Communicating with those in the final stages of life can be awkward and uncomfortable. Interacting with families connected to the dying loved one can also be strained.
Right words are sometimes elusive. Striking the balance between meaningful support and maudlin sentiment is a challenge — our interpersonal skills are being tested by the definitive stressor.
The value, however, of appropriately expressing our feelings, both to the person who is passing and the gathered bereaved, is inestimable. “While words can never fully express how much someone means to us, language can still provide comfort, solace, hope, and even inspiration,” deathcare expert Chris Raymond pointed out.
Just being present is a huge step in the right direction. When it comes to end-of-life care, sometimes significant others are scarce — fear of their own mortality or just general avoidance issues prevent them from visiting.
In terms of what to say, it’s best to go with your heart, at least reasonably speaking from the heart. As songwriter Oscar Hammerstein has written, your heart is “not always wise.” Speak of your feelings but do so with prudence.
In talking with the dying, it’s often best to follow their lead. The emphasis here is calm reassurance. Focus should be on the patient: their needs, physical or emotional, require attention. Talking about death, according to Dr. Christopher Kerr, may be what the loved one wants. If so, don’t hesitate to pursue the topic.
It can be a good idea to recall pleasant memories, experiences that are likely to engender peaceful moments. Similarly, physical contact may be in order: a touch, a hug, or holding hands may reduce any sense of isolation or distance.
In recent years, “holding space” is a concept deathcare professionals have been recommending — although society at large may not be familiar with the practice, it has antecedents which date back to the mid-twentieth century psychologist, Carl Rogers.
Therapist Divya Robin defined holding space as “the ability to create a safe, supportive and non-judgmental space where another can be fully emotionally, physically and mentally vulnerable.”
Author Heather Plett explained it this way: “It means we are willing to walk alongside another person in whatever journey they are on without judging them, making them feel inadequate, trying to fix them or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support and let go of judgment and control.”
The notion of holding space is very similar to the therapeutic technique of unconditional positive regard (UPR) developed by pioneering psychologist Carl Rogers in the mid-1950’s. Rogers, ever the humanist, believed a therapist should view clients with UPR — complete acceptance without judgment.
“When the therapist is experiencing a warm, positive and acceptant attitude toward what is in the client, this facilitates change,” Rogers wrote in On Becoming a Person. “It involves the therapist’s genuine willingness for the client to be whatever feeling is going on in him at that moment — fear, confusion, pain, pride, anger, hatred, love, courage, or awe…it means that he prizes the client in a total rather than conditional way. By this I mean that he does not simply accept the client when he is behaving in certain ways and disapprove of him when he behaves in other ways. It means an outgoing positive feeling without reservations, without evaluations.”
Now this does not mean Rogers necessarily agreed with the client — but Rogers respected the client’s core worth as a human being who is entitled to his own feelings.
Another technique Rogers developed, which dovetails with the notion of holding space, is active listening. That is, sensitive, participatory listening aimed at validating the speaker as a human whose feelings and opinions count.
The key to active listening is “to get inside the speaker to see things from his point of view.” When people are speaking, there are two components at work: the content of the message and the feeling content underlying that message.
Rogers emphasized the import of listening for the total message. Make sure the speaker understands the listener is connected — don’t interrupt, but when appropriate, ask clarifying, open-ended questions. Paraphrasing and summarizing content points are also reassuring.
It is imperative to engage in a positive, non-threatening atmosphere. The message is consistently the same — the listener respects the thoughts/feelings that have been expressed and knows they are valid for the speaker.
Rogers, of course, was doing psychotherapy. Holding space isn’t formal therapy and should not be viewed as such. But some of the techniques Rogers developed with UPR and active listening are valuable, especially when communicating with those in grief recovery.
As Rogers noted, “understanding a person is far more difficult than it appears. It takes patience and practice …and plenty of good will.”
Holding space, acceptance without judgment, and active listening are skills that can be relied upon in any difficult circumstance. They help to express the very essence of human nature.