Joey Wahler (Host): It can be a slippery slope. So, we're discussing starting a mental health conversation with a friend. Our guest is Dr. Christina Murray. She's a psychiatrist. This is WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome.

Dr. Christina Murray: Hi. Hi, Joey. Thanks for having me.

Host: A great to have you aboard. We appreciate the time. Interesting topic. So, to get us started, what is a good way to begin a conversation with a friend or a loved one perhaps when you're worried about their mental health?

Dr. Christina Murray: Yeah. So, that's such a beautiful question, and I think that one of the important things to recognize is that you don't have to be perfect. And I think that can be where people feel a little bit nervous. So, I think really what is the best thing to say is something just like, "I just wanted to check in."

You know, one of the things we can do as people concerned about our loved ones is make observations. And so, saying things like, "You haven't seemed quite like yourself lately. How are you doing?" You know, I think a lot of people feel like they need to avoid these conversations, because they're maybe afraid to make things worse. But you can even acknowledge the awkwardness and say, "Maybe I'm not quite right about this," or "Maybe I'm reading this wrong, but I care about you and I wanted to ask." And so, expressing that care can be super helpful.

Host: Gotcha. So if you're worried about making things seem awkward or saying the wrong thing, how can you try to prevent that? You just pointed out that to get things started, less is more, keep it simple, right? How about beyond that once the conversation gets going?

Dr. Christina Murray: Yeah. So once the conversation gets going, I think, again, it's just a give and take. I think it's about being observant and not judgmental. And again, so using those words, right? Like, "I've noticed." So, there are things that you can reflect on yourself, things that you're noticing about the person. Like, maybe, "You're canceling plans lately. I've noticed that, and I just wanted to see how you're doing." That's a whole lot less judgmental than, say, making an assumption, right? So, something like saying, "I think you're depressed." More importantly is we can make observations to the person. That can be a really lovely way to just kind of introduce it and introduce your worries, right? So, it's focusing on what we're observing as the person asking the question.

And I think the follow-up to that is that we're saying things like, "I care about you and I'm willing to listen." So, expressing that observation and expressing your concern. And that, I think, is a way to just bridge into that.

Host: So, let's say, Doctor, that all of the above goes well. The conversation is off and running. What might you say or perhaps avoid saying when someone starts to hopefully open up about things like anxiety, depression, or some other mental health concern? How do you keep the ball rolling?

Dr. Christina Murray: That's another beautiful question. And I think it depends a lot on the person. I think that giving agency to your friend or loved one that you're asking about is so lovely. And so, I think that for the first part is that validating can be so helpful. So, saying, "I hear you," or "That sounds really hard," is something that we can do that can be really helpful.

I think one thing to avoid is to say, "Just think positively." Because if we could all do that, we'd have an easier time in life. But I think what we want to say is just validate where they're at and say, "I hear you," and letting your friend or loved one know that you're present to them.

When I said agency, what I mean by that is once they start opening up to you, giving them options. You know, you can say something like, "I hear you, and I just want you to know I'm here for you. What would you like me to do? Would you like me to listen, offer advice, strategize?" Or you could even say, "Do you just want to vent?" You don't have to be so formal about it.

Host: And you led me perfectly into my next question there, Doctor, because I wanted to ask you, how important is simply listening at times without always focusing so much on what you should be saying?

Dr. Christina Murray: I think that that's number one. So, being present and intentional is really the biggest part of it. Because a lot of times, I think people, we go through life and people aren't asking us these questions. And so, I'm almost 99% certain that friend or loved one is going to feel valued just by having a listening ear.

I think that giving someone that opportunity when you express curiosity and kindness in a non-judgmental way to somebody, almost inevitably you won't be the one doing most of the talking because creating that venue for them is going to help them say what they want to and what's on their heart and mind.

Host: So, what should you do if your friend doesn't want to talk or maybe minimizes what's happening with them or perhaps becomes defensive? You mentioned earlier so much of this is about how they react. What if they react in a way where you're like, "Hmm, what do I do now?"

Dr. Christina Murray: Yeah. I think that sometimes that can happen, right? Because when we're talking about mental health, when we're talking about our feelings, people come from different backgrounds and different experiences in life, and that can be a very vulnerable space. It might be this person's experience that you might very well be the very first person who's talked to them about this. And so, that vulnerability sometimes can lead to defensiveness because that's how a person's learned to protect themselves throughout their life.

And so, I think, for one, to reflect that in simple terms, don't take it personally. But what I mean by that is just to reflect that it might be where the person's coming from. And then again, to lean into giving your friend or loved one that agency back and saying, "That's okay. I just wanted to let you know I'm here for you." And so, you're not closing the door. You leave it open and you acknowledge. You know, I think the way I phrase that is meeting someone where they're at, because sometimes people are not ready or maybe they will never be ready, but giving them the opportunity to come back and revisit it another time, I think, is the best thing that we can do.

Host: And you make a great point there, Doctor, about how much of this has to do with upbringing and background, because some people come from a family or a background where things are out in the open. Mental health and other things, they're discussed openly between people that are close. And then, others, quite the opposite. It's not something you necessarily talk about so freely, or maybe you come from a family that's been to therapy, that's sought professional help or, in contrast, one that hasn't, right?

Dr. Christina Murray: Absolutely, yeah. And that's another thing, because I think, as the asker and maybe even the whole reason we're having this podcast is that it can feel vulnerable to even ask these questions, right? But when we remember that if somebody does become defensive or maybe shies away from the conversation, it's not about you, the asker, or you having a problem. It's that we're all coming from a different place and that our learned experiences are very, very different.

Host: So along those lines, how can you support a friend that you think may be going through a tough time without feeling responsible yourself for trying to "fix the problem" or becoming their therapist? Because after all, you're trying to be helpful, but we're not professionals like you and yours, right?

Dr. Christina Murray: Absolutely, Joey. I think that some of the time, practical help can actually be really helpful. So, offering to sit with them while they make a phone call or even helping them find a therapist. You know, you can frame it in some way like, "I really care about you and I want to support you, and I also think this is something you deserve professional help with." And boundaries are important because we have our limits as human beings. We have to be good stewards of our emotions and our care, and setting boundaries like that does not mean you do not care. In fact, it means you care more. And helping a person understand that having a therapist in their corner is a good thing, that it does not mean somebody is crazy, nor does it mean they're weak.

It means that they can have a professional support them in this way. And so, sometimes that practical piece of even helping them find one can be really nice, because it sometimes feels daunting to even start that journey if it's not one you've done before.

Host: Couple of other questions for you. First, what should you do if you're worried that a friend may try to harm themselves or isn't safe?

Dr. Christina Murray: I think that there's a few different answers to that question. What I want to relay is that if you ever feel that this person is an imminent danger to themselves or to other people, to call 911 because that is an emergency. And if you're afraid that they are going to do something like that, 911 is the answer. I think that if a person expresses that they are in an emotional crisis or they're having a very, very difficult time, there's another line that they can easily call, called 988, which is a resource where people can help guide somebody through that mental health crisis and be present to them through that.

Host: And then, in summary here, Doctor, you've done such a great job of breaking down some of the details. Overall, as a takeaway here, what's your best advice for those joining us to help someone struggling with mental health, but to tiptoe that line of supporting them without overstepping, which is really what we're talking about here? what's sort of a rule of thumb to keep all that information you've given us in tow?

Dr. Christina Murray: I think that my leading words are kindness and curiosity. Because when we are being curious, we're not being judgmental. And then, finally, agency. I think of how we help people. And in my profession, it's more of I let my patients know too that you are the author of your narrative of your life.

And sometimes, in that narrative, you might drop your pen and you need someone to help you pick it back up. And that's how we are serving each other, our loved ones, our friends, just giving them their pen back to write their story. And that's how I think about it. To start the conversation, we're being kind, curious, and helping them lead the narrative of their life.

Host: Love the pen analogy. It definitely puts a bow on it all very nicely. Well, we trust you're now more familiar with starting a mental health conversation with a friend or a loved one. Doctor, keep up all your great work. We appreciate the advice, and thanks so much again.

Dr. Christina Murray: It's been my pleasure, Joey. Thank you.

Host: And for more information, please visit wakemed.org/conversations. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of WakeMed Voices.