I've supported many close friends through difficult times brought on by grief, illness, relationship dissolution, and major life changes. I've also volunteered in hospitals, providing psychosocial support to people of all ages. But when it was my turn to suffer serious health issues, I felt alone, unheard, and misunderstood. Even well-intentioned people seemed insensitive, invalidating, and completely unhelpful. So I decided to share some basic, easy to follow, guidelines on how to provide emotional support to a friend or loved one. I also wrote this article with the intention of giving those in need of support a means to improve communication with their family and friends. (A different version of this article was originally posted as "How to be a Good Friend to a  Brain Injury Survivor" for the Brain Injury Society of Toronto's Blog.)

Keep in mind that everyone needs different types of support and that those needs change circumstantially. So when you're with someone who's struggling, don't hesitate to ask them directly what they want - and what they don't want - you to say and do.

Step 1:  Set your own emotions aside.

Empathy allows us to understand and feel other peoples' physical and emotional pain. Hearing about someone else's struggles can make us feel uncomfortable, because we become reminded of our own fears and worries. So our initial reaction is to reduce our discomfort by disengaging from what we find upsetting. In conversation, we do this by fidgeting, looking away, or changing the subject. Even statements like, "I'm sure everything will work out" - when used too early in the conversation - clearly send the message, "Please stop talking about this". That person is then much less likely to speak openly about what's really going on, even when asked down the line.

Along those lines is, don't shy away from emotions. If someone starts crying, let them! Lean in closer and encourage them to let it all out. They will feel much better afterwards. The worst thing you can say to someone when they're crying is, "Don't cry" or "Shhh". Acknowledge that what they're going through is terrible and reassure them that their feelings and reactions are normal and to be expected. 

After my injury, I noticed that when I would talk about my symptoms (even after being asked about them), peoples' eyes would glaze over, they'd avoid eye contact, and would freeze up. So, for years, I avoided talking about my injury, all the while fearing rejection and feeling alone in my suffering. It also caused me to lose faith in the relationships that I had. This had detrimental effects to my confidence. So the next time you're listening to someone's problems, brush your own emotions aside and remind yourself that in that moment, it's not about you.

Step 2:  Listen actively.

To show that you care and that you're willing to listen to someone's problems, hear what they have to say, be patient by giving them enough time to finish their thoughts, and acknowledge and respond to what they've said using verbal or non-verbal cues (e.g. nodding your head). Then, ask some clarifying or thoughtful questions. Considering how unhappy topics make most people uncomfortable, I could always tell whether someone was genuinely concerned by the number and types of questions that they asked. Finally, end the interaction by making plans for the next call or get together, or by asking the person to update you on any major changes (positive and negative) to their situation. This implies that they can reach out to you if they need to talk to someone and that you want to celebrate their wins with them.

Step 3:  Don't do or say nothing.

When someone we care about is going through a difficult time, we might feel like we don't know what to say or do. Out of fear that we might do something wrong, sometimes we end up doing nothing or avoiding interaction with that person altogether. However, doing nothing makes the person feel like you don't care, which is probably the furthest thing from the truth. So when you don't know what to say or do, don't be afraid to admit that. You could say, "I am so sorry that this is happening to you. I don't know what to say, please tell me how I can help.".

I always tell my friends and family to be honest with me if something I'm saying or doing is not helpful, so that I can change my approach and try something else. Everyone has different needs that change depending on the situation. So be sure to ask, "What would be helpful right now?" and "Is this helping? If not, I can try something else.". Also, it's never too late to reach out. A simple, "I was thinking about you. How are you doing?" can mean the world to someone who feels alone in their sadness. Just don't take it the wrong way if they don't respond.

Step 4:  Don't take it personally.

Throughout my recovery process, I wanted to be alone but I didn't want to feel lonely. When I didn't have the energy or confidence to talk to or see my friends, it made all the difference when they tried to get in touch with me. I loved hearing from people, but I felt too much anxiety and grief to reply. My most helpful friends were the ones that didn't make me feel guilty for hiding and didn't give up on me. These special people left voicemails or sent text messages and emails every few weeks to see how I was doing, to offer to visit, or to invite me to their homes for a quiet dinner or get together. Despite my infrequent responses and frequent declined invitations, they never gave up on me and, more importantly, they never took it personally. This reduced my fear of being misunderstood, made me feel genuinely cared for, and let me know that I had good friends to return to when I was ready. Coming out of isolation was one of the most difficult, fear and anxiety-laden aspects of my recovery, but thanks to those friends and their maintained connections, it was easier for me to bounce back and rejoin society as my symptoms subsided. So the next time you check up on someone, don't wait to hear from them before you get in touch again. Your efforts are more appreciated than you know.

Step 5:  Be considerate.

One of my barriers to socializing with health issues had to do with limitations that healthy people would never think twice about. For example, brightly lit, crowded or noisy places wore me out and made it difficult for me to focus on conversations. Also, driving or traveling by public transit was exhausting, so I had few workable meet-up locations and times. My most understanding friends didn't always know or understand my barriers, but they always asked. For example, they would suggest an outing and then they would follow it up with, "Would that be okay for you?". They were also willing to offer other suggestions. While hanging out, they would check in and ask me how I was feeling. At their homes, they would say, "Let me know if you want to take a nap.". Those questions sound so simple, yet so few people that I know ever thought to ask them. In social situations, I was hesitant to speak up when I was approaching my limits, but thanks to my friends' pro-active thoughtfulness and willingness to accommodate, I had fun and I wasn't made to feel embarrassed while vocalizing my needs.

Step 6:  Support long-term.

Whether it's the death of a loved one, a cured cancer, or a brain injury, all traumas have long-term, sometimes life-long, effects. The more time that passes after a tragedy or accident, the less support that the survivors receive and the less likely they are to ask for help. Just because someone appears to be fully recovered doesn't mean that they don't have lingering issues. So, weeks, months, even years after the incident, be sure to check in with them to open a line of communication so that they can get the support that they need. 

Published by Alison F