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As a clinical psychologist, I’m often seeing individuals who are caring for a loved one. Their partner or parent or child might have a chronic illness, which may or may not be terminal. Most people know by now that it really tough to be a carer. Many know the statistics around the high rates of depression and anxiety in those caring for someone they love. Some people know how to care for the carers, but most don’t.
From all the stories I’ve heard over the past 25 years, a common thread is clear. The carers need more than financial and practical help. They need more than frequent suggestions by friends and family to “sing out” if they need a hand. They need understanding and empathy.
When an individual has a brain injury for example, that person may become abusive or aggressive at times. At the very least, they may say or do things that hurt their carer. Of course, the patient doesn’t mean to cause any pain. They can’t help it: they are unwell and affected by their injury. We all feel for the injured person and so we should. But what about the carer who has just been told that all their care means nothing? Or perhaps they have been accused of sticking around for the money. Or maybe they are being constantly told that they are not giving enough love or attention. The carer knows their loved one can’t always help what they say, but it still hurts.
We need to be sensitive to the pain of the patient and their carer. When a carer talks about the hurt they are feeling as a result of some harsh words or worse, we can’t immediately rush to the defence of the patient. When a carer hears: They didn’t mean it – they are unwell, the carer’s pain is dismissed and all that remains is guilt for having said anything.
In some circumstances, it becomes impossible for someone to be the permanent carer and so they may no longer live in the same house. But the carer doesn’t stop caring and the carer doesn’t stop hurting if the patient blames them for organising alternative arrangements. And the carer is deeply affected if their extended family and friends remain attentive to the patient and assume the carer can cope without support.
Hopefully we are getting better at knowing how to support those with a chronic illness and in many ways we are getting better at understanding that carers can break. Now we just need to know how to show the carers as much empathy as we show the patient.
It might seem cruel not to reassure a child or partner or friend when they are anxious or upset, but often reassurance makes things worse. In psychological terms, reassuring someone can negatively reinforce unhealthy thoughts and behaviour.
Most of us are aware of the power of positive reinforcement. If we are praised or rewarded, we are more likely to do the behaviour that earned us the praise again in the future. We are also familiar with the idea of punishment. If we get punished for bad behaviour, we are less likely to act in the same way in the future. But many people don’t realise that there is a third form of reinforcement and that’s negative reinforcement. Negative reinforcement occurs when an unpleasant emotion or sensation is removed. Whatever took the physical or emotional pain away is strengthened or reinforced.
A simple example would be when you have a headache and you take some paracetamol. If the pills take away the headache, you are more likely to take the paracetamol again when another headache comes along. If instead of taking a pain killer you drink a big glass of water or have something to eat and that’s what takes the pain away, you are more likely to reach for some water or food next time.
Similarly, if you feel stressed or anxious and you have a wine or a beer, which makes you feel more relaxed, drinking alcohol is negatively reinforced – you’re more likely to do it again next time you’re feeling stressed or anxious. But, if you do a relaxation exercise or go for a walk when you’re feeling stressed, and that’s what leads you to feel better, you are more likely to choose that option in the future.
So, back to reassurance …..
If your partner keeps asking for reassurance that they are loved, it’s easy to fall into the trap of telling them that of course you love them. But that is only reinforcing the reassurance-seeking behaviour. Better to ask them why they keep asking and why their confidence in your love is so low.
If your child keeps asking for reassurance that no one will break into the house and kidnap them in the middle of the night, it feels cruel not to reassure them that nothing bad will happen. But that is only reinforcing the reassurance-seeking behaviour and may be increasing their anxiety. Better to discuss how anxiety works and how they can manage anxiety with some slow breathing and relaxation.
If a friend keeps checking whether they have upset you with something they said or did, it feels like you should reassure them that they have done nothing wrong. But that just strengthens the checking behaviour and may be helping to increase their fear of upsetting anyone. By all means, reassure them once or twice, but if it’s an ongoing behaviour, it’s kinder to resist the urge to reassure.
If it feels too cruel to hold back some reassurance, give some empathy instead. Tell your partner who’s asking if they are loved that you can hear that they’re feeling a little unsure of themselves at the moment. Show your child who’s afraid of being kidnapped some empathy by saying that you know how upsetting it is to be anxious about something. And empathise with your friend who fears negative evaluation by saying that you know how much they hate the thought of upsetting anyone.
It may come as a surprise to many people to learn that one of the worst questions you can ask another person is: What have you been up to? It’s a really common thing to ask; a bit like: How are you? Except that it’s not like How are you? It often evokes a very different reaction – and not a good reaction.
It’s amazing how often this issue is brought up in my office. Most commonly, it’s a couple who discuss the arguments triggered by this simple question. Stay-at-home mums explain how the question makes them feel as if their job as the primary carer is not valuable. They struggle to justify how they have spent their day and they feel inadequate and judged by their partner. The partner is quick to point out that it’s just a greeting – not a judgment, but it doesn’t come across that way. In fact, stay-at-home mums often hate anyone asking this question – unless it’s asked by another stay-at-home mother for exactly the same reason – they feel as if the question requires a response that justifies their existence. (Stay-at-home dads may also dislike the question, but I haven’t heard them make the same complaint.)
What have you been up to? also upsets the many people who are between jobs or who are unable to work. For those seeking employment, this question leaves them stumbling for a credible answer and again they fear being judged. The person asking the innocent question would have no idea of the angst they may have just triggered.
The teenager hates the question because it suggests disapproval for sleeping in or watching clips on YouTube even if it’s a weekend or the holidays.
Even if you are not between jobs and you’re not a stay-at-home parent or a teenager, being asked to sum up your recent experiences is not an appealing invitation. You might be at a social function or you run into someone at the shops and if you’re asked: What have you been up to? your mind can instantly go blank as you try to find something worth mentioning. So we trot out responses like: I’ve been really busy or This and that or Not much and then it’s our turn to ask – And what have you been up to? and it’s their turn to try to outline their highlights.
Finally, for those countless people who are struggling with grief or depression or an addiction, being asked: What have you been up to? could trigger more pain for those who are not in any state to take it.
If it’s being discussed so much in my little office, it must be affecting a lot of people in the general population. So maybe we can all try to make our questions easier to answer or we should just stick to: How are you?
Vulnerability + empathy = connection
Too many people are suffering with the loneliness that comes from not feeling connected to other people. They may be part of a couple and have many friends, but they still feel alone because the relationships are not close.
Without vulnerability, you can’t develop intimacy. When we share our fears and our pain, we draw people in. When we hear about another person’s fears and pain, we are drawn to them. If all we share is small talk and pleasantries, there is no depth to the conversation or the relationship. But what happens next is just as important in the intimacy equation …
Once we have been open and vulnerable, if we do not feel some empathy coming back, the connection is broken and intimacy doesn’t develop. When we are talking so personally about ourselves, we desperately want to be understood. We don’t want to be judged and we don’t want to be advised. We just want the other person to imagine what it’s like to be us.
So if you’re one of the countless people who are feeling a lack of connection with the people in your life, ask yourself: Do I have the essential elements that make up the intimacy equation?
Just because we care deeply about another person’s pain doesn’t mean that we are necessarily good at showing them empathy. The most common conversation I have with couples is about how to show empathy. Even the loveliest people can struggle to empathise, which can damage their relationships. Without empathy, we don’t feel supported or understood and the connection between partners is reduced.
So how does empathy sound? Maybe it’s a good idea to compare non-empathic reactions to empathic reactions…..
Eg: I’m so stressed. I’ve got too much to do. I can’t cope.
You’re always stressed
Am I making you stressed?
Sit down and relax
What can I do to help?
You do have a lot on your plate
You must be shattered
I can see how much you do and how overwhelmed you are
Eg: I’m so nervous about having surgery tomorrow
You’ll be fine
You’re in the best hands
It’s a simple procedure
I know you are
I know you hate general anesthetics
I can see how nervous you are
Eg: I haven’t slept for a week!
That’s a bit of an exaggeration
Either have I
You need to go to bed earlier
How hideous. Why not?
You must be exhausted.
I can see you’re at breaking point
In other words, empathy sounds like you truly care. It doesn’t sound like you’re trying to solve the problem and you’re not dismissing the issue. All you’re doing is letting the other person know that you hear them and you understand what they’re saying (even if you have countless ideas on what they should be doing or not doing).
Avoiding anxiety-provoking situations increases anxiety.
Avoiding difficult conversations with your partner, friend, child or colleague can allow situations to become far more complicated.
Avoiding physical or psychological treatment exacerbates the condition.
Avoiding hard work makes the load greater.
Avoiding any type of confrontation or intimacy will significantly affect your relationships.
What are you avoiding? Instead of staying in your head and over-analysing everything, try changing your behaviour. Slowly face the things you tend to avoid. You might just find it easier than you’d imagined.
When someone we love is suffering, we want to take away their pain. When they hurt, we hurt and it can feel cruel to sit there and do nothing. But what if our attempts to stop their pain actually makes things worse? What if our discomfort adds to their pain? Often our partner or friend or child just wants us to be there and do nothing except listen and care.
People cry all the time in a therapist’s office and we welcome it. We don’t rush over with a tissue or a hug. We sit with the client’s pain and allow them to feel it and express it and learn from it. A tissue or a hug can send the wrong signal. You can inadvertently be saying: Shhh, Shhh, don’t feel like that. You might actually be saying: Shhh, Shhh, don’t feel like that. Either way, you could be telling this person that you don’t want to see or hear about their pain. Your friend or partner or child might stop crying or talking about their issue – not because they feel better, but because they can sense that you’re uncomfortable. In other words, without meaning to, you can be failing to give empathy, when that’s all you’re wanting to do.
Snot needs to be running down someone’s face before I’ll reach for the tissues (unless they ask beforehand). A hug is so powerful – after someone has been able to fully download.
One of the most important gifts we can give another person is to demonstrate that we can sit with their pain. After all, it’s about them, not us.