Some basic guidance, including how to create rapport, around being with someone who is ill, dying and/or in a coma.
You might like to read our Guide to Visiting the Dying
Visiting or caring for someone who is very ill or dying can be a time of intimacy and tenderness. It can also allow both you and the dying person to complete any ‘unfinished business’ and to say goodbye. As such, your being there can benefit not only the ill or dying person but also you – as a family member, friend or carer.
Yet our awkwardness may come in the way. For starters, if you are a visitor, on the practical aspect: You tell yourself you can’t go bare-handed, but what do you take them? How should you behave? Chatting about yourself can seem inappropriate but asking the other about themselves might be a minefield. Are they aware they are dying? How are they with that? Desperate to talk about it or in denial, furious, or sad? How do you cope with any emotions they express? What if they ask you a question you can’t answer?
As well, you might be shocked at how the other looks; embarrassed, even guilty, about your own comparative good health. And, whether you are aware of it or not, confronting the other’s dying might bring up fears about your own death.
The thought of such a situation may mean that you find reasons not to visit at all. Then by and by your friendship simply comes to an end and it’s understandable if your friend feels let down, abandoned and lonely. This, at precisely the moment when your company, your love and support is most needed.
Being with someone who is dying doesn’t have to be like that. With your gaining some understanding of what the other might be feeling, knowing how to stay centred, and having a few basic relating skills, the whole picture can be completely different – both for the dying person whom you visit and for yourself.
Some basic guidelines:
* Be sensitive to how close you sit to the other and what is comfortable for them. You might want to ask: Where shall I sit? or How comfortable are you with where I am sitting?
* How you feel, what your own attitude to illness and dying is, will of course influence your motivation to visit your loved one and how you are with their process. For example, if you view dying as a natural and inevitable part of living rather than as a calamity, you will be more at ease (and that being at-ease can only have a calming effect on the dying person).
* You are not expected to have morphed into a super-therapist! Your friend or family member wants to be with you, as they know you. So there is no need to be other than who or how you are.
* It’s helpful to understand what the dying person might be going through. That understanding will clearly inform how you respond, and to know what is helpful to say and do and what may not be. See Issues that may arise in Dying and Emotional Changes in Sickness and/or Dying as well as the Recommended Reading List below.
* Having some simple relating skills will be helpful. See Speaking of Dying in the Recommended Reading list below.
* Mindfulness, a regular meditation practice, is a great foundation for your being with someone who is ill or dying. It can provide some of the qualities and skills that are helpful when communicating with another.
* The ability to be present and relaxed
* An appreciation of the other’s uniqueness and their own process
* A felt understanding of the dying process as a letting go and moving inside, which is a profound and beautiful experience
* An ability to tune into or ‘create rapport with’ the other
* A sensitivity in how you respond
* The capacity to remain ‘centred’ when the other might be distressed
* An ease with being in the state of ‘not-knowing’
* A familiarity and comfort with silence – your own and the other’s
The Importance of Rapport
This is the harmonious connection with the other that can happen spontaneously and which we can also consciously help create. In psychological terms this is also known as ‘joining’; more colloquially, you might speak of being ‘tuned in’ or ‘on the same wavelength’ as someone else.
If you know well the person you are visiting or caring for you are probably already tuned into them. And it might be that if they are in physical or emotional pain, you might need to more consciously establish or re-establish rapport. It is even possible to create rapport with someone who is in coma.
If someone is in a coma, much of the above is still relevant. The person may appear to be totally unconscious and we may have no way of knowing how aware they are of what we are saying and how present we are with them.
It’s always important to gauge a person’s response to see if we are supporting them in a helpful way or inadvertently causing them distress. However, when someone is in a coma, their responses may be extremely minimal and we will need to interpret or intuit them. Perhaps their breathing will change in response to hearing what we are saying or perhaps there will be some other slight movement. Read more
Additional Considerations when being with someone who is seriously ill rather than imminently dying
Most of that which appears above applies when the other is seriously ill rather than facing imminent death.
As a visitor or carer, it is helpful to remember that the other is displaced from their usual world and way of being; is possibly affected by the hospital/hospice/home environment that has been adapted to their being an invalid; dependent on others; feeling weak, demoralised, uncertain of their future, anxious and in need of assurance, love and patience.
The ‘In Rapport’ workshop provides an opportunity to learn and to practice some basic relating skills, and to understand how to develop ‘presence’ and a being at ease with silence. Read the description and watch the video clip about the workshop. See more
Dr Robert Buckman
Part One, Talking and Listening, responds to the questions ‘Why talk?’ and ‘Why listen?’, explains what sensitive listening is and suggests why you need to know what’s going on.
Part Two, The Transition, includes sections such as The Stages of Dying; Facing the Threat, Being Ill and The Last Stage ( each of them covering the patient’s feelings; your own feelings, and a guide to giving support or things you can do).
Buy from Amazon: I Don’t Know What to Say
What Dying People Want: Practical Wisdom for the End of Life
David Kuhl M.D.
A unique approach to the subject of dying, attempting, as it does, to enter the minds and hearts of those who are facing death. The author is a medical doctor, has trained in counselling psychology and theology, has had clinical experience as a palliative care physician, and has written a thesis on the subject of this book.
The book includes guidance as to how to begin ‘the awkward and painful conversations with those with life-threatening illnesses to learn what they need and want.’
There’s guidance also on so many other important aspects of being with the dying. This includes a chapter on touch; on holding a family meeting and developing a health-care plan; and another chapter on the all-important ‘life review’ – the way in which a dying person can reflect on their life, a process, in Dr Kuhl’s words, ‘by which they make sense of their past with the desire to understand who they are, finding meaning in who they have been, and hope for the future.’ Highly recommended.
Buy from Amazon: What Dying People Want
Jean Shinoda Bolen, MD
Bolen suggests that ‘Illness is both soul-shaking and soul-evoking for the patient and for all others for whom the patient matters. We lose innocence, we know vulnerability, we are no longer who we were before this event, and we will never be the same. We are in unchartered territory and there is no turning back.” She takes the novel approach of drawing on ancient myths as metaphors for the experience of the sick or dying. Once you go along with that, the book is of great value in understanding what your loved one might be experiencing and how you can be there for them in the most helpful way.
Buy from Amazon: Close to the Bone
Dr. Louis Heyse-Moore
As the recommendation on the back of the book states, ‘Compassionate and tactful communication skills can make the difference between an awkward encounter with a dying patient, and an engaging, empathetic bond between two people.’
If you want to learn some basic counselling skills, this is your book! Heyse-Moore’s style is non-academic and user-friendly. Highly recommended.
Buy from Amazon: Speaking of Dying