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Conversations about awkward or tragic subjects can be very difficult. How should we respond to someone sharing bad news or raw emotion? What do we say, and what should we not say?

On Word of Mouth, Michael Rosen is joined by Kathryn Mannix – therapist, palliative care specialist and author of "Listen: How to Find the Words for Tender Conversations". They discuss tackling tender topics we would rather avoid, how to listen well, and why silence can often speak louder than words.

Kathryn started to use tender as a counter-response to the language used around conversations that we tend to call “challenging,” “difficult” or “courageous”.

“It seemed to me that all of those words were the language of fear. Of putting on our armour and bracing ourselves to do something really difficult,” says the palliative care specialist. “Actually, a lot of the time what these conversations really need us to do is be open to each other’s emotions.”

“Tenderness seemed to be to be a word that described that willingness to sit in a place of discomfort alongside somebody… It’s the language of gentleness and companionship, rather than armour and fear.”

Why is it important to be tender?

When a doctor examines a tender tummy, he needs to be careful not to make the pain worse. We need to take the same care when approaching someone’s emotional pain, advises Kathryn.

“We’re walking alongside something that’s very painful or difficult for the person to whom we’re listening, and therefore tenderness is our respect for the presence of their pain; the closeness of their pain.”

“When you’re talking about emotional pain, you cannot do something that takes the person’s pain away,” states the therapist. “But you can be rough and uncaring and leave them there in their pain alone, or you can be open and caring and be their companion in their distress.”

Telling stories can help us make sense of pain and trauma

Stories help us to make sense of the world, and our experiences within it, from a very young age. Sometimes things go round and round in our head, and we can’t make sense of them; we can’t get hold of the threads and tease them out. But as soon as someone engages us in a conversation in which we can explain our dilemma – and plant it out, one stepping stone at a time in front of us – they help us.

“In telling our stories, in engaging in conversation, we are listened to by two people,” explains Kathryn. “The person who’s sitting there listening but also ourselves. And it makes sense to us as we hear ourselves telling it aloud.”

Following this, a staff nurse called Dorothy came in, sat beside the woman, stroked her hand and asked questions – like “did you know your husband wasn’t well” – to help the woman talk through what had happened. “I’m watching this reprising of the situation,” recalls Kathryn. “Of Dorothy taking her back in time and then walking her slowly forwards, step by step, simply by asking questions and letting this newly bereaved wife describe the story of her husband’s illness that has led to his death.”

Sometimes simply asking questions can allow a person to open up, tell their story and process their feelings.

One of the things that we try to do, with the best intentions, is offer people advice.

“We as human beings want to cooperate; we want to help,” says Kathryn. “We feel this bubbling up from inside us of helpful suggestions. We want to fix it, we want to make it better, we don’t want them to feel this distress.” In reality, if the issue was so simple that the advice that we can give would fix it, the person would have fixed it themselves. “We need to recognise that we can’t make it better,” she states.

Instead, accept it isn’t simple, accept it’s going to be emotional, accept that you’re not going to know the right thing to say – and that’s ok. “Your job isn’t to offer the fix. Your job is to be that person’s listener, to be the space into which they pour their distress.”

“There isn’t a thing we can do that’s going to make it better,” she says, “and we’ll make things worse if we try.”

If you’ve been really well listened to when working through a conundrum, you won’t have noticed the silences because your brain was so busy thinking and formulating. And a good listener will have asked you questions that will have helped you explore your thoughts and options. Being comfortable with silence is “very, very hard,” she admits, but it’s a “really important part of the contract.”

Recognise that we are all different

“We have to keep reminding ourselves that this is not me, this is not my dilemma, this is not my sorrow. If I’m truly empathic I will understand how great the sorrow is for that other person, but it’s still not mine. It’s theirs,” says Kathryn.

“Actually, my contribution to them is my time, my listening, my kindness, my determination to not get in the way offering my own fixes that are not the right fixes for that person.”

It’s OK to take comfort from talking to someone who has died

People sometimes continue to talk to someone they’ve lost as if they are still there. It doesn’t mean they don’t realise they’re dead, or that they’re not processing the loss. It can simply be comforting ritual.

Kathryn’s uncle would set a place for his wife who had died and talk to her during mealtimes. “He described to me the comfort he got from talking to her and of ritualising her presence in the house,” she states. He knew his wife was gone, and missed her every day, but when he talked to her, he felt her presence.

“I’ve met many, many people subsequently in my life who in their bereavement have chosen to sometimes have a reality that’s different from the actual reality for periods of time, and take an immense comfort from it,” Kathryn states.

“When we’ve been in a really tender conversation, we’ve actually exposed our inner workings,” says Kathryn. It’s almost like we’ve come in from the cold, taken our coat off and relaxed into the warmth of the conversation together. And so closing the conversation takes some care – a little like a safety procedure.

Take a moment to say, “OK, it’s time for us to finish.” One of the best ways to do that, suggests the therapist, is to decide how much time you’ve both got at the beginning. “To close safely is to respect the time that’s available for both of us.”

Then towards the end of that time, ask the other person if they feel happy to stop the discussion there. Check they’re ok to step out of the conversation and into the immediate future. Where are they going now? Who will they speak to next? “It just helps us both to come back to the real world and metaphorically put our outdoor coats back on, ready to step out of the tender conversation and back into whatever the cold was that we were tolerating before,” explains Kathryn.

Crucially, it doesn’t have to be the end of the dialogue: “Sometimes a conversation dips in and out and it takes several sessions to really work through something, and that’s ok.”