Dr Kathryn Mannix knows how daunting difficult conversations can be.
She's been a palliative care doctor for 30 years and is a qualified cognitive behaviour therapist, in her time working with the dying and their families, she has had to navigate more than her fair share of tough conversations.
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She has written a book called Listen: How to Find the Words for Tender Conversations.
A series of small conversations rather than once emotionally exhausting one is often the best approach, she told Kathryn Ryan.
“So simply saying, here's the thing that we could really do with talking about very often, the other people or person involved in that regard, say thank goodness, it's out in the open.”
She had a hard lesson in how to deliver bad news as a young doctor, she says.
A man came in to the hospital where she was working having collapsed and could not be resuscitated. She was sent to tell the man’s wife.
“I was a young doctor, I'd been trained to do it, I knew there was a way of doing this; that you check first of all that you're talking to the right person, so I checked her name.
“And then you give them a warning shot, I'm sorry I've got really dreadful news for you. And then you don't beat about the bush and torture the person, you tell them the news. I'm just very, very sorry to tell you that your husband and I called him by his name has just died.
“And she had kind of shot up. And then she stood up and screamed at me that that couldn't be true. And I must be telling lies, and I was a liar. And then I had a horrible pain in my face and staggered backwards and could see orange lights, and I realised that she must have punched me, although I still don't remember the punch.”
Meanwhile the woman collapsed into a seat and was sobbing and wailing, says Mannix. Just at that moment a nurse arrived, she says.
“She just gave her masterclass in communicating properly. She sat down next to this weeping woman, and I could feel myself thinking like, why the hell didn't I sit down. And then she just started stroking the woman's arm and calling her by her first name.
“And saying this is really shocking, this is really, really difficult for you. I'm so sorry. And gradually as this newly bereaved wife stopped weeping, the nurse said to her, have you been worried about your husband? And this woman said, 'oh, yes, ever since he had his first heart attack a few years ago I thought we'd been on borrowed time'. And then this nurse asked her a series of questions. Had you been more worried about him recently, and this woman talks about him being very stressed at work and that she'd seen him looking grey this morning.”
The woman started to calm slightly and explain to the nurse her increasing worries about her husband’s health, Mannix says.
“What this nurse had done was kind of rewind time for her and take her back and let her walk herself through her own worries about her husband's health, so that by the time they were talking about him having had another heart attack, and having died, she wasn't brutalised by the shock of it, she was kind of noticing that she was already anticipating this.”
Her book helps people guide a conversation to allow the other to start processing difficult emotions, she says. This could be conversations with teenage children, a partner or a sick relative.
“We're very rarely talking completely out of the blue about something that's difficult to talk about. And by helping somebody to tell a story, stories are the way that we make sense of situations and even our own lives.
“So, by letting them tell the story by us simply asking questions, and being curious, we help them to set a scene. And as they're speaking to us, they're hearing it themselves, they're noticing it, and they're taking themselves to the place where now we can start to talk about the issue that needs to be addressed.”
If a difficult conversation is needed then set a time together, she says.
“Seeing each of these conversations as a collaboration, it's not me doing it to you, it's me inviting you into a conversation, or you are inviting me into a conversation.”
And don’t be afraid to set a time limit, she says.
“Each time we have one of these conversations, start off by saying how much time have we got? And do you feel okay to use all of that time? Would you prefer to be shorter? And then to give each other time warnings as we move through.”
Set a time for the next conversation, she says.
“One of the things about staging a conversation like that, of doing it in several small chunks, is that each time we talk to each other, and we listen to each other, we slightly change our understanding of the other person, the situation and the way they perceive it.
“So, when we come back together again, next time, we're in a slightly different place, we understand each other a little bit better than we did last time.”
