When a family member or friend gets sick or injured, it’s easy to feel powerless: What do you say? How do you help? When should you check in, and how often? How much is too much?

These questions are woven into classes taught by Tufts’ Department of Occupational Therapy. Students learn to help clients improve their ability to perform daily activities while retaining optimal quality of life—and a sense of identity.

Occupational therapist Heather Gilbert, a lecturer in the department, spoke with Tufts Now to share advice for loved ones who might wrestle with how to help, when to back off, and what to say.

Occupational therapy is a term that people might know but not understand. What does it entail? 

Occupational therapy sits at the powerful intersection of physical health, mental well-being, and daily living. Our goal as O.T.s is to help people gain, re-gain, and/or maintain independence and quality of life. The right support can really transform someone’s experience of illness and disability.

According to the CDC, more than one in four adults in the United States live with some sort of disability. Disability prevalence increases with age, but it can occur at any stage of life. And an increasing proportion of Americans are dealing with multiple chronic conditions—about 42% have two or more. 

That means many of us will be in the position of wanting to help, maybe without knowing how. How might family and friends support someone going through a health crisis?

The first step is just being present. Sometimes, people get nervous. They don’t know what to say, and they unintentionally withdraw. That’s the worst possible thing, because it can already feel so isolating to go through a crisis. The person going through the health crisis is already worrying: Am I going to be able to do the things that matter to me? Am I going to be able to be a part of my loved ones’ lives in the way I’ve always assumed I would be? Those are big, existential questions.

So, check in with people. Spend time with them. Don’t assume that they don’t want to do things that they usually did. 

Ask them, “What do you need today? Do you want to just vent? Do you need a good laugh or a good cry? Do you want to watch the same show we always watch together? What’s helpful for you right now?” 

Then, follow their lead. Some people are going to want to pretend nothing’s happening and make their routine look as normal and consistent as it had previously. Other folks will act very differently. As a support person, we need to be prepared to accept and embrace whatever we’re getting.

Is there anything to avoid? 

We definitely don’t want to minimize anyone’s experience. We don’t want to do the whole “Everything happens for a reason.” We need to validate someone’s feelings. It’s OK to say, “This is really difficult. It’s OK to feel overwhelmed.”

Be careful not to offer unsolicited advice, talking about whatever new alternative medicine or cutting-edge thing you have found online. Ask someone if they want suggestions before bombarding them with information that may or may not be helpful.

Try not to make assumptions about people’s needs. Feel free to ask, “Is it helpful if I do this? Would you rather do it yourself?” For example, “Is it helpful if I come over and do the dishes today?” or “What’s one thing I can take off your plate today?” Offer something that’s concrete and clear. It can be hard for them to ask for help, but we also don’t want to assume that someone wants us to run in and do everything for them.

O.T.s talk about communicating with empathy. What does that mean?

When we talk with a loved one, the goal is to understand their perspective and their feelings. We want to be able to recognize and validate emotions without judging them. We want to respond in a way that lets them see that their feelings matter, rather than jumping into “let me fix this for you” mode.

To do this, acknowledge emotions and reflect back what you are hearing: “It’s completely understandable that you’re feeling angry. That makes a lot of sense. It’s so frustrating that this is interrupting your work or interrupting your ability to take care of your kids.” 

Then, if it seems that they want to talk through things, it’s OK to ask, “How else is this affecting your day to day?” You could ask questions that invite them to go deeper with you, rather than “Are you feeling any better?” which isn’t as helpful.

Some silence is OK. We don’t have to fill every moment. If someone’s shared difficult news with us, we don’t need to immediately have a perfectly crafted response. I think we’re so concerned about saying the right or wrong thing that it can make us speak too quickly, and react too fast, without thinking.

In the same vein, if we say the wrong thing, it’s OK to say, “I think I’m coming on strong here. I want to rephrase that.” 

We can be human, recognizing and admitting if we’re getting it wrong.

Sometimes, it’s hard to know what the right amount of care actually is. You don’t want to bother someone, but you don’t want to ghost them. Do you have a framework for the proper level of presence?

I don’t think it’s one-size-fits-all. That’s why transparency is important: “I love you, I care about you, and I want to be here for you, but I also don’t want to suffocate you. I’m going to check in at least once a week. Tell me if that at any point feels like too much. I’ll follow your lead.” 

Where can family and friends seek additional advice, and maybe emotional support for themselves?

It’s normal to feel intense emotions when a loved one is going through a difficult time. We don’t need to be robots, we can show some emotion, but we don’t want to become so dysregulated that now our loved one feels like they have to turn around and comfort us—we need to use our own resources to take care of ourselves if we’re hurting.

Depending on the condition, find a reputable national organization to try to get a sense of what that person might be experiencing and what might be coming, rather than having to ask them questions. We can educate ourselves a little bit. 

Many of those organizations will offer support groups, whether it’s for the person with the health condition, caregivers, or loved ones. Those can be nice places to connect with other people who are supporting someone going through something similar. 

There’s also an organization called the Caregiver Action Network. It provides education and peer support for loved ones who are supporting somebody through a tough life circumstance.

What do you wish more of us understood about supporting people in a crisis?

Emotional support is completely inseparable from practical assistance. Being able to help someone maintain their sense of identity and purpose is just as important as being able to address their medical needs, which are likely addressed by their providers.

When you’re a close loved one, you have a real opportunity to help someone still feel a bit like themselves as they redefine what their life might look like. It’s an opportunity to actually grow closer to someone, if we can show up in the right way and follow their lead.