Do we know how to have the important conversations that we should have while we’re still here? We have choices at our end of life and we should make plans now. It starts with a conversation. We can speak with our healthcare providers, family, and friends.
Conversation is a dialogue or a group conversation with the idea that there is give and take, back and forth. I say something, you say something, and most people in a group will chime in as well. What about the one-on-one conversations? In conversation there is listening, which we’ve talked about before in previous podcasts. What do people want from conversation? It can be as simple and as difficult as feeling heard. How does someone feel heard in a conversation? There is a technique called Mirroring. This is an exercise where the listener mirrors back to the speaker what they heard being said. For example, a speaker says “I was so exhausted yesterday! I didn’t think I’d finish out the day. I have so many tasks unfinished and I am worried my boss will be unhappy, while at home my spouse is on my case about spending so much time at work”. My mirror response could go like this: “So you were feeling pretty exhausted and concerned about your boss being unhappy and your spouse being unhappy”. The speaker then can validate or correct you, like this: “Yes, I was exhausted but I am not concerned about my husband because he knows this is my busy season. My boss may be unhappy but knows that I will get the work done.” In this example we may have missed the mark a bit or the listener did not want to accept your interpretation, either due to lack of insight into their own emotion or a dismissal of the information that was mirrored because it may have hit a nerve. Sometimes when we point out, even if repeating back what was said, a speaker may not want to own that. Let’s look at another example:
Mirroring and Validation
“I was really angry the other day at the hamburger joint because I asked for no mustard and darn it if they didn’t put mustard on my stupid hamburger! That really irritates me!” If I were to mirror that, I would say, “You sound really frustrated by this hamburger joint putting mustard when you are there on a regular basis and they continue to make this mistake on your burger. The person who shared about this experience would say, “Yes, I’m so frustrated”, or they would reply, “No, I’m not frustrated, I’m just mad! They messed up by burger again!” This is the speaker acknowledging that I may have heard the words but got the emotion off from what was really being expressed. I said ‘frustrated’ and the speaker emphasized they were ‘mad’. I mirrored what they said but inserted my assessment of the emotion by using “frustrated”.
Another example would be: “I was really angry that my son came home two hours late. I have talked to him and talked to him about curfew and he keeps coming in late. I don’t understand this. I think he’s rebellious-I can’t decide. What do you think?” My perception of what I had heard could be mirrored back in this way: “You were angry about your son’s rebelliousness”. In response to the request for my opinion, I could go forward to validation: “You sound really angry because your son keeps rebelling against your rules.” If I am accurate, the speaker could reply, “Yeah! I don’t get it! I’m just doing this because I want to make sure that he’s safe. I set these boundaries because it keeps him safe”. To mirror this, I would reply: “Your son doesn’t understand that the rules he is breaking are put in place to keep him safe”. I reframed the same words used by the speaker. If I got it correct, the speaker would feel validated. To validate rather than mirror, I could say, “You’re really concerned about keeping your son safe.” The speaker could reply, “Yes, I really am. I don’t know what I would do if he was in a car wreck.” Further validation would be: “I’m sensing a little bit of fear about what could happen if your son happened to be out past curfew and got in a car wreck.” “Yes, I’m really afraid of him getting in a wreck or maybe even dying in a wreck, or hurting somebody else.” We could continue in this manner of reflecting and validating to dial into my friend’s core emotion. Anger is what she began with but through our conversation and my reflection of her own words with my use of validating language, she was able to express that her anger was really from her fear.
The more that we can listen and seek to understand what our speaker wants us to hear by mirroring what we think we heard, we can dial into a deeper emotion. Perhaps at the beginning of this conversation the speaker was not able to address fear because the anger was so strong. My use of mirroring and validation allowed her to explore or hear her words and decide if it was plain anger or a little of what I offered, which was fear.
When someone we love wants to talk about their end-of-life wishes, we want to hear what the loved one has to say, so how can we validate when we don’t feel comfortable about the topic? How can we understand their true feelings when we don’t want to think of them dying? Perhaps through this conversation you could discover the loved one actually hasn’t made a decision at all, but is expressing their confusion or fear. If we use the two techniques of mirroring and validation, we can help bring out these feelings or thoughts.
I Could Have Done it Better
In a conversation with my dad a few months before he died, I had come to visit. He had been in cancer treatment for five or six years by this time and knew that his options for treatment were decreasing. I joined him in the den, sitting across from one another. I had brought him a yellowish-orange flower in a brightly colored pot. I called it my “little pot of sunshine”. It sat on the table between us. My dad started telling me that the pain was getting to the point that he may have to start taking pain medication and was concerned about it. He told me he was afraid about becoming addicted to the pain medication. What I wanted to say to him was, “You’re at the end of your life. It doesn’t matter. Take the pain medication”. Those were my thoughts, though, not what he was expressing. To validate my dad, my response, so that he would fee heard, would rather have been like, “I hear you’re concerned about addiction. But Dad, your pain is getting worse and worse. I’m wondering if your fear of addiction is maybe something else.” My dad could have come back and said, “I just don’t want to be asleep all of the time and I have heard that pain medication makes you tired and kind of loopy”. “So, Dad, you’re maybe concerned that you might not be present mentally if you’re on this pain medication and maybe you might miss out on some important moments.” “Yes, you know, my wife is really trying to talk to me. She is not really ready accept what is going on with me and every night we sit together or lie together in bed and she cries and cries and cries. She doesn’t want me to go but I just hurt so bad. I’m ready.” “Dad, I hear that the pain might be becoming unbearable for you but you are concerned that you and your wife won’t be able to have those last conversations together. Maybe your concerned that you won’t be coherent enough to tell her how much you love her and how grateful you are for the way that she has been taking care of you. “Yes, I am. She means a lot to me and she has been taking care of me so much. I want every moment we have together to be deep, meaningful and loving.” “Dad, I hear you say that you know you are getting close to the end and that maybe treatment isn’t available for anymore.”. “Oh, no, no, no! The doctor said we have several other trials that I can do and I have signed up for those. She and I talk about that too, but until then, I want to be clear.”
In this scenario, I was able to bring out that my dad had a fear of missing out on those deep conversations with his wife. He was in a deep amount of pain but it was not because he knew it was the end of his life that made him want to be clear and coherent for these conversations. It was rather a desire to be clear and coherent so that he could pursue these other treatment options. What I had gathered from that is that he was not ready to accept that he was at the end of his road of treatment. Returning to the conversation, how could we talk about that?
“Dad, I hear you say that you have a lot of options left and that the doctor is still optimistic that there could be a treatment plan out there for you, but you are really hurting right now”. “Yes, I am hurting right now and maybe, if I can do the next protocol, I won’t be in this much pain and I will be able to last until way past my birthday. I think that’s the best thing that I can hope for at this point, and I am ready! I am going to fight until I can’t fight anymore!” “So, you want to keep fighting and your doctor has given you some hope that maybe some of your pain can be reduced in the course of those treatments.” “Yes, I think so. I think that’s the way we want to go.” “Alright Dad, have you considered taking just a little bit of medication to kind of take the edge off so that you can still talk to your wife?” “Well, we talked about that. There are also some other options besides the heavy duty pain medicine. Maybe that’s what I could do.” “So you’re saying that you have other options for pain control, too.” “Yes, there is more than that opioid stuff and it isn’t just going to make me loopy and confused.” “So, I hear you saying that maybe you’re kind of looking forward to the possibility of exploring those options as well as the treatment options that are coming.” “Yes, yes, I’m just waiting for that call from my doctor and once it comes I know that I will just get onto something. The tumors are going to shrink and I’m going to feel good.” “That sounds really encouraging Dad, I’d love to hear more about that when your doctor does call you about it.” “Yes, sure. I’ll let you know as soon as the doctor tells me and after my wife and I talk about it.” “That sounds great Dad. I’m really glad I came today so that I could hear this encouraging and positive news.” “Oh, yeah. It’s all positive until the end, and that’s a long way off yet.” “Yes, I can hear that you are really looking to extending your life as much as you can.” “Yes. My wife and I haven’t been married very long so I want to make it as long as possible. If we can hit the 10-year mark, that’s even better.”
In this conversation, we went from this idea of my thinking that he was close to the end of his life and he was thinking he was close to the next treatment. It is a difference of life situation and understanding but, when I realized where his mindset was, which was treatment and maybe even different medication options, I was able to change my questions or validation or mirroring statements to reflect the changes in his point of view. Actually, his point of view never changed, it was just the way we had to dance a little bit to get the heart of the matter. It still was able to expressed, however. I think that is the key here. Remember, I am not a therapist, doctor or nurse, and I am not professionally trained in this sort of communication. This has come from experience and learning. Also, because we have been in therapy, learning mirroring and validation, with the help of the therapist, became an important tool for my husband and I when we were trying to improve our dialogues. It would have been helpful in the scenario with my dad as well, because my desire is to fix. I recall saying something like ‘Dad, just take the medication for a couple of days and then stop’, or something like that. My dad didn’t need that from me in that moment. He needed to be able to talk about how important it was that he stayed the course as long as possible and took every treatment that was possible and to prolong his life so that he could prolong his marriage, hopefully to ease some of the burden and pain that his wife was experiencing in the moment of not being able to have these conversations much longer. He was also encouraged and positively looking at all of the other options available to him. I wouldn’t want to step over that because it was really important to be able to catch his thoughts. I can’t say that’s how conversations always went with my dad. When we had the pain medication conversation, it went more like, ‘Oh, Dad, you can just take it. It’s not going to be a problem. Your doctor won’t let you get addicted, it’s no worry at all.” Was I addressing his fears or his concerns, or did I completely bypass and then miss this positive energy that he was really trying to build up and express? I would have called that a lost moment. I was eventually able to hear about hopefulness and other thoughts about his marriage but not without doing a dance of me sharing my opinions and missing his emotions and thoughts before we got there.
My dad and I talked about other things as he progressed in his disease, such as losing his continence, having to wear diapers, what kind of food what he was eating, also not wanting to eat at all, saying that his wife was trying to feed him food that he really didn’t want, and how would he deal with that? We had times for apologies and seeking forgiveness, times of laughter, sharing memories, all really good stuff. I wouldn’t say my validation or mirroring was on point at all. Some of the communication was definitely one-way: just a lot of listening. I’m okay with that, because I got to hear some really good stuff coming from him. I was able to hear him express some thoughts about the way he raised me and my siblings, what he thought of me and my kids, what he thought of his mother, who had the same cancer but was treated by one surgery. My dad was not so fortunate. We talked about passing on before his mother and how hard that would be for her. These conversations were touching, memorable and loving. I think there was no kind of anger or any resentment or feelings that really needed to be discussed by that point so that I think be the time we started having the pain discussions, the ‘no more treatment available’ discussions, the ‘no more traveling to different hospitals or out of the country for treatment’ discussions, all those things fell away because they were no longer an option for him. When we cleared all of that away and it came to ‘this is the time I have left and this is how I want to use it’, we were able to make the most out of those conversations.
Looking On to Having These Conversations in 2023
As we wrap up the series on listening and look at the New Year, I believe I’d like to call 2023 The Year of Conversations. I will be speaking with people I know very well, some who are acquaintances, people I follow on social media or maybe folks I don’t know at all, to explore the different ways of the conversation dynamic of expressing feelings, hearing feelings, sitting through some really tough conversations, and maybe having the desired outcome of a conversation or maybe realizing we may never get it. What do we do with that? Do we cry in these conversations? Is that okay? Is it possible to have laughter in these conversations? I say yes! I have lived that. I have had periods of time when there was nothing positive in certain conversations. That is also a reality, and we cannot ignore that there may be an impossible completion of a conversation as the emotion is just too much and we have to get out of the room. Perhaps the relationship we have is so strained that it is not possible to talk or communicate together. What are our options in that case? Let’s explore that in 2023. For the remainder of 2022, I hope we can explore conversation and the idea of dialogue, validation and mirroring, expressing our own thoughts and feelings to those we love, and feeling heard.
I think this will be a great experience and I hope you’ll be coming with me!