Say What?

Dr. Elizabeth Cleary knows a thing or two about life-changing challenges. Shortly after Dr. Cleary graduated from college, her mother died. As she grappled with her own loss, she devoted herself to her work at Massachusetts General Hospital’s Center for Anxiety and Traumatic-Stress Related Disorders. Later, she went on to UCLA, where she received a Ph.D. in clinical psychology.

Today, Dr. Cleary provides counseling to individuals, couples, and families in UCLA oncology clinics and teaches advanced graduate students in clinical psychology and social work. She has co-authored more than a dozen research papers, including several on psychological adjustment to cancer, and in a recent discussion with us she shared some ideas on what to say to someone facing a life-changing challenge, whether it be a devastating diagnosis, a significant loss, or something else.

Here are edited excerpts from our conversation.

It’s hard to know what to say when you first find out that a loved one is experiencing a crisis or life-changing challenge. What sort of things can be helpful?

I think thoughtful people get caught up in finding the right thing to say, which can delay or prevent them from saying something at all. What people will remember and hold onto is not the specifics of what you said, but a more general sense of whether you were present and connected to them during their toughest stretches. The goal of reaching out is to express support and empathy, not to say something that will magically make their situation better. I think it is helpful to lower your own expectations for saying the right thing and instead focus on letting them know that they are on your mind, that you care for them, and that you plan on supporting them.

Something as simple and honest as, "I am thinking about you and care for you," "I am so sorry that you are going through this, and I plan on supporting you in whatever ways I can," or "I know there aren't words to make this easier for you, but please know that I am sending you my love," are great places to start. Have it sound like you. Kindness, honesty, and just saying something go a long way.

What are some verbal snafus that your patients have found hurtful or unhelpful?

Things to avoid saying include offering a silver lining. Silver linings are perspectives for people to arrive at on their own, in their own time. When offered by others, they are often invalidating and minimizing of someone's experience.

For example, when talking about cancer, you might be tempted to say, "Well at least they caught it early," "Thank goodness you have great medical care," or "That’s wonderful that you don’t need to have chemo and only need surgery." Those things may be true, but there is no such thing as “only surgery” or a “better type of cancer,” and saying so can minimize the fact that someone is devastated by their situation.

Rather than offering these silver linings, I suggest asking more open-ended questions, like "How are you feeling about your medical team?" or "Do you feel like you're getting enough support from others?" and really listening. This allows people to share things they're feeling grateful for—or identify places where they need more support—without being made to feel that they need to be looking on the bright side of things. With any questions that you ask, also be prepared that someone might not want to get into details, so you can preface things by saying, “Please tell me if you would rather not talk about this right now, and I’m happy to talk about other things.”

Is there anything else your patients have found particularly unhelpful?

Another unhelpful response is to try and relate someone else's experience to your own or someone you know. If you have experienced something similar, you could say something like, "I know our losses/diagnoses/situations are different, but I am always here to talk if you want to share aspects of your experience that may be similar to mine or hear about some things that I've found helpful." Telling someone about the experience of your cousin/uncle/nextdoor neighbor's niece rarely makes someone feel seen or heard, even if your goal is to show them that you understand.

Finally, I recommend not acting on a common urge to ask questions to reassure yourself that there is some reason that protects you against a similarly awful thing happening to you or someone you care about. A classic example in the cancer context is asking if someone with lung cancer smoked. It is hard to tolerate the possibility that there may not be a reason why something bad has happened, and that can leave you feeling vulnerable, but going hunting for that reason often creates distance between you and the person you care about, rather than closeness.

On the topic of asking someone how they are doing, is that a fair question to ask and how do you gauge when someone wants to talk about the issue versus escape from it for a while?

It is great to be transparent about your awareness that someone may not want to talk about their illness/loss/situation. You can say, “I called to see how you are feeling, but we can also talk about other things if you’d rather. I’m here for emotional support but also for distraction, humor, whatever you feel like you need today.”

I think we actually trend toward being too cautious and avoiding asking about hard things, though, especially when it comes to loss. We might worry that bringing up someone’s loss might result in feelings of sadness for them, but typically the feelings of grief are already there. Acknowledging someone’s loss can lead someone to feeling less alone and isolated with their experience. It is rare that the patients I work with complain about too many opportunities to share how they are doing, and more common that people are hurt by others not seeming interested.

Dr. Elizabeth Cleary

Dr. Elizabeth Cleary is a Licensed Clinical Psychologist at Simms/Mann-UCLA Center for Integrative Oncology. For more information, click here.