The Hidden Structure of Difficult Conversations

Yesterday they said yes. Today it’s no. When people seem to flip-flop, it’s not always about them changing their minds.

There’s a hidden structure in those conversations - and once you know it’s there, things make a lot more sense.

You have a conversation with someone - in a hospice, it might be a patient or a family member. You explain the options clearly, show empathy. Everyone nods. Preferences are documented.

Then later they say the document is wrong. They say they weren’t heard, that staff didn’t listen to what mattered to them.

But some hospice staff have found a way to avoid the flip-flop. And what they do reveals the hidden structure of conversations.

Helen Slocombe, a Clinical Lead Nurse in end-of-life care, found herself alone with a dying man she’d never met. His family were worried — did he understand what was happening? Was he scared?

He said: “I’m going to be going over the wall soon.”

Helen didn’t translate “over the wall” into “dying.” She asked: “What kind of wall?”

What followed was a conversation his daughter described as unlike anything she’d ever heard from her normally closed-off father. He talked about who was waiting for him on the other side. And then, unprompted, he said: “I’m not scared” — the very thing his family had been afraid to ask.

Photo by Annie Spratt on Unsplash

Here’s what most of us do in conversations, without realising it: someone says something, and we immediately translate their words into our words.

“I’m going over the wall” becomes “dying.” “I need support” becomes “home care package.” “I’m tired” becomes “needs rest.”

It feels normal, because it is normal. But here’s the problem: your translation might be completely wrong. And you’ll never know, because you never checked.

So you respond to your translation, not to what they actually meant. You document what you heard. You think the conversation went well.

And then later, they say they weren’t heard. Or they change their answer. Not because they’ve changed their minds, but because their real concern was never addressed. It was there all along, underneath the words you translated past.

That’s the hidden structure. The flip-flop isn’t inconsistency on their part. It’s the gap between what they meant and what you heard, finally surfacing.

Helen didn’t translate. She followed his exact words. And because she did, she found out what actually mattered to him — which wasn’t fear of death at all.

It’s not just dying patients. Cathy Hasty, who trains chaplains in North Carolina, describes a moment when someone’s father had just died. “He was a special dad,” the son said. Cathy asked: “What kind of special?” And the son opened up about their relationship in ways that made him feel truly heard — not just acknowledged.

Same question. Different context. Same result.

Try it yourself. Notice when someone uses a vague word — support, tired, worried, busy, difficult, scared. Words that could mean anything. Then ask: “What kind of [their exact word]?” and stop talking.

That’s it. You don’t need to interpret. You don’t need to fix. Just follow their language with genuine curiosity.

It works in hospices. It works in hospitals. It works in team meetings, in difficult family conversations, anywhere that words matter - which is everywhere.

• Fellow WhisperQuake director Steve McCann and I will be sharing this with in an online event members of the Texas and New Mexico Hospice and Palliative Care Organization tomorrow. Why not join us? Register here »