Real Conversations, Real Connection
The goal is to be understood, not to be right.
What we say and what someone hears can be very different. These guides show common phrases, how they may land, and gentler ways to say what you mean.
Five skills that work in every conversation
Listen to understand
Not to reply. Reflect back what you heard: “It sounds like you feel…”
Curiosity over correction
Ask open questions: “What's that like for you?” instead of “That's not true.”
Name feelings, not flaws
Use “I” statements about behaviors and your feelings, never labels for the person.
Offer choices
Choice returns dignity and control: “Would you rather talk now or later?”
Repair when you get it wrong
“I said that badly. Can I try again?” builds more trust than being right.
Speaking with someone who is autistic
Many autistic people communicate directly and literally, and process sensory input and social cues differently. Clear words and patience build connection faster than reading between the lines.
When you say
“Look at me when I'm talking to you.”
They may hear
“My way of listening is wrong.”
Try instead
“Listen however feels comfortable for you.”
When you say
“You don't seem autistic.”
They may hear
“Your struggles aren't real, or I'm hiding myself well enough to be ignored.”
Try instead
“Thanks for telling me. What helps you?”
When you say
“You know what I mean.”
They may hear
“A puzzle I'm expected to solve.”
Try instead
“Here's exactly what I'm asking: …”
When you say
“Calm down, it's not a big deal.”
They may hear
“Your overwhelm doesn't count.”
Try instead
“Would a quieter space or a break help?”
- Say what you mean; avoid hints, sarcasm and vague timelines.
- Give time to answer — silence is often processing, not refusal.
- Offer text or written options when talking is hard.
- Respect stims, routines and sensory needs.
Speaking with someone who doesn't believe they are ill
Some people with serious mental illness truly can't see their own symptoms — a brain-based condition called anosognosia, not stubbornness. Arguing about the diagnosis usually ends the conversation. Focusing on their goals keeps it open.
If someone may be in danger, call or text 988 or call 911.
When you say
“You're sick and you need help.”
They may hear
“You think I'm crazy and you're against me.”
Try instead
“You seem really stressed lately. What's been the hardest part?”
When you say
“Take your meds.”
They may hear
“You want to control me.”
Try instead
“What would help you sleep (or feel safer, or keep your job)?”
When you say
“Those voices aren't real.”
They may hear
“You don't believe me.”
Try instead
“That sounds frightening. I don't hear it, but I believe it's real to you.”
When you say
“You always do this.”
They may hear
“I'm a problem, not a person.”
Try instead
“I care about you, and I'm worried. Can we talk about what you want?”
- Listen first, reflect back what you heard, and agree where you honestly can.
- Work toward their own goals, not the label.
- The LEAP approach (Listen, Empathize, Agree, Partner) was built for exactly this.
- Have a safety plan; if there's danger, call 988 or local emergency services.
Speaking with someone in active addiction
Shame keeps addiction going; connection helps break it. You can be honest about how their use affects you without labels, threats or lectures.
When you say
“You're an addict.”
They may hear
“That's all I am to you.”
Try instead
“I've noticed you're using more, and I'm worried about you.”
When you say
“Why can't you just stop?”
They may hear
“You think I'm weak.”
Try instead
“What makes it hard to cut back right now?”
When you say
“If you loved me you'd quit.”
They may hear
“My illness proves I'm unloving.”
Try instead
“I love you, and I can't keep covering for this. Here's what I can do to help.”
When you say
“You're throwing your life away.”
They may hear
“There's no point anymore.”
Try instead
“You matter to me. Whenever you're ready, I'll help you find support.”
- Talk when they're sober, not mid-crisis or mid-use.
- Use “I” statements and name specific behaviors, not character.
- Set boundaries for yourself, and keep them kindly.
- Keep naloxone (Narcan) on hand if opioids may be involved.
Speaking with someone who has a dual diagnosis
When mental illness and substance use happen together, each one feeds the other. Many people have been told to “get sober first” or “fix your mental health first” and bounced between services. Treat the whole person.
When you say
“Your drinking is the real problem.”
They may hear
“My depression (or trauma) doesn't matter.”
Try instead
“It sounds like you've been carrying a lot. How are you feeling, apart from the drinking?”
When you say
“Come back when you're clean.”
They may hear
“Nobody will help me as I am.”
Try instead
“You don't have to fix everything first to get help.”
When you say
“You're just self-medicating.”
They may hear
“You're dismissing why I use.”
Try instead
“What does using help you get through?”
- Look for integrated (co-occurring) treatment that handles both at once.
- Expect setbacks; they are part of recovery, not failure.
- Ask what has and hasn't worked before.
Speaking with someone who is homeless
People experiencing homelessness are often ignored all day. Being seen as a person — a name, eye contact, a real question — can matter as much as anything you hand over.
When you say
“Why don't you just get a job?”
They may hear
“You think this is my choice.”
Try instead
“How's your day going? Is there anything you need right now?”
When you say
“(Walking past without a word)”
They may hear
“I'm invisible.”
Try instead
“Hi, I'm ___. What's your name?”
When you say
“You should go to a shelter.”
They may hear
“You don't know my reasons.”
Try instead
“Would it help if I looked up places nearby that fit what you need?”
- Ask before helping, and respect “no.”
- Practical items help: water, socks, a phone charge, a bus pass.
- Share 211 — it connects people to local housing, food and shelter.
- Use “person experiencing homelessness,” not “a homeless.”
Speaking with someone who may be thinking about suicide
Asking directly about suicide does not plant the idea — research shows it can bring relief. Your calm presence matters more than perfect words.
If someone may be in danger, call or text 988 or call 911.
When you say
“You're not thinking of doing anything stupid, are you?”
They may hear
“Don't tell me the truth.”
Try instead
“Are you thinking about killing yourself? I can handle the answer.”
When you say
“You have so much to live for.”
They may hear
“You don't understand how I feel.”
Try instead
“That sounds incredibly painful. I'm glad you told me.”
When you say
“Think about how your family would feel.”
They may hear
“More guilt.”
Try instead
“I want you here. Can we call or text 988 together?”
- Stay with them, and help put distance between them and anything they could use to hurt themselves.
- Call or text 988 (Suicide & Crisis Lifeline), or 911 if danger is immediate.
- Follow up in the days after — check-ins save lives.
Speaking with someone living with trauma or PTSD
Trauma can keep the body on alert long after danger is gone. Safety, choice and control are what help people feel calm enough to connect.
When you say
“That was years ago, let it go.”
They may hear
“Your pain has an expiration date.”
Try instead
“It makes sense that it still affects you.”
When you say
“Why didn't you leave / fight back?”
They may hear
“It was my fault.”
Try instead
“You did what you had to do to survive.”
When you say
“Tell me everything that happened.”
They may hear
“I have to relive it for you.”
Try instead
“Share only what you want to. I'm listening.”
- Let them set the pace and the topic.
- Avoid sudden touch; ask first.
- Notice grounding needs — a seat near the door, a calm voice.
Speaking with someone who is grieving
Grief isn't a problem to fix. People rarely remember what you said — they remember that you showed up and said their loved one's name.
When you say
“Everything happens for a reason.”
They may hear
“My loss was meant to be.”
Try instead
“I'm so sorry. I don't have the right words, but I'm here.”
When you say
“At least they're not suffering.”
They may hear
“I shouldn't be sad.”
Try instead
“Tell me about them, if you'd like.”
When you say
“Let me know if you need anything.”
They may hear
“Please don't actually ask.”
Try instead
“I'm bringing dinner Thursday — is 6 okay?”
- Say the person's name.
- Remember the hard dates: birthdays, anniversaries, holidays.
- After a suicide loss, avoid “committed suicide”; say “died by suicide.”
Speaking with someone with ADHD
ADHD is a difference in attention regulation and executive function, not a lack of effort or caring. Many adults carry years of being called lazy.
When you say
“You'd remember if it mattered to you.”
They may hear
“I don't care about you.”
Try instead
“Would a reminder or a shared calendar help?”
When you say
“Everyone gets distracted.”
They may hear
“You're exaggerating.”
Try instead
“What does it feel like for you?”
When you say
“Just try harder.”
They may hear
“I'm failing on purpose.”
Try instead
“Let's break it into smaller steps together.”
- Give one or two steps at a time, ideally in writing.
- Praise effort and systems, not only results.
Speaking with someone who has relapsed
Relapse is common in recovery and is not the end of it. Shame after a relapse is one of the biggest risks for continued use — and for overdose, since tolerance drops.
When you say
“I knew you'd mess up.”
They may hear
“I was never going to make it.”
Try instead
“I'm glad you're still here. What do you need right now?”
When you say
“All that time wasted.”
They may hear
“My recovery doesn't count.”
Try instead
“What you learned in recovery is still yours.”
- Ask about safety first, especially overdose risk.
- Encourage reconnecting with a sponsor, peer or meeting today.
The Missing Piece: A Full Medical Workup
Once someone has a mental health or addiction history, doctors and crisis systems often assume every change is behavioral and skip basic physical checks. This is called diagnostic overshadowing. Many treatable medical conditions can look like psychosis, depression, anxiety, agitation or confusion.
Ask the doctor about a complete workup, which may include:
- Thyroid function — an over- or underactive thyroid can mimic anxiety, depression or mania.
- Hormones — including sex hormones, cortisol and changes after pregnancy or during menopause.
- Urinary screening for bacteria — urinary tract infections can cause sudden confusion, especially in older adults.
- Antibodies — autoimmune conditions such as autoimmune encephalitis can cause psychiatric symptoms.
- Infections such as HSV — herpes simplex and other infections can affect the brain. HSV swelling of the brain (encephalitis) is a medical emergency and needs treatment the same day.
- Thiamine (vitamin B1) — low thiamine, common in people who drink heavily, can cause confusion and memory problems and needs treatment right away.
- Vitamins, blood sugar and blood counts — low B12 or iron, or unstable blood sugar, can affect mood and thinking. Vitamin D may also be checked, though the evidence linking it to mood is weaker.
- Medication and substance review — interactions and withdrawal can change behavior.
Get emergency care the same day for sudden confusion with fever, a severe headache, a seizure, a stiff neck, or new trouble speaking or walking. These can be a brain infection or another medical emergency, not a psychiatric episode.
You can say: "Before we decide this is only psychiatric, can we rule out medical causes?" Bring notes on when the changes started and anything new — illness, medications, sleep or pregnancy.
Rethinking the Default Advice
Why coercion and "rock bottom" often backfire, and what actually keeps people alive
Families are often handed three scripts: call the police, have them "sectioned" — a U.K. term for what the U.S. calls an involuntary hold — or cut them off so they hit rock bottom. These are the answers given most often — but they are not the answer. Too often they reflect gaps in care and failures of facilities, not what helps people heal.
Walking away
Rock bottom can mean death, prison or losing everything. You can hold limits without ending the relationship: "I won't give money, but I will always answer when you want help."
Calling police
Police contact can escalate a crisis and break trust. Where available, ask for a mobile crisis team or call 988 first. If there is immediate danger to life, call 911.
Involuntary holds (sectioning)
Also called an involuntary hold — a "5150" in California, the "Baker Act" in Florida. Holds may be needed when life is at risk, but they can be traumatic. Ask what happens after discharge and push for follow-up care, not just containment.
Harm reduction
Naloxone, safer-use supplies, testing and staying connected keep people alive long enough to choose change. Keeping someone alive is not enabling.
Accountability and connection can coexist. People can be responsible for harm without losing every shred of themselves, and families can protect themselves without walking away. Safety first, dignity always, and connection wherever possible.
See crisis help without police: mobile crisis teams, local numbers and harm reduction →
These guides are educational and are not medical, legal or crisis advice. Every person is different — when in doubt, ask them what helps. In the U.S., call or text 988 for the Suicide & Crisis Lifeline, or dial 211 for local services.