Dr. Kathryn Mannix: ‘We don’t have the slightest idea of how to talk to someone that is facing a difficult situation’

Some conversations are not easy. Like those you have with a person who has lost someone close, been diagnosed with a serious disease or got laid off; sometimes even when there is a need to discuss more mundane matters, such as money. With three decades of professional experience as a palliative care doctor, Kathryn Mannix is an expert in uncomfortable conversations. Through a series of stories (some true, some invented by the British author and some based on real events) her book Listen: How to Find the Words for Tender Conversations offers a compendium of everything a person should take into account when talking to someone who is suffering because of something that is going on in their life — or just to have an empathic conversation.

Question. The impression one gets after reading your book is that people don’t have the slightest idea of how to talk to someone that is facing a difficult situation.

Answer. I think that’s right. We think we do. And I think we think we should help by reassuring them, telling them what to do. Who takes anybody else’s advice? Nobody takes anybody else’s advice, do they? The advice we follow is the advice that comes from inside us. So I think we can help, but we help by asking the questions that help the person to think around the problem and see their way forward.

Q. Do we listen too little and speak too much?

A. We listen to answer. What I’m saying is: listen to understand. Listen to make sense of it, and don’t worry about what to say. I used to do it, too, to work out in my head: what will I say? What words will I use? And then all you can think about is remembering the words. But they won’t remember the words. The words don’t matter. They remember how it felt. The kindness, the desire to support. So listening to understand helps us find better words.

Q. Is there a listening technique?

A. The only question you can plan is the first question that you ask. After that, every question you ask is a question about what the person just told you. You have to listen. You have to reflect on it in your head, make sense of it in your head. And, of course, that leaves a silence. We worry about silence, but the silence is good because that’s the place where that person can see that you’re thinking. You’re not just rushing in with something you already thought of that you wanted to say to them. You’re going wider and wider and deeper and deeper. When I teach young medical students, I tell them to do a waltz: It’s question, question, summary. Question, question, statement. Question, question, check.

Q. It is difficult to avoid the temptation to provide solutions when faced with a problem.

A. It’s so hard. So hard.

Q. Even for you?

A. Oh, yes, yes. And the closer we are to the person, the more their pain hurts us. I’m a parent. It’s so hard not to fix problems for our children, but they have to learn to fix their own problems. Good parenting is: you keep them safe, but you let them sort it out. I find myself giving advice. But you have to think about what you’re doing and go back to questions.

Q. Is there any situation in which it is a good idea to give advice? Maybe if it is something that we know a lot about or have experience with?

A. If somebody asks us for advice. I think that’s completely different. But even then, you have to ask yourself what the other person is looking for. I’m an expert on dying. That doesn’t mean that’s what they want to talk about. So maybe when somebody asks us for advice, the next step is to give them a sort of menu. Shall I talk about this, or would it help more to talk about that? What will help you most? What have I got that will help you most? So they stay in control.

Q. You also write against comforting phrases. Aren’t there any that could be helpful?

A. I was talking to somebody yesterday who was saying her friend’s mother recently died. And many friends are calling her or sending messages to say they’re sorry, and “she’s at peace now” and “she’s in a better place now.” And she’s finding those messages really difficult because they’re somebody else’s belief. They are not acknowledging her sorrow, her grief, her sadness. So maybe to say: “yeah, that’s awful. Yeah, it really sucks. I don’t know how you’re dealing with it. How can I help? Do you want help with the shopping? Can I pick your kids up from school?” You know, offer some practical things we might be able to do, particularly for people who are newly bereaved.

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