AS@W
PCHC Positive Coping with Health Conditions
Relationship Building

“I don’t talk about the illness too much with my family. They’re helpful but I don’t want them to feel bad by looking at me.”

“I want to talk to people who’ve got the same thing I do. I can find out what they are doing and what they’ve been able to do.” *

* Quotes from members of a chronic illness support group.

When you’re dealing with a health condition, relationships with family, friends and healthcare providers take on extra importance. The practical and emotional support you get is extremely valuable.

Some people have few connections to other people or maybe have relationships that are not very close. For them, relationship-building skills may help to form new connections or repair strained relationships. Others have close connections to family and friends, but find that their health condition places extra pressure on these relationships. For example, you may require assistance from family or friends with medical appointments, self-care activities or household chores. You may need more emotional support as you deal with the stress of your condition. We will show you two ways to build your connections to others: Increasing Social Contact and Improving Your Relationships.

Increasing Social Contact

The steps toward Increasing Social Contact are:

  1. Identify social activities to increase
  2. Set realistic social goals
  3. Carry out your goals
  4. Review your goals

Why Is this Important?

It’s more difficult to deal with a health condition when you’re cut off from other people. This can happen because you had few relationships at the time you developed the health condition, or because the stress of being ill caused you to withdraw from others. In either case, tension, irritability or low mood make it more difficult to make connections or maintain your existing connections to other people.

Increasing social involvement is helpful because:

  • It is encouraging to feel connected to others
  • It gives others the chance to provide
    emotional or practical support
  • It distracts you from worrying about your health condition

How Can I Increase Social Contact?

The most effective approach to increasing social contact is to use the skill we’ve called Activating Your Life, with a focus on social activities. Here’s how to use this skill to increase social contact:

Image

1

Identify Social Activities to Increase

One way to increase social contact is to re-engage with social activities you used to enjoy but have stopped doing. This might include attending family events you’ve been avoiding or calling up friends and acquaintances you’ve lost touch with. Another way is to sign up for continuing education classes or volunteer organizations. Yet another way is to participate in disease management support groups, which may be provided through local health agencies. Nonprofit societies focused on chronic illnesses such as diabetes, arthritis, COPD or coronary heart disease often sponsor this kind of support group and they are available in many communities. Check with your family physician or other healthcare provider regarding availability of disease management groups in your community.

Think of one or two social activities that you might try to increase. Write them here.

Pencil Social Activities:

 

 

 

2

Set Realistic Social Goals

For each of the social activities you have chosen, set a manageable goal for the coming week. Keep in mind that health conditions or mood problems make it difficult to get moving. As a result, you may need to set your goals lower than you ordinarily would. For example, if you want to contact friends you’ve lost touch with, your first goal might be to talk to one friend on the telephone for five minutes.

Try setting a social activity goal that would be realistic to do this week. Decide how often and for how long you will do the activity, and when exactly you’ll do it. Make sure the goal is scheduled: write it into your calendar or diary and then check it off once you’ve done it. It can be helpful to think of things you used to enjoy doing, before you developed your health condition. You might also look again at the list of activities on page 35.

Social Activity Goals:

Activity

How Often?

When Exactly?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Carry Out Your Goals

It’s important to realize that you often won’t “feel like” doing your social activity goals. Dealing with symptoms or fatigue, especially if you’re feeling discouraged, can reduce your motivation. But if you wait until you feel like it, most likely nothing will happen. Do the activity because you set a goal for yourself and because it will help you get better. After you’ve done and checked off each goal, you’ll see what you’ve accomplished.

If you’ve been avoiding people because of low mood, you might not get much enjoyment from social contact, at first. But as you continue to work on increasing social involvement, you’ll find yourself learning to enjoy other people again. Be patient – it may take weeks or months before you start feeling like yourself socially again.

When you complete a social activity goal, be sure to congratulate yourself. Every small victory is important and worth recognizing, especially when you’re dealing with the stress of a health condition.

If you didn’t succeed at your social activity goal, what got in the way? What can you do to make the goal easier? Perhaps your goal was too ambitious and you should try a smaller one over the next week or two. Scale back to something you’re sure you can do, even if you feel no better this week than you did last week. Allow yourself to get started slowly, gradually building more social contact into your life.

4

Review Your Goals

After a few weeks of doing your social activity goals, review the situation. Are there any goals that were not getting done? What got in the way? Do you need to reduce or change the goal?

If your goals were accomplished, do you want to increase them slightly or keep them at the same level until it feels natural? It’s your choice. You might want to add another goal.

Continue to set your ongoing goals, and consider adding additional goals as your energy permits. If you complete a task (for example, if you have now finished gathering information about recreational activities in your community), then move on to a new goal. Keep using the procedure:

  • Set your 1-2 goals.
  • Write them in your schedule.
  • Check off each goal as you do it.
  • Praise yourself each time.

Improving Your Relationships

The steps toward Improving Your Relationships are:

  1. Recognize connection bids
  2. Notice how you respond to connection bids
  3. Make more connection bids
  4. Keep practicing connection bids
  5. Make more Turning Toward responses

Why Is this Important?

Dealing with a health condition can place a strain on relationships. Pain and other physical symptoms can make it hard to be with others. You might withdraw into yourself. Dealing with a health condition can negatively affect the quality of your relationships. But having rewarding and positive relationships makes it easier to live with a health condition. So it makes sense to improve your relationships, to make them as positive and supportive as possible.

How Can I Improve My Relationships?

We’re going to show you an effective way to help improve your relationships. It uses a method developed by a researcher who has studied this area for the last couple of decades, Dr. John Gottman.* Dr. Gottman has discovered that relationships are built up from:

Connection bids

A connection bid happens when one person reaches out to another for contact. A bid could involve an expression of interest or affection, a request for information, a humorous comment or offer of assistance – all the ways people reach out to each other. For example, “Would you like to see a movie with me?” is a connection bid.

Responses to these connection bids

When someone reaches out to you, you can respond in three different ways:

  1. Turning Toward: You respond to the bid in an accepting, warm, encouraging or interested manner. “Yes, I’d like to see a movie with you. Do you know any good ones playing now?” OR “I won’t have any free time in the next couple of weeks, but I’d like to see a movie with you sometime after that. Could I call you then?

  2. Turning Against: You respond to the bid in a rejecting, hostile, irritable or dismissive way. “You know perfectly well I can’t go out to a movie. I’m exhausted.” OR “How come you never want to see a movie when I suggest it?

  3. Turning Away: You respond to the bid in an uninterested, ignoring way – maybe you don’t even notice the bid. “I haven’t felt much like seeing movies lately.” OR “I should go check my blood sugar now.”

Connection Bid Diagram

Dr. Gottman’s studies show that people who respond more often to connection bids with a Turning Toward style tend to have stronger relationships.

Here’s what Dr. Gottman wrote about Turning Toward responses:

“If you want to build a deeper emotional connection with somebody, turn toward that person as often as you can…in general, if you can turn toward any significant person in your life – even when you’re angry, frustrated, complaining, or sad – your relationship will grow stronger. Then, if you face a time when turning toward one another is impossible, the goodwill you’ve accumulated will be enough to see you through to better times.” *

Now that you’re familiar with these basic ideas, you can use them to improve the quality of your relationships.

* John Gottman (2002), The Relationship Cure. (New York: Three Rivers Press)

 

1

Recognize Connection Bids

A connection bid may involve:

  • Asking for information
  • Expressing caring or support
  • Offering assistance
  • Making a humorous comment
  • Showing interest in a person’s opinion
    or preferences

There are other ways of seeking contact, but these are the ones we’ll focus upon.

So the first step is to identify bids for connection. We’ll start with your own connection bids. By learning more about your own bids, you will also get better at recognizing bids by others. It’s easier to identify your own bids – after all, you know what you’re trying to communicate.

As you go through your day, make a mental note each time you make one of the types of bids described in the list above. Then, when you get the chance, write a few notes about your bids. Of course, you’ll only be able to recall some of the bids you make, but it should give you a sense of your own way of connecting to other people. For each of the bids you notice, write down what you said or did and what kind of response the other person made – was it Turning Toward, Turning Against or Turning Away?

Here’s an example of writing down connection bids. Patricia is a woman of 63 who was diagnosed with coronary heart disease five years ago. This is what she wrote:

My
Connection Bid

How the other person responded
(check the one that applies) check

Comment

Turning
Toward

Turning
Against

Turning
Away

Asked my nephew Tom about his recent holiday.

check

Complimented my next-door neighbour on her garden.

check

Asked my sister whether she had decided about selling her house.

check

She ignored my question. It must be a touchy subject.

 

Pencil Now it’s your turn:

My
Connection Bid

How the other person responded
(check the one that applies) Check

Comment

Turning
Toward

Turning
Against

Turning
Away

         
         
         
         

 

2

Notice How You Respond
to Connection Bids

Over the next week, notice when somebody makes a connection bid to you and how you respond: was your response Turning Toward, Turning Against or Turning Away? Make a mental note when you experience one of these bids, and later, when you get a chance, write down what happened. Use the form on next page.

Here’s an example of writing down responses to connection bids. This is what Patricia, from our example, wrote:

Other Person’s
Connection Bid

How I responded
(check the one that applies) check

Comment

Turning
Toward

Turning
Against

Turning
Away

My friend June asked how things are going with my new medication.

check

My husband said he doesn’t think I should do housework anymore because of my
health condition.

check

He makes me mad when he treats me like I can’t do anything.

Several people in my self-management group said supportive things when I talked about fear of having another heart attack.

check

A newly-hired staff person asked my advice about how to solve a work problem.

check

 

Pencil Now it’s your turn:

Other Person’s
Connection Bid

How I responded
(check the one that applies)

Comment

Turning
Toward

Turning
Against

Turning
Away

         
         
         
         

 

3

Make More Connection Bids

Since connection bids are so important for relationships, it makes sense to make these bids often. Perhaps you already make a lot of connection bids, but many people find that they don’t make as many bids as they would like. Furthermore, having a health condition may cause a person to be so preoccupied with pain and symptoms that they make few connection bids.

We’d like you to deliberately make two or three connection bids during the next week. You might ask someone a question about a hobby or their job, make a caring or supportive comment, offer some kind of assistance or make a gently humorous comment, etc. We’re not talking about connection bids that are profound or risky – just the kind of connection bids that happen in everyday conversation about small things. Then, when you get a chance, write down what you said or did, and how the other person responded.

Try to identify at least three of your bids and write down the results.

You can use the form below:

My
Connection Bid

How the other person responded
(check the one that applies) Check

Comment

Turning
Toward

Turning
Against

Turning
Away

         
         
         
         

 

Practicing this exercise will give you a better understanding of bids and the kind of responses they get. As you do the exercise, notice how it feels when somebody responds to your bid by Turning Toward, Turning Against or Turning Away.

4

Keep Practicing Connection Bids

If you want to achieve a lasting improvement in your connecting behaviour, set yourself the ongoing goal of making several connection bids each week and writing down what happens. Over time, you will become more skilled at making connection bids and this will help build your relationships, especially when you combine it with the next step.Image

5

Make More Turning Toward Responses

Since Turning Toward responses have a positive effect on relationships, it makes sense to respond this way often. Of course, there are situations where Turning Toward responses don’t make sense – we’ll leave that up to you to decide. Also, we can’t tell you how many Turning Toward responses to make in the next week – that depends on how many bids other people make to you.

When someone makes a connection bid during the next week, try to make a Turning Toward response. Remember, a Turning Toward response is one where you respond positively to that person’s bid, indicating that you are pleased by it and interested in further contact with that person. Even when you don’t agree with that person’s opinion or don’t want to do something they suggest, still try to respond in a way that shows interest in connecting.

It’s not always easy to express a Turning Toward response. Sometimes you’re feeling resentful of the other person or preoccupied by pain or too low to care much about contact. But it’s worth the effort to try this kind of responding to another person’s bid for connection. The stronger your connections are to other people, the more you’ll be able to get support with the burden of your health condition. It’s a long journey – sharing the journey with others makes it a lot easier.

JeanRelationship Building:

Mei-Yin’s Story

Mei-Yin, age 65, had retired from her career as a librarian. She had been married for 30 years, but she and her husband Peter had grown less close over time – they didn’t talk much and Mei-Yin didn’t feel as connected to him. And without social contact at the workplace, she felt lonelier. This feeling of loneliness made it more difficult to deal with the stress of her diabetes. During a checkup visit, Mei-Yin’s family doctor asked how she was coping with retirement and she opened up about her sense of isolation and stress. Her family doctor recommended she get a copy of this workbook and pay special attention to the section on Relationship Building.

Mei-Yin downloaded a copy and read through the introduction, then focused on the Relationship Building skill. Reading it helped her to realize that she missed her co-workers – and missed feeling close to her husband. She missed the way they used to talk about books or go out to different restaurants or movies. They’d gotten out of the habit of doing things together. She decided this had to change.

She showed the workbook to Peter and asked if he’d be willing to use the Positive Coping ideas. He agreed, although a bit doubtfully. He read through the sections she suggested, and promised he would give it a try.

Mei-Yin and Peter set a specific goal together, focusing on increasing their shared activity:

Activity

How often?

When exactly?

We will see a film or go out to dinner.

Once per week

Thursday night

After a month of doing this goal, which went pretty well, Mei-Yin began to pay close attention to how she responded to Connection bids, especially Peter’s. For example:

Other’s Person
Connection Bid

How I responded
(check the one that applies) check

Comment

Turning
Toward

Turning
Against

Turning
Away

Peter said, “You should read this newspaper article about the sub-prime mortgage scandal.”

check

I didn’t feel very interested so I didn’t bother looking at the article.

Peter was going out for a walk, and he asked me to come along.

check

I just said, “I’m too tired, I’m going to curl up with a book.” I didn’t show I was pleased that he’d asked me or suggest going for a walk another day.

 

Mei-Yin noticed that she and Peter both used a lot of Turning Away responses. This was a bad habit. She also noticed that she wasn’t making many Connection bids – asking about his day, expressing interest in what he said, making suggestions to do something together, etc.

She decided to set two new goals: I will make a Connection bid almost every day, no matter how Peter responds; and If Peter makes a Connection bid, I will try to respond with Turning Toward. She asked Peter to work on this as well. So they were both deliberately making more Connection bids and Turning Toward responses. It felt a bit unnatural at first, but they kept on with it, reminding themselves that improving their relationship would be a huge accomplishment.

Over the next few months, they began to see changes in the relationship. They were doing more things together and talking more. Sometimes they laughed about their whole Connection bid project, but it actually helped. For Mei-Yin, feeling more supported in her relationship made it easier to handle her diabetes. They planned meals together, and it worked out great, because the foods she needed to eat for diabetes control were also good for Peter’s health. Overall, they felt emotionally closer. They continued to make an effort to notice Connection bids and Turning Toward responses, so they wouldn’t fall back into old habits.

“That’s the beauty of feeling emotionally connected to others. Whatever you’re facing – serious illness, divorce, job loss, grief over the death of a loved one – you don’t have to face it alone. Sharing your experience with other people who express understanding and sympathy may be helpful in ways we’re only beginning to understand. “

John Gottman, The Relationship Cure