Top tips for structuring a difficult conversation
Avoid criticising and focus on your concerns rather than the failings of the other person. For example: ‘I think this,’ or, ‘I feel this,’ is better than, ‘you do this and it drives me crazy!’ Don’t state your opinions as fact. You might want to say, ‘I’ve noticed that you appear to be finding it harder to xxxx’ or ‘I might be wrong, but it looks like you’re having difficulty with xxxx’.
Remember that the tone of your voice is important, too. Use a gentle and encouraging tone. Frame your concerns as questions and ask how they see things. Don’t launch straight in with opinions or instant solutions such as, ‘I think this should happen’ or ‘you need to do xxxx’ as this could end the conversation before it’s begun, or even cause an argument.
Listen to their point of view
Communication involves both talking and listening. Active listening is very important. Encourage your loved one to tell you how they're feeling and let them speak for as long as they want, or need, to explain things from their point of view. What concerns do they have?
- Try not to interrupt or contradict.
- Don’t give advice at this stage, unless it’s specifically asked for.
- Don’t try to offer help or solutions immediately. You need to listen to everything that they have to say first so you understand the whole situation.
- Show that you’re listening by maintaining eye contact and nodding and smiling at appropriate times. Don’t be tempted to flick through the newspaper or check your phone.
- Keep an open mind. Try to put yourself in their shoes and see things from their point of view. How might they be feeling? Don’t forget that fear may initially be expressed as anger or denial. For example, they might be worried that their memory is failing and don't want to admit that it’s happening. Or they might be scared at the thought of going into a care home so appear angry at the suggestion that they may need to.
- Sympathise with any problems and give reassurance (but not false hope) where possible.
- Read between the lines – is there anything that they’re avoiding talking about? Is their body language consistent with what they’re saying? Can you see if they’re upset about anything in particular?
Encourage your loved one to tell you how they are feeling and let them speak for as long as they want, or need, to explain things from their point of view.
Be mindful of your body language
- Sit down opposite your family member or friend, where possible. If you’re facing them, it's easier to maintain eye contact to show that you're interested in what they’re saying.
- Stay on the same level – don’t stand up if they’re sitting down.
- Don’t get too close as this could come across as intimidating or aggressive in some situations.
- If appropriate, a light touch on the arm, holding a hand or giving a hug can speak volumes, particularly when someone is upset.
- Don’t fidget or you’ll look nervous – you want to create an air of calm.
- Don’t cross your arms as this can come across as defensive or not wanting to be open.
Ask what they want
Give your loved one an opportunity to suggest ideas, before you suggest yours. This will help him or her feel in control of the situation and give them a chance to voice their own opinions before being influenced by yours. What do they think would be the best way to address the problems that they’re experiencing? What help do they want or need?
They might have fixed ideas about what they want, or they might be unaware of the options available. Find out what their preferences are and what they would ideally like to happen in the future. For example, their priority might be to stay at home for as long as possible, or to move closer to family.
Explain choices and discuss options
Talk to your loved one about the options available – this may be things that they have suggested, or options that they hadn’t thought about or weren’t aware existed. Think back to any research that you’ve done and try to discuss all the relevant options and the pros and cons of each.
Try to remain impartial at this stage so that your loved one has a chance to think about the options independently. Consider arranging ‘research trips’ – most care homes will allow you to visit so that you can see the setup (but always phone the care home manager first to pre-arrange this).
You might want to ‘postpone’ the conversation at this stage to give your family member or friend time to think things through, or to find out more information about the options discussed. If you do this, make sure you schedule a time in the near future to make decisions.
Try to remain impartial at this stage so that your loved one has a chance to think about the options independently.
Help with making decisions
It’s OK to give your opinion on which solution(s) you think are best, but don’t assume that your views are the ‘right’ ones. Your loved one might have different ideas to you about what is best for them.
Think about what they have said and try to summarise the key points. This shows that you have been listening to them, understand how they feel and take their concerns seriously. Take the time to make statements such as, ‘So, if I’ve understood you correctly, you are worried about xxxx and feel that xxxx?’
As long as they are able to make their own decisions (not lacking mental capacity, perhaps due to more advanced dementia, see advanced stages of dementia), you should respect their decisions, regardless of whether you agree with them. Offer to assist in solutions – they may be more likely to follow a particular course of action if they know that you will be there to help.
However, if you think your loved one has an illness that could impact on their decision making, either try to postpone the decision or take a more active role in the decision-making process. For practical advice on discussing this with someone who has dementia, see communicating with someone who has dementia.
It can be difficult to broach a subject that might upset a loved one - a little planning should help.
Advice on how to overcome common problems you may encounter during difficult conversations about care.
If your loved one has dementia, you may need to take a different approach to discussing care options.