Family Stress and Communication
Couples Coping Together
Cancer impacts the person living with cancer as well as family coping. Listen to Sarah as she describes some of the communication challenges of cancer and how cancer can impact intimacy.
Ten Strategies to Enhance Couple’s Communication
1. Pick a good time and place. Find a convenient time for both of you to talk. Do not expect your partner to be at his or her best before bedtime, before a meeting or presentation, etc. Arrange a limited time period in a place protected from interruptions.
2. Write it down. If it is a complex topic, take some time to write down your responses before your discussion. This may help you clarify your thoughts. Some questions that couples with cancer have found helpful include: 1) What frightens you most? 2) What is most stressful? 3) What have you appreciated most about each other in the past few months?
3. Know what you want. Know when you start the conversation if you a) simply want to be heard or b) want to be heard and want help with problem solving. Too often, listeners will jump into the problem-solving phase without asking their partners if this is, in fact, what they want or need. Sometimes just being heard can be enough.
4. Balance the discussion. Don’t allow your conversational space to be occupied by problems or things that need to be changed. According to marital research, a healthy relationship consists of 5 positives to every 1 negative (see John Gottman: The Magic Relationship Ratio or John Gottman’s book, The Seven Principles for Making Marriage Work for an overview). Strive for balance in the positive direction. If you are going to discuss something difficult or stressful, also be prepared to discuss something that is going well or something that you can look forward to as a couple. If you are going to point out a negative behavior, be prepared to offer a compliment as well.
5. Use “I” statements when possible. Rather than criticizing your partner, express how his or her behavior impacted you. Say, “I felt hurt when you said _______,” rather than, “You were mean to me.
6. Avoid “should” statements where possible. The word ‘should’ implies that there are behavioral rules that are set in stone and need to be followed precisely. In life, there are more often preferences and wishes versus “shoulds.” “Should” statements can make you and your partner feel guilty and angry. For example, “You should be more attentive to me after doctor’s visits” versus “I would really like it if you would try to be more attentive to me by hugging me or being near me after doctor’s visits.” The latter response avoids should statements and is more specific.
7. Be assertive. If you want a positive change, state what you would like directly. For example, “I would appreciate it if you called me when you were going to be late.” Ask for what you want. Avoid behaving like you are your partner’s boss or parent or like he or she is a mind-reader.
8. Say what you are willing to do to help. Acknowledge your role in the problem. Offer to help, rather than expecting your partner to be the only one making changes.
9. Listen and validate. Do not interrupt or simply wait for your turn to speak. Focus on your partner’s words as if you were listening to your partner for the first time. Make sure you understand what they are saying before you speak. Even if you disagree with your partner, acknowledge that you understand what they are saying and can understand how they might feel.
10. Metacommunicate. Communicate about your communication with your partner. If things are going off track or getting too heated, discuss it. For example, you might say, “I see we are both getting upset” or “We seem to be getting off track.” Focus on the process of your conversation. Take a break to calm down or redirect your conversation back to the topic at hand.
Resources for Couples Coping and Communication
Supporting Your Loved One with Cancer
This information is based on many studies done with cancer patients regarding what they find helpful and unhelpful in coping with their cancer experience. This may not apply to your specific situation as every person with cancer is unique and has different needs based on his or her personality, cancer type, treatment, and course of illness. The best way to know what kind of support your loved one needs is to talk openly about how you might help. Ask your loved one what has been helpful and what they want to continue doing independently.
Common Helpful Behaviors
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Reassure your loved one of continuing love and support
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Attend appointments and treatments (these can often be high stress times)
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Plan something fun the night before an appointment
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Listen without judging; hear without constantly attempting to solve problems
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Share feelings openly
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Assist with financial and insurance matters if invited to do so
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Help with household chores and meals if invited to do so
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The two most helpful behaviors are often just being there and expressing love and concern.
Common Unhelpful Behaviors
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Excessive telephone contacts or communication. Your loved one may be fatigued from the disease or treatments. Allow them to take the lead regarding how much interaction they can tolerate.
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High expression of emotions. Some emotional expression is good, but it can be unhelpful for your loved one for you to over-express your concern or worry. One patient summed this up nicely, “I don’t want anyone to pity me, cry over me, or try to search for encouraging words to say. Just be quiet and support me. You can support me without saying anything."
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Unsolicited advice or information. Your loved one may just need a caring ear. He or she may appreciate information to help sort through difficult decisions, but allow the patient to take the lead in making decisions. Cancer and cancer treatment can increase feelings of vulnerability and feeling out of control. The more control you can give your loved one in terms of decisions and daily activities, the better.
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Taking over. Be sure to ask what kind of assistance your loved one might want. Don’t assume that taking over household chores, financial tasks, medication management and other activities will be helpful. Some patients report feeling treated like an invalid. While a patient may be experiencing some difficulties, it is important not to assume that these problems encompass all areas of the patient’s life. Allow the person with cancer as much independence as possible. Allow the patient and his or her physician to decide when additional supports or precautions are necessary. If you are concerned about your loved one performing certain activities, talk to his or her health care providers and allow them to advise you and the patient regarding this activity.
We hope that you will find these tips helpful in knowing how to best support your loved one. However, the best way to know what is helpful or unhelpful to your loved one is to talk openly about what support is desired and what support attempts are unappreciated.
Resources for Talking to Children about Cancer
Caregiving Stress
Providing care for someone living with cancer can be stressful at times. It can also be rewarding to know you are doing everything possible to help someone you love. Just as they say when a flight is taking off, “Passengers, please make sure your masks are on first before assisting other passengers or children; in order to provide care for long periods, it is essential that you take care of yourself first.
Chronic stress and lack of self-care can have physical (e.g. sleeplessness, muscle tension, weight changes), emotional (e.g. anger, guilt, depression, anxiety) and social costs (e.g. isolation, conflicts, poor work performance). On the next page we provide strategies for managing the physical, emotional, and social aspects of stress.
Resources for Caregivers
Taking Care of Your Yourself
Taking Care of Your Body
1. Exercise regularly. Try to exercise at least three times a week for 20 minutes. Even gentle exercises such as stretching, light yoga, walking can be beneficial to help relieve stress. Exercise can enhance sleep, reduce tension, and help maintain a healthy weight.
2. Eat regular meals with nutritious foods. Being a caregiver requires long-lasting fuel. Eat an abundance of fresh fruits and vegetables. If you are running short on time, buy pre-sliced fruits and vegetables. Eat foods high in protein and fiber versus foods high in fats and sugars to have more energy throughout the day. Keep yourself hydrated by drinking 6-8 glasses of water per day. Dehydration is a major risk factor for fatigue.
3. Consider a massage. Make an appointment for a massage to help relieve muscular aches and pains.
Taking Care of Yourself Emotionally
1. Tell guilt feelings to take a hike. Caregivers often report feeling guilty. You might feel that you aren’t doing enough at times and guilty that you are doing too much at others. You might feel badly sometimes that you are feeling angry or stressed and wish you were more positive or cheerful. Tell these feelings to take a hike. You are doing the best that you can and are doing just what you need to in order to take care of you and your partner.
2. Make time for yourself. Give yourself some time each day to recharge your batteries. Set aside at least 30 minutes (longer if possible) each day to do something you enjoy. See the handout (Session Two of the binder) – Emotion Focused Coping: Mood-Boosting Activities – for some ideas. What do you want to do today to give your mood a boost? Challenge any notion that you are being “selfish” for making time for yourself. Making time for yourself is essential to being a good caregiver.
3. Seek help for depression or anxiety. If you find that your feelings of sadness or worries are getting the best of you or if you have ANY thoughts of suicide, seek care immediately. Sometimes even a few meetings can help you find resources and coping strategies that can support you on your journey as a caregiver.
Exploring Your Options for Support
1. Ask for help. Some caregivers suffer from the glass forehead syndrome, whereby they expect others should know what is needed and help without being asked. Asking for help may avoid the anger and frustration experienced when others do not volunteer assistance they did not know was wanted or needed. Be specific and direct when asking for help. Make a list of projects or activities that you need help with and ask someone who may have specific talents to fit each activity. Asking others for help allows them to show their concern and feel good about the support they provide. It can also reduce others’ guilt and possible distancing due to emotional discomfort.
2. Make time for friends or join a support group. If you are feeling isolated, call a friend. Talk to a friend you can really open up to and one with whom you can laugh. Having a good sense of humor can get you through even the most challenging times. Consider a support group. Caregiver support groups can help you understand that you are not alone with your fears and frustrations. Support groups can be a source of emotional support and a source of information. Other members may be dealing with some of the same problems you are experiencing and they may have found creative solutions.
3. Schedule appointments to meet your needs. Appointments first thing in the morning or at the end of the day are the best way to reduce waiting times and make sure your questions get answered. Write down your questions and call ahead to request additional time if necessary. Let the medical team know what symptoms or problems are most stressful for you and ask if there might be community resources to assist with home health needs if you are feeling overwhelmed.