Beginning

Becoming a Good Companion

Notes on Providing Emotional Support

‘Helping a person will not necessarily change the world, but it can change the world for that person’

Fundamentals

What do we hope to achieve when we offer emotional support? A starting point would probably include: Helping someone to cope with the difficulties that they are experiencing; helping them to find a way forwards; identifying and ensuring that the support that they have or need, is appropriate and available. Someone that is able to fulfil this role, could be described as a Good Companion; that is; someone who is there when needed, and is able to empathise with them; that is, someone who understands how and why someone else feels the way that they do about a particularly difficult situation that they may be experiencing.

Many of us have a good network of friends and family.  The help they provide can include emotional and financial support. However, there are a significant number of us who don’t have this; many people have very little or no social support and could be experiencing loneliness and isolation, which can seriously impact physical and mental health. Even those that do have support, will sometimes find that the one that they have turned to, either doesn’t know what to say, or is afraid of saying something that may make things worse and so says nothing.

Compassion is based on empathy, respect and dignity. While empathy is the ability to put yourself in the other person’s place and understand their distress, compassion has the additional element of actively wanting to help them. It is the ability to understand and sympathise with the emotional state of another person while having the motivation to help and prevent their distress. The compassion shown to them can affect how people perceive their interaction with individuals and services and can make them feel valued and cared for. Most significantly, showing compassion – towards yourself and others – is a skill that can be learned. Acting compassionately does not require any specific resource, time or money. It just relies on you being able to relate to someone else’s emotional state and crucially, wanting to support them. The most important thing to remember is that you don’t need to be an expert to help someone experiencing distress. The most valuable thing is that they don’t feel alone and that they know someone cares.

(Please note that the preceding two paragraphs are copied from a Samaritans Cymru document: ‘Working with Compassion A toolkit for Wales’

https://media.samaritans.org/documents/Samaritans_Cymru_Working_with_Compassion_English_9D2e5df.pdf

Whenever someone needs to talk, they need someone with the ability to listen. This seems straightforward, but there are techniques that can be learned to become a better listener, a listener who doesn’t just hear the words that are being spoken but is able to understand what is truly being said, and why. Some, but not necessarily all of the following ‘active listening’ techniques may help you to listen more effectively:

• Eye contact is important when the conversation is face-to-face, not staring, but not avoiding eye contact. If eye contact makes you feel self-conscious, try focussing on the speakers forehead or mouth.

• Acknowledgement – using short words, sounds, or phrases to show that you are paying attention – things like ‘yes’, ‘I see’, or simply ‘mmm’. Beware of just saying ‘Oh’ as that can sound judgemental, depending upon when it is used, and the tone of voice used.

• Reflection – This is an initial step towards interpreting what has been said, and can include phrases such as: ‘That sounds difficult’; ‘I imagine that could be a bit of a worry’; ‘that seems like something that would be easier if you have some support’.

It is important to avoid using words like ’must’ as in ‘that must be hard’. Using ‘must’ may result in a response like... ‘Who are you to tell me how I must feel?’.

• Clarification – It is important to avoid misunderstanding due to crossed wires, or to unfamiliar phraseology, and more importantly, to resist the temptation to make assumptions. Don’t be afraid to ask; ‘when you say… do you mean…‘or ‘are you saying….’ Try to use the speaker’s own words or phrases when looking for clarification.

• Open questions - Questions that don’t have a simple yes/no answer encourage the speaker to expand on what they are saying, Typically, these are questions that begin with: ‘How’, ‘why’, who, ‘what’ and ‘when’. They provide a natural lead into the next phase of emotional support, understanding how someone feels about a troubling situation:

How do you feel about… ‘your diagnosis’  - ‘the professionals that are looking after you’ - ‘the support that you have’ - ‘Who do you turn to when you are having a hard or difficult time’

Which leads naturally to asking; ‘Why do you think that you feel that way?’

• Encouraging – Gentle encouragement is recommended, a simple ‘well done’, rather than ’Wow, that’s great’

Be aware that being judgemental should be avoided, however I believe that there is an acceptable difference between a judgemental comment that expresses disapproval, and one that expresses mild encouragement.

• Summarising -  It’s not necessary, and probably not helpful to wait until the end of a conversation before a short summary is used, because what you are trying to do, is to put what the speaker has said, into your own words, and that will help with clarification, and a shared sense of understanding.

• Silence can be used as an active listening skill; many people feel awkward when a conversation has apparently stopped, and sometimes may say something that they had been holding back, or something that they might otherwise find uncomfortable to say, but a long silence can also signal a lack of interest in the conversation, or a loss of concentration, both of which can be damaging.

Confidentiality: Cancer treatment often has side-effects that some may consider to be sensitive subjects, especially bodily functions, and topics related to more intimate activities, it may therefore be necessary to reassure the receiver of the support, that whatever is said, will be respected and not repeated to anyone else. 

Giving Support

How to refer to the participants? Someone in need of support may be: Someone living with cancer; someone caring for someone living with cancer; or simply someone who cares about someone living with cancer. There is no single word or term that may be used to describe all of these categories. Words like: patient, client, colleague, friend, customer or service user are all in some way inadequate, so to avoid confusion, I shall refer to the one receiving the emotional support as Someone (Someone being supported), and the one giving the support as the Good Companion. This could be, a friend or relative, a neighbour or a colleague, and Good Companion seems to me to be entirely appropriate.

I am not aware of a defined method of providing emotional support; as a Samaritan Listening Volunteer, I once told a caller, ’I’m not a psychologist, I’m not a psychiatrist, I’m not a psychotherapist, I’m not a psycho anything.’. That comment raised a chuckle from the caller, and I knew then that a bond had been established, and it was likely to be a rewarding call – it was. Giving support is a very individual process, and a style that suits the giver will develop with practice. The notes that follow, are intended simply to provide a framework that may be used as a starting point.

The ‘open questions’ component of active listening, could equally be called ‘exploring’, as it is one of the techniques that help us to establish empathy, determine what support is available or needed, and it can help to establish the way forwards.

Therefore, this framework can be divided into three parts: Exploring feelings; exploring needs; and exploring options, but firstly, how to begin?

Gently, after all, it should be a conversation, not a consultation or an interrogation and so, could typically start with a simple question… ‘How has your day (or week) been?’   ‘How are you feeling?   ‘What’s been on your mind lately?’   ‘I wondered if you have anything special planned for today?  ‘Are you expecting any visitors today?’. Probably best to resist the temptation to dive straight in with ‘How did you feel when you were told that you have cancer?  Questions similar to the ones suggested should provide a natural lead into…

Exploring feelings; this is where we start to build empathy, so that we can understand how Someone feels, and why they feel the way that they do. One point to remember, is that when it comes to how someone responds to a distressing experience, there is no such thing as ‘normal’. In difficult or distressing situations, we will often experience a range of emotions, and our feelings are related to the emotion that is uppermost in our mind at the time. This concept is well illustrated by responses to bereavement which can induce: Sadness, loss, bewilderment (Why has this happened?), relief, isolation, and sometimes a feeling of simply being overwhelmed. However, there is one response to distressing news that is very common, especially when we know that it is someone close to us that has been given the news. Many people respond by saying… ‘If that happened to me, I’d be...’. However, the reality is often not always what we expected.

The answers that help build empathy are unlikely to be forthcoming straight away, and that is why the active listening techniques are necessary; probably starting with reflection and clarification, as suggested here.

Reflect - ‘You just mentioned… I wonder if you could/would be able to tell me a bit more about that?’ or ‘Earlier in the conversation you said… I wonder how else you might have said the same thing?

Clarify - ‘When you said… Did you mean..? or ‘Are you saying…? (repeat in your own words what you think that Someone intended).

Conversations develop a natural flow, but beware of being intrusive. As a Good Companion, you know what your objective is, and it is easy to become too focussed on that and lose the overall intention, which means thinking about how you are going to move on to…

Exploring needs: A useful place to begin is by asking… ‘Does anyone else know what you’re going through at the moment?’  this will have one of two answers: No-one, or a named someone. If the answer is no-one the response of the Good Companion could start to explore why no one else knows. Typically, the reason could be that Someone doesn’t want to be a burden on friends or family; Someone doesn’t have anyone to talk to; Someone doesn’t know how to ask or feels that the subject is too difficult or sensitive to talk about.

Having no one to talk to; being a burden, or difficult subjects can be resolved by suggesting something that includes… ‘If you have no one to talk to, perhaps you could try talking to me. I won’t share what you’ve said with anyone else, so please don’t worry and I’ll give you time to think about what you want to say, and how you want to say it. You’re not a burden to me, that’s what I’m here for.’

If the answer is a named, but Someone doesn’t know how to ask, that may be overcome by suggesting the following: ‘If you’ve got time, there’s something on my mind that’s bothering me, and it would really help if I could talk to someone about it. I don’t want to be a burden, and I wouldn’t want you to worry if you don’t know how to respond or are afraid of saying something that might make it worse. I don’t expect you to solve my problems for me, just someone to help me find a way forward. (they may also need to mention that it’s a sensitive or difficult subject)’

It may help the Good Companion to know why Someone had the confidence to share their problem; how they felt supported, and perhaps what kind of support was provided – maybe it was practical support such as help with transport, shopping, household activities such as cooking and cleaning, or where help is given to alleviate a physical impairment.  More importantly there is an opportunity to find out how the support could be improved. What is important to Someone, and how are their needs prioritised? This is where familiarity with services provided by Macmillan or local organisations is useful, as is a knowledge of how to access these services.

One aspect of feelings and needs that is often forgotten about is how Someone’s experience affect other people, especially those that are close to them, they might have needs of their own arising from the support that they are providing; Surely something worth exploring.

Exploring Options: This is often where a Good Companion may be asked for advice and is something that needs to be addressed with care. We are individuals, and what is right for one or many, may not be right for everyone. Being advised to follow a course of action that has worked for others, but doesn’t work for someone looking for support, can be counterproductive as it can raise the question ‘What is wrong with me?’ a disheartening experience that has the potential to cause unnecessary worry. For clinical advice, the cancer care team should be the first port of call, so knowing how Someone gets on with their oncologist, nursing team and GP is worth exploring. When they meet the specialists for treatment or a consultation, do they go alone,  do they go with a prepared list of questions? What do they do if the answers aren’t forthcoming or are unsatisfactory? 

Consequences need to be considered and knowing what they are likely to be will depend upon the amount of prior information or knowledge that Someone has. The simpler consequences are likely to be... ‘How will this option affect me? - How will I cope? - Will I need extra help? Perhaps the more important questions are those that begin with ‘What if...?’ -  ‘I can’t cope – it’s not successful – it’s taking longer than expected’ because the answers to those questions may be the deciding factors

For the Good Companion, knowing what options are available, or have been offered, allows the GC to start exploring how Someone normally makes important decisions. Are decisions made intuitively, and on the fly, or do they use a more formal method such as listing and perhaps weighting, ‘Pro’s, Cons, and Interesting’ tables or Mind Maps or Flowcharts, and if they do, has the method generally been successful? – What’s the next step?’ Helping Someone to think about what and who is important to them, and why, may help the decision-making process.

One last thought: The best help we can give someone is the ability to help themselves.

The following snippets may be helpful:

A simplified version of the Serenity Prayer – or, as written here, more of an aspiration than a prayer:

Give me the strength to accept the things that I can’t change,

The courage to change the things that I can change,

And the wisdom to know the difference.

A question that everyone can ask themselves

We live in an imperfect world, what can I do to make it better?

Appendix 1

Potential source material

• Ted.com, a website with talks on a wide range of subjects given by speakers who knowledgeable about their topics, or have some experience what they are talking about, useful for finding information about how others may have faced the same problems, but as with all websites, caution and a degree of scepticism may be required;

https://www.ted.com/talks

• Book - ‘Nonviolent Communication’ - author Marshall B. Rosenberg, very good on feelings, empathy, and barriers to communication.