Transcript Difficult Conversations

Difficult Conversations
Baby Boomers & Aging Parents
Gail Henson, Ph. D.
Hospice Institute
Bellarmine University
Goals
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What are stressors for the baby
boomers?
What are the difficult conversations?
Why are they difficult? Barriers, issues,
roles
How can we have them? Models
Facts about baby boomers
• Born 1945-1964
• 2000 Census Figure:
61,952,636
• US percentage= 22%
• Kentucky: 45-64=
23%;
Baby Boomer issues
• Have not had same
kinds of hardships as
did parents
• Did not fight in World
War II, Korea
• Did not live through
Depression
• We expect a high
standard of living
Paying for children’s
education
Saving for retirement
We have big mortgages,
debt
We’re overweight
We like to eat out
We like to travel
We’re really tired
So here you are-• The baby boom generation’s latest, and in
some ways most agonizing, life crisis
• What to do what the parents who once
took care of you can no longer take care of
themselves.
• What hats do you wear? Name them!
What are the difficult
conversations?
• When do they arise?
• Why are they so difficult to have?
• What can help us have effective family
conversations about difficult topics?
Difficult Conversations
Exercise 1
Individual surveys
Group discussion & activity
Difficult conversations: health
• Use of pain medication
• Advanced directives (living will, use of
CPR, artificial feeding, breathing,
hydration)
• Power of attorney
• True status of own/loved one’s/parent’s
health
• Where to die
Safety
• Driving
• House
• Food
• Memory
Conversations about personal
conduct
• Hygiene
• Exercise
• Finances
• Care of home
Difficult conversations: end of life
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Family relationships that need resolution
Death
Funeral plans
Burial, cremation plans
Wills
Naming an executor
What to do with possessions after
death
Conversations –
Religious & philosophical
• Religious concerns about
death
• Why is life so fragile?
• Why is everything living
transient?
• How do I deal with
suffering? How can I
deal with pain or
discomfort as I die?
• Do I fight death or do I
embrace it?
• Why am I suffering?
• What is quality of life?
• What is the meaning of
my life?
• What is my legacy?
• What is a good death?
• What will the hour of my
death be like?
• Can I prepare for death?
• Does anyone care about
my death?
• Does my death affect
anyone?
• What loose ends need to
be tied up before I die?
More conversations…
• What will happen to my
body after death?
• Will I continue suffering?
Will I be reborn into a
new existence or into a
cosmic nothingness?
• How do I go into the next
stage? Is it dark or light?
Is there a life after this?
• What is heaven (or hell)
like?
• Will there be angels or
demons?
• Will I see God (or a
devil)?
• Will there be a judgment?
• Will there be people,
places, or animals I
know?
It’s tough to talk with your parents
Many factors affect any
conversations
How can you prepare for the
challenges?
Consider such factors as
relationship, culture,
communication patterns,
verbal communication,
and nonverbal
communication
Family Relationships
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Defined roles
Commitment to preservation
Recognition of responsibilities
Shared history and future
Shared living space
Family culture
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Religion
Politics
Education
Economic level
Race & ethnicity
Geographic culture
Values
Communication patterns
So why is it so hard to have tough
conversations?
• Roles that have been
played such as….
• Boundaries long
established
• Feeling it would be
disrespectful
• Fear
• Anger
• Embarrassment
• Not knowing how to
begin
• Geographic distance
• Dislike or disgust
• Not having the
emotional energy to
do this
• Not motivated
• Personality clashes
Perhaps these conversations are
tough because….
• You don’t know how to begin—
• You’re surprised, confused, upset at what
has happened--• You’re anxious about what you might hear
or see—
• You’re anxious about death itself--• You’re afraid your parent might get mad at
you! For example----
Let’s get serious—have these
situations ever happened to you?
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Your parent wants all your time & attention
Makes unreasonable demands
Is inflexible, critical, and negative
Complains about real or imagined physical
symptions
• Uses inappropriate/foul language
• Exhibits bizarre behavior
It’s tough to have conversations
with a parent who
• Has become suspicious and paranoid
• Is experiencing increasing levels of
memory loss
• Makes up silly lies, exaggerates, cries wolf
• Stays in bed, does nothing—waiting to die
• Refuses to take showers or change
underclothes
• Gets furious if something doesn’t happen
at a specific time
It’s tough to have conversations
with a parent who
• Gets mad when told “No” they can’t do
something
• Is a danger on the road but refuses to give
up driving
• Needs but refuses to allow any caregiving
help in the home.
• Wants to eat constantly or only wants to
eat the same thing
It’s tough to have conversations
with a parent who
• Can no longer take proper care of their
bills, insurance, finances
• Refuses to see a doctor/dentist, but is not
getting adequate care
• Needs to see a psychiatrist but refuses to
go
• Acts completely normal and charming in
front of others (Jekyll & Hyde)
It’s tough to have conversations
with a parent who
• Fakes illness at the Adult Day Care to avoid
staying
• Cannot be reasoned with when they go into an
illogical rage
• Has pushed me to feelings of resentment and
guilt
• Is completely unmanageable and needs to be
placed into a home
• Refuses to allow a cleaning person into the
home
Difficult conversations lead to
drawing lines—setting boundaries
Sometimes it’s hard to establish
boundaries with your parents
• May feel you’re
selfish
• May seem like you’re
being disobedient
• If you set boundaries,
you may be hurt by
the consequences
• If you set boundaries,
you may hurt others
• You may think that
boundaries mean
you’re angry
• You may feel so
obligated to your
parents that you may
feel guilty
• You may feel like
boundaries are
permanent
Before the conversations begin
Check family communication styles
• Avoidant— unable to ask for help,
recognize own needs, let others in;
withdraw when have needs
• Compliant—one can’t say no
• Controller— sees others “no” as a
challenge-can’t respect other’s limits; don’t
take responsibility for own lives
• Nonresponsive: don’t pay attention to
responsibilities of love; beyond insensitive
What kinds of boundaries exist
between you & your parents?
• Functional boundaries—a person’s ability
to complete a task or job:
Performance, discipline, initiative, planning
Can your parent remember to wash his/her clothes?
Eat? Pay bills? Take pills?
• Relational boundaries—your ability to
speak truth to those in a relationship
If you’re a compliant person, you
may have a hard time, due to fear
• Fear of hurting your
parent’s feelings
• Fear of abandonment
• Fear of their anger
• Fear of punishment
• Fear of being seen as
bad or selfish
• Fear of being shamed
• Fear of being
unspiritual
• Fear of your own
overstrict, critical
conscience
• Can you say, “No”
without one of these
fears?
Fears of elderly or terminally ill
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loss of self image
loss of control over life
loss of independence and fear of
abandonment
fear of living alone and being lonely
fear of death
So you have a difficult conversation
coming up? Is this how you feel?
What’s in your toolbox of strategies
for conversation?
“If the only tool you
have is a hammer,
you tend to see
everything as a
nail.”
Abraham Maslow
Oasis
• Open— crisis, planned,
casual, spontaneous
• Articulate the
question/problem/issue
(does the person
perceive there to be an
issue/problem/question)
• Search for solutions
• Integrate options into
action
• Study and evaluate
O.A.S.I.S.
Opening
Study &
evaluate
So here’s the difficult conversation
• Goal is it to understand?
is it to feel a certain way?
is it to do something?
• Context
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Context: planned, unplanned—
crisis, spontaneous
Perceptions
• Barriers & boundaries
Physical—verbal
Nonverbal-Relational--Roles
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Gender
Comm
Emotion
Culture
Work
Finances
Children
Culture
Challenges to plan for before the
conversation
• Risks
• Verbal—actual understanding of
situation, technical level of
language, physical ability to hear or
concentrate
• Nonverbal—tone of voice, gestures
• Context—what’s going on at the
time of conversation
• Past patterns of family
communication
Do your parents understand what
you mean? Perhaps not….
• Are you sure they hear you?
• Do they understand the words you’re using?
• Do they understand things in a way you did not
intend?
• Lesson 1 Meanings are always in people
• Lesson 2 Meanings are more than words and
gestures
• Lesson 3 Meanings are always unique, one-time
• Lesson 4 Meanings have both connotations and
denotations
• Lesson 5 Meanings are always context based
Nonverbal matters that can help or
harm your conversations
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Paralanguage
Listening
Touch
Gestures
Dress
Physical environment
Nonverbal issues and your parents
What are the bodies saying?
• Body orientation (facing toward or away
from each other with body, face, head)
• Posture
• Gestures
• Face and eyes
• Voice
Nonverbal: paralanguage
How you say things counts!
• Stress on words,
syllables
• Pitch (shrill, high, low)
• Rate (fast, slow)
• Volume (loud, soft)
• Rhythm
• Examples: crying,
whispering, moaning,
belching, yawning,
yelling, screaming
“Don’t use that tone of voice with
me!”—Parents of the world
Getting through the barriers
• Fences with gates, not walls
• Try to determine the fences in advance
• Learn how to open the gate…….
Things that often don’t work well
Avoiding the topic
Minimizing the issue
Blaming the person
Silencing the person
Gunnysacking—saving up all the issues and
dumping them
Beltlining
Force
Personal rejection
Listening and your parents
Obstacles can take the form of…
• Preoccupation with self
• Preoccupation with external issues
• Taking a “you’re with me or against me”
attitude
• The law of least effort
Listening and your parent
Feedback is important
Giving feedback
• Honesty
• Immediacy
• Appropriateness
• Clarity
Receiving feedback
Sensitivity
Supportiveness
Open-mindedness
Being specific
Nonverbal issues with families
Your face speaks volumes
Intensifying
De-intensifying
Neutralizing
Masking
Nonverbal issues The eyes have it.
Eyes may indicate….
• Positive or negative
responses
• Dominance or
submission
• Interest or fear
• Involvement or
withdrawal
• A signal to turn the Compensation for distance
conversation
Signal nature of
• Feedback
relationship
Nonverbal: touch
• Expresses positive or
empathetic response
• May be ritual
• May express control
• May be task related
• May be playful
Nonverbal issues to consider with
your parent
• Which part of the
body does the
touching
• Which part of the
body is touched
• How long the touch
lasts
• How much pressure
is used
• Whether there is
movement after
contact is made
• The situation in which
the touch occurs
• The relationship you
have with the parent
Nonverbal: gestures
What do the hands say?
• Illustrators—scratching your head, snapping
your fingers; decrease when someone is
cautious
• Emblems: nodding head for “yes” or putting a
hand to your ear “I can’t hear you”
• Adaptors—nervous habits—fiddle with hair
• Too few gestures may be significant as an
indicator of a mixed message as too many.
Nonverbal issues
Appearance leads to assumptions
Factors
• Hair
• Dress
• Body odor
• Grooming
Assumptions
• Moral character
• Attitude
• Trustworthiness
• Success
• Level of sophistication
• Note: assumptions
not always accurate!
Exercise 2
What’s your nonverbal
communication style with your
parent(s)?
So you have to talk—how to get
started
• Allow your parent to
talk about whatever—
they may give you an
opening…
“When I’m no longer
here, I want you to
have this…”
“It seems like every
friend I have is
gone…”
• Answer such leading
statements with
responses that invite
more conversation
“You seem to feel that
life is getting short…”
“It must be getting
very lonely for you…”
Open: Look for Opportunities to talk
• Circumstances or events can provide a
chance for you to make statements that
lead to difficult conversations
– Death of friend of family
– News
– Article in a magazine or newspaper
– “Dad, do you ever daydream about your
funeral?”
– “Mom, what do you think heaven will be like?”
Articulate the issue
• Does your parent/the person perceive a
problem or issue exists?
• What are the risks if this problem is not
addressed?
• What are the risks of the conversation
does not occur?
• Given the risks and problems that could
occur, how is your goal affected.
Clarify the problem/issue
• Nature of the problem
• Effects of Problem
• Your desire for change
Search out options
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Use positive thinking to help solve problems
Understand the situation or condition
Decide if you need professional help
Plan what you will do
Consider obstacles and how to deal with them
creatively
• Develop, carry out, evaluate and adjust your
plan
From The American Cancer Society
Initiate the Conversation
• Context determines beginning
• Risks to autonomy, pride, self-concept
affect the progress of the conversation
• Nonverbal and verbal issues affect the
conversation
• So how can we manage the conversation?
Tips
• Refer to your own thoughts and feelings
• Keep the conversation going with
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Facts
Ideas
Reflections
Descriptions of what you see or hear—use objective
language
– Use provisional statements—asking questions rather
than judging—It seems to me that…or If I remember
correctly…
• Summarize, paraphrase, bring closure
Listening to your parent
• Paraphrase what you
heard to check your
understanding—is
this what you mean?
• Express
understanding (if you
understand)-empathy
may be a challenge if
you’re tired!
• Ask questions
• Try to get your parent
to explore feelings
• Talk less
• Affirm and validate
Strategies for Difficult
Conversations
• Stop
• Step Out
• Step Back In
Warning! Don’t let anger sabotage
your conversation
Be determined NOT to get
angry yourself (right)
Get on the same physical
level as your parent
Be silent so you won’t say
something you’ll regret
Express your concern
nonverbally
Make appropriate
empathetic statements
“I think I can see why you
are so upset”
DO NOT say
“I know just how you feel”
(can you read minds???)
Remind yourself that YOU
control your emotions
Angry outbursts rarely
change someone’s mind.
O.A.S.I.S. Eggshell Exercise
• Open—
• Articulate the question/problem/issue
(does the person perceive there to be an
issue/problem/question)
• Search for solutions
• Integrate options into action
• Study and evaluate
Suggestions for Reading
• Final Gifts***
• I’ll Take Care of You
• Are Your Parents
Driving You Crazy?
• Aging Parents,
Ambivalent Baby
Boomers
• Elder Rage: How to
Survive Caring for Your
Aging Parents
• Family Ties that Bind
• Boundaries. When to
say YES;When to Say
No to take control of
your life.
Workbook to
Boundaries
• Boundaries Face to
Face
• Crucial Conversations
• Feeling Good
Difficult Conversations
Baby Boomers & Aging Parents
Gail Henson, Ph. D.
Hospice Institute
Bellarmine University