How to talk and be a good listener
Being a good listener can help you understand in part what another person is feeling. Good listening can be divided into two parts: the physical part and the psychological part.
We can never completely understand another person’s thoughts and feelings, but listening helps us understand enough for them to feel that we empathise with them. Empathy means sensing what another person is feeling. It’s an important way of showing love and concern for another person. This, in itself, can be very reassuring to a person with cancer.
A lot of the most awkward gaps in communication are due to not knowing some of the principles that help people talk freely. These are discussed below.
Getting the setting right
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This is important and is worth taking time to get right at the beginning of the conversation. You should:
Switch off your mobile phone so you won’t be interrupted.
Take off your coat - this signals that you’re not in a rush to be somewhere else.
Get yourself comfortable.
Let your relative or friend know that you have time to sit and talk with them.
Sit quietly - this will give the impression of calmness even though you may not feel relaxed.
Suggest a cup of tea if you feel it’ll help.
Keep your eyes at the same level as the person you’re talking to. This almost always means sitting down. If your relative or friend is in hospital, sitting by the bed is better than standing. You can ask if it’s OK to sit on the bed if that’s easier.
Try to keep the setting as private as possible. For example, in hospital avoid talking in a corridor or on a staircase, where passers-by can hear what you’re saying. There may be a day room you can go to. If the person you’ve come to see is confined to bed, you could suggest drawing the curtains to give as much privacy as possible.
Avoid speaking too loudly, especially in a hospital ward where your conversation could be overheard by others. Talking too loudly may put the person off saying anything themselves. On the other hand, don’t speak so quietly that they struggle to hear what you’re saying.
Be aware of the distance between you both. If you’re too far away, a conversation can feel awkward and formal, but if you’re too close, the other person may feel their space has been invaded. Be especially sensitive to this if you’re talking to someone who’s in bed and not able to move themselves.
It helps to make sure there are no physical obstacles (desks, bedside tables and so on) between you. A physical barrier such as a desk can have a distancing effect on your conversation. If a barrier is in the way, you could say something like, ‘It’s not very easy to talk across this table; can I move it aside for a moment?’
Looking at the person during your conversation tells them that you’re giving them your undivided attention. But remember that while in some cultures it’s acceptable to look directly into someone’s eyes, in others it’s not. Be aware of how the other person feels, and don’t maintain eye contact for so long that it feels as though you’re staring at them. If you’re talking about difficult issues and, during a painful moment, you can’t look directly at each other, you can still stay close by. Hold the person’s hand or touch them if you know them well enough to do this.
Find out if the person who is ill wants to talk
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Your relative or friend may not be in the mood to talk to you that day, or their treatment or symptoms may mean they don’t feel well enough. Or they may just want to talk about ordinary things, such as television programmes, sports events or what’s been happening in your life.
Remember there’s something very reassuring about everyday small talk, and sometimes people simply want to enjoy a ‘normal’ conversation. Don’t be offended or feel it’s your fault if they don’t want to tackle big questions such as how they’re feeling about their illness just then. It will still help them if you simply listen and pay attention while they talk.
If you’re not sure what your relative or friend wants, you can always ask, ‘Do you feel like talking?’ This is better than going straight into a deep conversation (such as a serious discussion about how they’re feeling), especially if they’re tired or have just been talking to someone else.
When someone is talking, it’s important to listen to them and to show that you’re listening. Don’t get caught up with thinking about how you’re going to reply or what you’re going to say next. If you’re thinking about your response, this may stop you from listening properly.
To listen properly, you need to give your full attention to what your friend or loved one is saying. Remember that you listen with your whole body. If you look at your relative or friend, sit facing them and indicate that you’re taking in what they’re saying, they’ll notice this. If, however, you’re looking around the room, moving your arms and legs restlessly, or interrupting them and changing the subject, they will not feel heard.
Avoid talking while they’re talking - wait instead for them to stop speaking before you start. If they interrupt you while you’re saying something with a ‘but’ or ‘I thought’ or something similar, you should stop and let them carry on.
Encourage the person with cancer to talk
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You can actually encourage the person who’s ill to talk about what’s on their mind. Simple things work very well. You can try nodding or saying things like, ‘Yes.’, ‘I see.’ or ‘What happened next?’ These all sound simple, but during stressful times, it’s the simple things that help.
Showing empathy is also helpful. If the person starts to cry as they talk about their situation, you could say something like, ‘I can see how upsetting that is for you.’ If you are very close to the person, you may simply hold their hand and say, ‘I’m sorry.’
You can also show that you’re listening by repeating two or three words from the person’s last sentence. This helps the person feel that their words are being understood. For example, if the person says, ‘I went to the hospital and the consultant ordered lots of x-rays.’ and then lapses into silence, you may say after a little while, ‘Ordered lots of x-rays?’ This may help them start talking again.
You can also repeat back what you’ve heard - partly to check that you’ve got it right and partly to show that you’re listening and trying to understand. You may say things like, ‘So you mean that …’ or ‘If I’ve understood you, you feel …’. You may find your own way of saying this, especially if you know each other very well.
Use silence and non-verbal communication
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If someone stops talking, it can mean that they’re thinking about something painful or sensitive. You may be able to sense what they’re thinking or feeling. Wait with them for a little while - hold their hand or touch them if you know them well enough - and then ask them what they were thinking about. Don’t rush, even if the silence seems to last for a long time. Most of us aren’t used to sitting silently with another person, and we may feel embarrassed. There’s no need. It’s perfectly fine to wait until they feel ready to talk again.
Sometimes you may think, ‘I don’t know what to say.’ Perhaps there isn’t anything to say. If so, don’t be afraid to say nothing and just stay close. Just being there and offering a touch or an arm around a shoulder can help more than words.
Non-verbal communication (communicating in ways other than speaking) is just as important as words. We all learn to pick up subtle non-verbal signals from others. A smile, a frozen face with staring eyes, a restless movement of the body, slumped shoulders, a tremor in the voice - these all speak volumes.
You can also apply this to physical contact. For example, if you touch your relative or friend and they pull their hand away or look uncomfortable, you’ll know that this is a signal to give them space. But a touch may be just what’s needed to help them talk. It shows that you care and want to support them. They may cry when you touch them, but this is natural and can be healing.
Don't be afraid to say how you feel
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It may be helpful to say things like, ‘I find this difficult to talk about …’ or ‘I’m not very good at talking about ...’ or even ‘I don’t know what to say.’ You may worry that saying things like that will cause your loved one or friend further distress. However, in practice it tends to have the opposite effect, and the person you’re talking to may be relieved that someone understands.
Being honest about your own feelings will help develop trust between you, and it’ll make it easier for the other person to be honest about their own feelings. It’s quite possible that the person you’re talking to feels the same as you. Even if you share the same feelings, remember not to stay focused on your own feelings. Make sure that you bring your attention back to your relative or friend.
Make sure you haven't misunderstood
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If you’re sure that you understand what your relative or friend means, you can say something like, ‘You sound very low.’ or ‘I imagine that must have made you very angry.’ These replies tell them that you’ve picked up on the emotions they’ve expressed while talking to you. But if you’re not sure what they mean, you can ask, ‘What did that feel like?’, ‘Do you mean that …?’ or ‘How do you feel now?’
Misunderstandings can occur if you assume that you know how they’re feeling. Saying something like, ‘Can you say a bit more about what you mean?’ or ‘I’m not sure that I know how you feel.’ may help make sure that there are no misunderstandings.
Staying with the subject
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If your relative or friend wants to talk about how awful they feel, it’s important to let them. It may be distressing for you to hear some of the things they say. However, it can really help them if you’re able to stay with them and just listen while they talk. If you find it uncomfortable and too difficult to cope with just then, you could suggest a short break for a cup of tea or you could take a quick look around the room while you compose yourself. This will help move your attention away from what is distressing you.
If after a short break you still find that the conversation is too hard for you to bear, you could say so and offer to discuss it later. Say something simple, such as, ’I’m feeling a bit emotional and it’s hard for me to talk about this now - could we talk about it later?‘ Don’t simply change the subject without acknowledging the fact that what your relative or friend is talking about is very important.
When your relative or friend brings up the subject of their cancer, don’t immediately start talking about someone else you know who has, or has had, cancer. You may mean well, but remember that each person’s experience of cancer will be different, so talking about someone else’s experience may not be helpful. Treat your relative or friend as an individual and focus on them rather than comparing them with others who have cancer.
You may want to advise your relative or friend about something that may help them feel better. But it’s probably more helpful to simply listen for as long as they wish to talk and then ask if there’s anything you can do to help them. You may be surprised at their answer, as they may come up with something unexpected.
You may have your own ideas, but it’s worth pausing and asking yourself if your idea will really be helpful. If you’re not sure, you could make a tentative suggestion like, ‘I wondered about …, but I don’t want to suggest this if it’s not the sort of thing you want.’
Remember that your advice may not be something that your relative or friend can accept. If they reject your suggestion, don’t take it personally; their preferences may differ from yours. It could also be one way that they can stay in charge of their life when other parts of it feel out of control.
You may imagine that there can’t possibly be anything to laugh about if someone has a major illness such as cancer. But humour is actually one of the ways that we deal with difficult things. Laughter can relieve emotional tension. Laughing at what feels threatening is a way of bringing it down to size, gaining perspective and helping people feel more in control and able to deal with their situation. It may also help the person feel like their normal self.
If your relative or friend wants to tell jokes and laugh about things that have happened to them during their illness, remember that humour can be a healthy response to their situation. It will help them if you go along with it, even if you find it difficult.
It’s quite natural for people to feel frightened, upset and sad when they’ve been diagnosed with cancer or are having treatment. Some people think that being positive can help cure cancer or make the treatment more successful. They may be afraid that feeling sad and having negative thoughts or emotions may make the treatment less successful, make the cancer grow faster or make it more likely to come back.
Although the development of cancer may be influenced by our thoughts, feelings and attitudes, research studies haven’t shown any convincing evidence that positive thinking can make treatments more effective or stop the cancer from coming back. It’s also important to remember that cancer is influenced by many other things, such as our environment, smoking habits, diet and genetic make-up.
If you believe that your relative or friend needs to be positive to get rid of the cancer and the cancer comes back, they may think that it’s their fault because they weren’t positive enough. People sometimes put unfair pressure on their relative or friend by saying that if they fight hard enough, they can overcome the cancer. If a cancer does come back or can’t be cured, it’s often beyond their control. Cancer is a complicated illness, and even with modern treatments, not all cancers can be cured.
Allow your friend or relative to be sad or upset
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It’s important to allow your relative or friend to be sad or upset at times. You may find that they want to talk about difficult topics, such as the chances of being cured, whether it’s worth having another course of treatment or making a will.
You may find yourself wanting to cheer them up by saying things like, ‘Oh, don’t worry it will all be OK.’ or ‘Of course the cancer won’t come back; try to be positive.’ This is understandable, but it may make them feel that you don’t want to talk about their feelings, so they could end up feeling isolated and saying nothing. It may help to say something like, ‘I can understand you feeling low with the chemotherapy making you feel so ill.’ or ‘It’s hard to look ahead when you’re not sure what will happen.’ This will allow them to continue talking about what’s important to them.
If your loved one cries, saying something like, ‘It’s OK; it’s fine to cry.’ will tell them that you’re not put off by their tears. Sometimes touching, holding hands or giving a hug may help too. Tears are a natural response to distress - they may be a very helpful release of inner tension for your relative or friend. Some people don’t want to cry because they feel that once they start, they won’t stop. This is not true, as feelings often come and go.
Some people experience repeated episodes of anxiety and depression at some point during their lifetime. If your loved one has struggled with anxiety or depression in the past and they develop cancer, they may have more intense feelings and reactions. In this case, they may be better helped by a trained counsellor. Their GP or the hospital staff will be able to refer them for counselling. If your loved one or friend has counselling this doesn’t mean that you can’t visit, listen or talk with them. Your input will still be valuable. We have more information about how professional help when you're coping with the emotional effects of cancer.
Religious and spiritual support
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Sometimes when people are very ill, they start to question their beliefs about life and its meaning. This may happen whether a person has a particular religious faith, is agnostic or is atheistic.
It’s important to distinguish between religion and spirituality. Religion concerns a particular faith, such as Catholicism or Buddhism. Spirituality has a wider meaning and applies to everyone. Spirituality means different things to different people, but some people may think of it as anything that relates to the ’inner soul and being’. A person may describe a piece of music, watching a beautiful sunset, a book that means a lot to them or being in love as something that has spiritual significance for them.
When people are seriously ill, they may feel emptiness, despair or hopelessness. Listening to and being with your relative or friend can really help support them at this difficult time. You don’t need to share a particular belief system to support them in this way.
If your loved one has concerns about their religion or spirituality, they may wish to speak with a hospital chaplain or other spiritual adviser at the hospital or hospice.