Samantha, a 36-year-old woman, comes to the office to see Dr. McKnight, after experiencing the devastation of a severe earthquake, in her birth country. She brings her 12 year-old-daughter, Marilyn, whose father is yet to be found, since the earthquake; her grandmother has been pronounced dead, and one of her siblings is severely injured. Both Samantha and Marilyn sit in the office, sobbing. Samantha is trying to comfort Marilyn, but, clearly, Samantha also needs someone to console her.
Everyday, millions of individuals experience emotional pain and loss. Some have no one to turn to for support, while many may surround others, but feel overwhelmed, not knowing how best to provide solace. Here are 10 tips for showing support to those around you who may be experiencing emotional pain or going through a loss. I invite you to also share your wisdom and experience.
1. The power of your presence
Many people think they have to say something in order to be helpful. But, it is worth remembering that for those experiencing difficulty, they mostly need people to just be there. Jean, who lives in Paris, travelled to Haiti to be with family, soon after the deadly 2010 earthquake. This was his first time, in ten years, back to Haiti. It was an unplanned trip; so, Jean could only pack clothing and a few personal items. After the trip, Jean reported, "Even now, 7 years later, my family still calls me to remind me how my presence there was more than any other type of help they received." Next time your loved one is going through pain or loss, remember that just showing up is indeed a first best step.
2. The power of silence
What happens after you have shown up and your presence can be felt? Your natural tendency might be to start talking, “quick, say something.” But this should be resisted at all cost. Be comfortable just being there, being present and staying silent. Silence, especially in the face of suffering, may be difficult, but it can be very needed. Laura, a very skilled child psychiatrist, one I was privileged to mentor and supervise, once said: "It is so atypical to ‘just be there,’ it can be taxing." And she was absolutely correct. There are many tips I can share to help you acquire this skill (See my upcoming blog entitled, “10 tips to help you use the power of silence.”). As is true of most skill sets, you get better with practice. Do not let your difficulty in remaining silent prevent you from showing up and being present, but do strive to use the power of silence as much as you can.
You have now shown up; you allow your loved one to start the conversation, and you do your best to be silent, while truly being present with her or him. Now, it may be time to say something. Your loved one may need some occasional feedback. But what should you say? The answer— validate, validate, validate. If you have to say anything, especially when your loved one asks for feedback, start always by validating. Validating is supporting, accepting and recognizing someone else’s truth. It does not need to be your truth, you don’t even have to agree with anything, but you do need to acknowledge that this is someone’s reality, at least, for that moment. Marisol brought her 5-year-old-boy to the clinic, stating: ”Joe needs help. I did everything I could. But someone needs to do something.” The doctor had already looked at Joe’s chart. He had been here one year ago, but Marisol, his mother, had decided against the clinic’s recommendation for Joe to receive Applied Behavioral Analysis (ABA) for his diagnosis of autism. After hearing Marisol, and knowing the background information, the doctor looked at Marisol and said: “I am sure you have been doing your best, and that includes being here today. I am glad you are here.” Marisol starred at the doctor and could not help but cry. Everyone has his or her own reality, and validation is the best way you can help someone during times of difficulty. This is even more important in the midst of emotional pain and loss.
Reframing is seeing the frame of the spoken words, while also hearing the unspoken assumptions and finding an alternative view–lens for your loved one. You are not challenging the facts but the assumptions, and you are doing so in the subtlest ways possible. Reframing will be most successful when you avoid confrontation, but connect it with something your loved one truly believes in, not something just cognitively based. Lastly, to make this approach more powerful, ask for permission and first offer validation. 27-year-old, Jacqueline was helping her dad write a textbook during his sabbatical, until his sudden death from a car accident. Jacqueline’s role was researching and summarizing anything she could possibly get her hands on for her father, that might be helpful for his textbook. During her first grief-counseling visit, Jacqueline reported: “I don’t want to work on the textbook, because it makes me feel even more sad.” With Jacqueline’s permission, and after a short validating statement, the doctor responded: “Jacqueline, what small part of that task might you work on for now, one that might even leave you feeling happier and helpful to your father, now, even after his death?” Jacqueline’s posture straightened, she had not considered that continuing such a noble work might be one of the best ways to honor her dad. And this in turn could help her during the mourning process.
5. Use yourself but not the moment
Use your presence, your silence, your validation, and reframing, but do not make it about you. Sitting with someone who is going through emotional pain and loss can often stir your own emotions related to either the past, present, or anticipated future loss. You can also become emotional, because you care so much about someone who is hurting, in turn, making you either upset or helpless. A friend of mine, who has a draining job, called me after one of her most exhausting days at work. I know all she needed was someone to listen, validate her, and simply allow her the space to process her day, on her own, with me on the phone. Instead, that day, I broke my own standards, and I allowed my own emotions to take over. I spoke and, to use her words, “She felt worse for being lectured to, instead of listened to.” My speech seemed helpful, in my mind, but my timing was off. And, as a result, I made matters worse. When you interact with someone who is hurting, do your best to take yourself out of the equation. Briefly state the feeling you are experiencing in the moment, to help add value but nothing more. You may use your personal experiences to help offer support, but avoid trying to communicate your own frustrations in the moment.
6. Avoid giving advice
Advice is generally welcomed when coming from the “expert,” those knowledgeable or authoritative. When someone is hurting, in pain, or going through a loss, more than knowledge or advice, he or she needs your support, someone to listen, knowing they are not alone. Yves, a close friend, often jokes how he never learns his lesson when it comes to dealing with his wife. After work, in response to the usual question “how was your day,” Yves’ wife starts to tell him how horrible a day she had. As a surgeon, Yves spends his day “curing everyone.” And a few seconds after his wife starts talking, he interrupts her to give her some well–intentioned advice, only to experience “kick-back” interruption from his wife, jokingly: “Yves, all I want is for you to just listen. I know what to do, I am a psychiatrist.” Just as it is a challenge to remain silent, restraining from offering advice, in presence of pain is no small task. This is also related to the need to help, to say something, “to save the day.” Even when someone asks for advice, he or she most likely needs a sounding board, and if you are ever pressed for feedback, start by validating, then reframe, then proceed with a careful use of Socratic questioning, and you may surprised how powerful this process can be.
7. Offer concrete help
Avoid giving advice, but be generous with some concrete help. Offer a glass of water, your handkerchief, some food, or even be willing to give more of your time. Offer to babysit, to clean the house, or to go out to get groceries. These concrete ways of helping will make a major difference in your loved one’s life. You may judge them too small, but, nevertheless, these basic needs carry much importance. When Jean left Paris to visit his family in Haiti, he stopped in the Dominican Republic to buy water, matches, painkillers, and some other basic items. It was no surprise Jean was met with huge needs, but he was glad to be of help, at least, for one or two days. Regardless how small you think your help might be, simply offer it, you would be surprised of how much of a difference it will make.
8. Follow up
Support becomes more meaningful when you consistently follow up, until your loved one adapts to the pain or loss. A phone call, an email or text, a brief visit after work, can all help “cement” your initial consolation. If you can afford it, an invitation for lunch or dinner, where you take the tab, will be seen as kind, generous, and can serve to promote psychological healing for your loved one. Ralph lost his fiancée in a tragic car accident, and while recovering from his severe injuries, mourning the loss of his fiancée, he began to experience survivor guilt—he was alive, but his fiancée was dead. Wood, Ralph's best friend, visited him at the hospital, then came back every day after work, and eventually brought two more of Ralph's friends. Together, they would visit him on a daily basis. The visits continued after discharge from the hospital, for more than the three months it took Ralph to fully recover at home. His three friends helped him get to and from rehab and other doctor visits; they alternated grocery shopping, cooking, and together, on a daily basis, they helped Ralph narrate his story, his mourning process, his bereavement, and relationships. It was this type of follow up that made a big difference for Ralph.
9. Recommend any needed professional help
You have managed to be present, you validate, you help reframe, reflect, you offer concrete help, and you follow up. But what happens if your loved one fails to show any progress and instead starts to deteriorate and worsen. This may be a sign, indicating the need for professional help. Here, I am not talking about mistaking the humane response to loss or grief as pathologic but more so, about the added benefit of professional help. In the case outlined above, Ralph later on reported how he, at times, considered suicide, as the only way he would "get over this." Matthew, one of his friends, proposed that Ralph see a grief counselor, one who was known for good outcomes. Sometimes, your support may be enough, but other times you can reinforce this by recommending someone with professional, expertise training, to help the process. If you have to provide one bit of advice, let it be this, and make it in due time. (In my upcoming blog entitled: “10 tips to help you recognize when to seek professional help,” I will provide tips on how and when to recommend professional assistance.)
10. Be genuine
Lastly, in all you do or say, be sure to offer authenticity and your genuine self. When sitting with your loved ones, avoid getting distracted, as much as possible. Be there in body and spirit, and make sure to be yourself. For example, if it is hard for you to stay silent, just say it instead of struggling or feeling anxious with the related discomfort. If your loved one’s situation is such that you are unable to contain your emotions, just acknowledge that and be yourself. Your authentic and genuine self can be surprisingly powerful. As Samantha and Marilyn reported their losses and mourning, Dr. McKnight listened attentively and silently; she validated their emotions, reframed at times, and got to the point, where she could no longer hold her tears. This moment became pivotal in their therapeutic relationship, and they have since then made much progress.