She sighed and said, "I've been feeling horrible! I haven't been able to eat and I can't sleep at night, and I can barely concentrate on anything." She did not elaborate much so I prompted her with some questions that might stimulate the conversation.
Objective questions about her weight seemed unnecessary since she admitted to the problem. Some of the objective questions I asked were far more difficult to talk about. For example, I asked, "At what point did dad start treating you this way, and at what point did it start bothering you so much?" I asked if things were ever alright, whether dad always treated her poorly or whether he was only occasionally irritable. I asked her how exactly she was dealing with dad: did she raise her voice or lose her temper? Did she ever think that there was anything she could do better? Was she doing too much for him, thus making him feel overly dependent and emasculated? What did she think was going to come from all this? Did she envision a change for the better and did she have any concrete plans to address her weight loss? I asked her to describe for me exactly what a day in her life was like, to ascertain exactly what words or actions might be triggers for her. Did dad act out more at certain times of day than others? If she took care of his basic necessities and nothing more how did he react? Had her sisters mentioned anything to her, had they expressed any concerns? Had she read any self-help books that offered advice that might be applicable? Was she getting any exercise? When she ate, what was she eating? Did she ever talk directly to dad about his behavior, and if so how did he react? I asked her whether they had talked to dad's doctors about changing his medications, and finally, I asked her if she had tried to reach out to other people and if so, how and to what result.
The next phase of the conversation involved reflective questions. I asked her how she felt when dad became angry with her. Did she feel angry too? Hurt? Rejected? Sad? Did she fear for his life? Did she feel he was being ungrateful? I asked her what made her most upset: was it dad's illness itself or was it the way he was treating her? Were there any outstanding incidents that she could think of that really upset her? Did she recall a turning point in the evolution of their relationship? How did she feel about herself? Did she feel sorry for herself? Did she feel powerless, inept? Did she feel frightened about her own health or mortality? How was she feeling otherwise: what was her overall energy level like, and did she notice any health problems of her own? I asked her why she felt unable to open up to people that loved her, like me and her two sisters. Did she ever feel positive or optimistic: had there been any good moments or days when she felt clear and healthy and able to eat and sleep? I asked her how she felt about doctors, and asked her also how she felt about counselors. I asked her why she felt at once totally self-sufficient and at the same time painfully withdrawn. Did she feel angry that dad wasn't treating her better and did she feel that it was possible for his behavior to change in spite of his being on the medications?
A then shifted toward the interpretive questions. I asked her what she felt her responsibilities were to dad, to me, and to herself. I asked her to analyze her various physical and psychological manifestations and determine whether she thought that she needed help. I asked whether she thought that forging more meaningful relationships with other people might ease her own pain. What did she think was the most important thing in her life? What did she think would make her happy, other than of course, my dad feeling better? Was there anything that she needed from me? Did she believe that she was going to grow and learn from this experience or did she feel simply disheartened and disillusioned with life? Did she view this as a spiritual crisis? Did she feel any sense of meaning or did she feel lost and confused? What did she feel that she could do differently in terms of relating to dad and what did she feel would help her avoid some of the health problems that she had developed such as loss of appetite and insomnia? Did she ever wonder what the implications of her self-neglect were on other people, including me and dad? I asked her if, in general, she felt like a significant person, and whether perhaps a sense of insignificance was causing her to withdraw. Did she feel that perhaps a fierce conversation between her and dad might be of some benefit to both of them?
Finally, we addressed some of the decisional questions. In order to elicit a collaborative resolution, one that she felt comfortable with, I began by asking her simply what she thought needed to be done. Did she need to change? Did she need to eat more? Did she need more sleep? Did she need a vacation? Did she need to go to a doctor? Did she believe that opening up to other people might be safer and more effective than she believed? Would she be willing to see a counselor if the doctor recommended one? Did she realize that I was there for her and that we were in this together? I asked her if she could make an appointment with her doctor, even if just to get a check up. I asked her if there were any constructive things she could do on her own, such as meditate, exercise, do yoga, or try eating different foods. Did she want me to come visit more often? Did she think it might be good for her to come visit me? Would she be open to maybe trying some anti-depressant medication if her doctor advised it? Would she be interested in reading any books that might be able to help her cope?
As the conversation drew to a close, I asked her if there was any other issue that was bothering her and that we might need to address. How did she feel? Did she feel alright about this conversation? Did she feel better or worse than before we had the talk? Would it be ok to talk to dad about our conversation? Was there anything she had been dying to tell me, or something that I had totally missed? Had I correctly assessed her feelings? Did she think the conversation was helpful and did she feel more open to going to the doctor? What actions could she take today, right now: did she want to take a walk with me and shake out our heads after this heavy discussion? I mentioned that maybe we could go shopping and that I thought she deserved to pamper herself.
Having this fierce conversation with my mother helped to make the invisible visible. I believe that this conversation at the very least eliminated her denial that she had a problem and instigated her to taking some positive action. For me, the conversation gave me a huge dose of self-confidence, a result I hadn't expected beforehand. By courageously addressing issues that I had been thinking about for so long, I feel assertive and more able to confront other problems in my life. This boost in self-confidence and assertiveness will greatly help me in future professional and personal relationships. If something bothers me, I will be less likely to let it pass and more likely to nip the problem in the bud. The sense that something invisible, and therefore unreal, became visible and real in my own life bears testimony to the power of the fierce conversation. The brief introduction might have been one of the most effective parts of the conversation. I might have otherwise lingered too long on that part of the conversation, which would have probably made my mother feel defensive and threatened. She might have felt like I was attacking her if I dwelt too long on examples of her behavior and how it was hurting me. The objective questions were also very helpful because they kept the conversation focused on the facts and not based on assumptions. There isn't much I would have done differently. I feel like I followed the fierce conversation plan and based on my mother's openness, she did not feel overwhelmed and even appreciated my willingness to be so frank with her without losing my temper, getting impatient, becoming judgmental, or overreacting to what she had to say.
In the book Listen Up, Barker and Watson emphasize the importance of keeping emotions under control when…