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 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?

Avoidance is an excellent strategy if we’re referring to staying out of dangerous situations. But avoidance should often be avoided!

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.