Fierce Conversations About Five Months

Fierce Conversations

About five months ago I found out that my father was diagnosed with multiple myeloma, or cancer of the blood. He is 60 years old and the prognosis is good, but he is undergoing extensive chemotherapy and radiation treatments. The drugs he takes make him irritable, angry, and intensely moody. Much of his anger is directed at my mother, because she is constantly with him and tries to help. Because my father has been taking his anger out on my mother and resents her helping, she has become depressed. She stopped eating properly and does not get enough sleep. My mother also has few friends and refuses to open up to me or to her sisters. Although I visit my mother in Worcester as often as possible, my visits seem to offer little consolation for her. Her sisters live in other states, which impedes their relationships. I am worried about my mother, which is the main reason why I needed to initiate a fierce conversation with her. The core issue is her refusal to see a therapist about her problems. I feel that a therapist will help her deal with her feelings vis-a-vis my father and relieve her tension, anxiety, depression and her sense of helplessness about my father's illness. Unfortunately, my mother does not "believe" in therapy, which she feels is only for "crazy" people. She feels like she can handle her issues without any help but she isn't fooling anyone but herself.

A approached my mom in person during one of my visits. I made the drive from Boston on a Saturday morning. When I arrived she had lunch prepared, and I was easily able to launch into the fierce conversation while we ate. After initially asking her how she felt and if she wouldn't mind talking with me, the first thing I told her was that I knew she was having a hard time with dad and that he was difficult to deal with. I offered her sympathy and acknowledged that his anger was largely misdirected. I assured her that dad probably felt angry at his illness. I wanted to make sure that she didn't feel threatened, because I know that she might be prone to being defensive if I had immediately started talking about her depression. From here, I was able to broach the core of the matter, which is my concern about my mother's depression and my desire to see her seek help through therapy. This was the first phase of the fierce conversation: naming the core issue with focus and clarity (Scott 149).

Remembering the importance of offering brief but poignant examples, I came prepared to discuss one specific instance that underscored the severity of my mother's depression. The example I used was her weight loss, because it is such a concrete, observable phenomenon. Her weight loss also made a good example because she could first focus on the physical problem without feeling like I was accusing her of having psychological problems. Therefore, I felt it easier to address her depression through a physical matter to reduce the chance that she would defensively shut down the conversation. The very nature of denial can make a person defensive.

I told my mom that the last time I came out for a visit, that she actually came right out and told me that her clothes don't fit her anymore. To me, this showed that at least she was aware that she was not eating and had lost weight, and I'm pretty sure she knew that her weight loss and loss of appetite were due to her feelings about my father. I began by asking her how much weight she had lost. When she replied that she didn't weigh herself and that she didn't know, I said that her clothes might be a pretty good indicator. I said, "Remember when you showed me how your pants don't fit anymore?" She admitted that she hadn't been feeling well and wasn't eating properly. Because she seemed open, I continued by linking her weight loss with the overarching issue of her depression and a possible need to at least see a doctor. I said directly, "Mom, I am worried about your health because you have obviously lost a lot of weight, and I can also see by the circles under your eyes that you haven't been sleeping well." I kept my comments about her weight as brief and to-the-point as possible. As Susan Scott advises on page 149 of Fierce Conversations, "this example must be succinct." Furthermore, this was just the opening statement of the fierce conversation.

A next told her how I felt. As Scott notes, "Telling someone what emotion his or her behavior evokes in you is intimate and disarming," (150). Disarming my mom is exactly what I needed to do, and I also needed to create a sense of intimacy with her or else she would shut down and refuse to listen. I said, "Mom, I'm really frightened about your health. I mean, of course I'm worried about dad -- we all are. When you don't take care of yourself it just adds to my overall sense of worry and pain. it's hard enough for me to see dad suffering through his illness and all the chemo, and I admit, it even makes me a little angry to see you becoming so withdrawn and depressed. I didn't dwell much on this phase of the fierce conversation, but I elaborated as best I could on the full gamut of my feelings, which include worry, fear, and anger.

The next part of my opening statement involved telling her what was at stake. I said that her health was at stake and that I couldn't stand to see both of my parents suffering. I said that our relationship was at stake because I hadn't felt close to her in a while. I also told her it was also possible that her depression might be hurting our ability to help dad recover. The more weight she loses and the more depressed she becomes, I said, the less present she would be with me, dad, or anyone else in her family. Finally, I told her that my well-being was also at stake. Because it worried me to see her so lonely and depressed, I was less able to concentrate on school, and I found myself becoming preoccupied and not taking as good care of myself as I could.

On page 151 of Fierce Conversations, Scott advises, "Identify your contribution to this problem." Therefore as step five of the conversation I initiated with my mom, I told her that I might not have been the best daughter that I could have been. I said that because I lived in Boston and she in Worcester that I must have seemed distant and unavailable to her. I also mentioned the fact that I lead a very different life from hers and dad's, I have my own friends and my schoolwork to deal with. I said that as a result we weren't as close as we could be to begin with, even during this upsetting time. I acknowledged that I might have contributed to the problem by being geographically distant, and also by not having confronted her sooner about the problem.

The next step was a declaration of my intent to resolve the problem. I prefaced this by saying that of course I loved and cared about her, and that I wasn't accusing her of anything. I reiterated my fears for her health and how her weight loss added to my already deep concern for my father. I said that I thought she might do well to at least go and see a doctor and see what he or she said. I felt it best at this early phase of the fierce conversation to avoid the word "therapist" or "psychiatrist" because I didn't want her to feel threatened. I understood that she felt that therapy was not for her, but I did hope to later get to the core of her prejudices against psychotherapy. I focused on her weight loss and inability to sleep to encourage her to resolve the problem by seeing a medical doctor, who I assumed might refer her to a therapist. Also, at this phase of the conversation I said that I hoped to resolve the issue because I wanted to see both her and dad healthy and happy.

Next, I invited my mother to respond and share her feelings. Here marked the beginning of the end of the opening statement and marked the beginning of the actual conversational portion of the exercise. Until now I had been telling her more about how I felt and why I thought that a fierce conversation was necessary. Now it was my turn to listen and then to ask her objective, reflective, interpretive, and decisional questions according to the ORID format. My mom seemed quite disarmed after the opening statement, which made the remainder of the conversation flow relatively smoothly. 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?