that his stomach cancer was incurable, and he had only a few months to live.

In the office, he accepted the news as if he learned he had a minor problem. But when they got home, he broke down and cried. “I know this is frightening for you,” his wife said. “I’m scared, too. I want you to know when you’re ready to talk, I’m here.”

Instead of forcing him to begin the conversation, she quietly sat next to him, held his hand and compassionately witnessed his emotional pain. She understood that beginning an end-of-life conversation while he was in emotional shock probably wouldn’t be helpful. The next day, they talked about a house remodeling project that would take over two years to complete. Although she believed her husband was delusional or not prepared to accept the diagnosis,  she didn’t confront him. She rightly believed he wasn’t ready to talk about his death, and until he was, she would wait. Three weeks later her husband was admitted into hospice service.

“I didn’t believe my physician when he told me I had only months left,” he said.

I knew I was going to die, but I still had years, but my body is telling me it’s going to fail soon.”

He was reluctant to discuss his death with his wife, since if he did, “she’ll know I’m dying.” The prior week his wife said, “I know he’s dying but I’m afraid to say anything about it. I’m sure he still thinks he has a lot of time left.” When I was alone with her husband, I said, “I think it will be all right for you to talk about these things with your wife.” When I returned the following week, they told me they had started talking about his death when I left, and continued the conversation each day.

The wife could have persisted in wanting to talk about her husband’s impending death during his denial period. If she had tried, it probably would have resulted in a defensive reaction that could have delayed this important conversation or prevented it from happening at all. Forcing loved ones and friends to “face reality,” whether it involves the acceptance of a chronic illness or their impending death, rarely works.

When Waiting May Not Work

There are times when waiting for a topic to lose it’s fear factor doesn’t work. When that occurs there are two approaches you can use: one is the blunt-instrument tactic and the other is the roundabout one. The blunt-instrument approach involves haranguing your loved one about waiting so long. It’s straight-forward, sometimes effective but often leads to unintended consequences such as making your loved feel guilty for not making an important treatment decision. While your approach might be successful, you may unintentionally create animosity since you weren’t sensitive to the issues behind her inability to decide.

The round-about approach still has the same goal of enabling her to decide, except it begins with having a discussion of why the choice is so difficult. I’ve found starting with trying to understand the problem will often have the same intended result as the blunt-instrument approach, but without the unintended consequences.

The Importance of Timing to Reduce Defensive Reactions

Timing conversations about frightening events is critical for reducing defensive reactions. I think it has a lot to do this a person’s receptivity to listening and reacting to terrible information. We have just so much ability to deal with difficult issues. The more energy I use to cover over a frightening topic, the less will be available to listen and discuss it.

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