Tag: Social Conditions and Trends

Don’t Worry, You Can Learn to Talk to People Again

Soon we will no longer be lurking in our homes and skittering away from strangers. A few experts remind us how to be social again.

After a year of isolation, there are things you start to forget. You forget how to stand in a crowded commuter train (legs apart, slight bend in the knee) or how to shimmy sheepishly past theatergoers to reach a middle seat (face away, apologize repeatedly).

And, without a constant parade of baby showers and work mixers, you forget how to talk to strangers: The witty banter, the conversational volley, the way you break the ice with “How about this rain, huh?” instead of “So, what do you consider your greatest failure in life?”

But the world is starting to open up again, and that means having to engage in that dreaded four-letter word — chat — with people you don’t know. If the idea makes you nervous, you’re not alone.

“Social anxiety is extremely normal,” said Stefan G. Hofmann, director of the Psychotherapy and Emotion Research Laboratory at Boston University. “As humans, we have a strong need to belong and feel part of a group.”

Still, knowing something is normal doesn’t make it easier. How can you coax yourself out of hermithood and talk to people when your social skills feel blunted by quarantine? Here’s some advice from people whose jobs require them to make friends with strangers every day.

Embrace the awkward bits. (And there will be awkward bits.)

Amanda Zion, a hair stylist in Davidson, N.C., is well-versed in making small talk. But for someone who gets shy around new people, it doesn’t always come naturally. “It’s excruciating,” she said. “I get anxious before every client.”

Her golden rule? When an interaction feels stilted, she acknowledges it out loud. “I’ll say, ‘I’m sorry, I feel so awkward today,’ ” she said. “I try to break down the barrier with honesty or even a joke — like, ‘Wow, those 37 cups of coffee didn’t help!’”

A one-two punch of self-deprecating humor and direct instruction can work wonders, said Jennifer Hornbeck, an Episcopalian priest in Sonoma County, Calif., who’s had “a lot of practice” mingling at after-church coffee hours in the 20 years since she was ordained. “Make light of it, then give the other person a framework to help you,” she said. “I’ll say ‘I seem to have forgotten how to have a conversation. Can you tell me about your day?’”

Use the pandemic to connect, but tread carefully.

Whenever Ms. Hornbeck has felt stuck talking to congregants this year, she’s leaned on a fail-safe topic: the pandemic.

“It’s a jumping off point we didn’t have before,” she said. “I like asking, ‘What hobby did you think you’d take up in quarantine but never did?’”

Establishing commonalities is how we connect, said Dr. Hofmann, so a collective experience like the pandemic can provide us with ample discussion points. Still, he said, remember that it’s not always innocuous.

“If the person you’re talking to has lost a job or a loved one, they may not want to discuss it with a stranger,” he said.

It helps to share your own experience first, said Larry Cohen, a therapist in Washington, D.C., who runs social anxiety workshops. “That way, you’re the one being vulnerable and opening the door, and they can walk through it if they want to.”

And if you walk through it to find yourself in a wildly different room, it’s fine to walk back out. When a recent conversation about masks veered into uncomfortable political territory, Ms. Zion was loath to join in. To extricate yourself gracefully from a topic you’d rather not touch, “say something affirming and sincere — ‘Yes, these are really hard times,’ — and then move to a different subject,” said Mr. Cohen.

Interject a little positivity.

While commiserating over a shared adversity can be a bonding experience, Mr. Cohen said, “you don’t want the focus with a new person to be overwhelmingly on the negative.”

When a conversation feels like it’s verging on a complaint-fest — cathartic, sure, but kind of a downer — Ms. Zion steers it toward more optimistic territory. “If someone only wants to talk about how bad their vaccine side effects were,” she said. “I’ll ask, ‘But what are you most excited to do now you’re vaccinated?’”

Clementina Richardson, a celebrity eyelash stylist whose clients include Mary J. Blige and Julia Roberts, makes the positive comment personal.

“I always try to offer a compliment,” said Ms. Richardson, the founder of Envious Lashes, an eyelash extension salon in New York. “People haven’t gone anywhere for a year. Some of them are feeling a little self-conscious about their appearance. Noticing something — their hair, their bag — and saying something nice about it helps make them feel more comfortable.”

Don’t overthink it.

Meghan Dhaliwal’s work as a freelance documentary photographer (including for The New York Times) means she has to gain the trust of strangers on each assignment, despite being a self-described introvert. In some cases, the person she’s photographing has undergone a difficult experience, and her role is to capture them intimately without stepping over delicate boundaries.

To lower the pressure of the situation, she tries to put a subject at ease by tuning in to the way they’re feeling, matching her energy level to theirs and paying attention to their body language.

“I’ll start by asking something light that has nothing to do with why I’m photographing them,” she said. “I’ll listen and take my cues from their answer. When you give someone a little space to warm up to you, it’s easier to start chatting and find common ground.”

Mr. Cohen gives his patients a similar exercise, what he calls “curiosity training.” While it can be tempting to construct a conversational safety net by continuously planning out the next thing you’re going to say, it also makes it harder to pay attention to the exchange you’re having.

“The better thing to do, even if it feels like a leap of faith, is to listen with curiosity,” he said. “Step away from the idea of performance, of ‘I need to make this go well,’ and try instead to adopt a stance of mindfulness.”

Allowing yourself to become absorbed in the conversation, Mr. Cohen said, means your brain will start doing the work for you, tossing out questions and opinions you can contribute.

Practice being in control.

While this may not be the time to expose yourself to large crowds, “taking small, safe steps toward socializing again” can alleviate some of the pressure you might feel about re-emerging into the world, said Mr. Cohen. “Make it a goal to interact with one person every day.”

In her job as an account manager, Chicago-based Lindsey Friesen often challenges herself to spend 20 minutes calling clients before allowing herself to do more introspective work. To prepare for a return to networking events, she’s practicing what she calls “a sort of informal exposure therapy”: Running one errand a week that will result in a social interaction.

If she meets someone she knows she’ll see again, she makes a quick note of something they talked about as conversational fodder for next time. And if she needs a moment to collect herself, she falls back on a trick she learned in therapy for a childhood stutter.

“I always keep a water bottle with me, so I have a reason to stop talking,” she said. “When you take a sip of water, it’s a pause that isn’t weird. It gives you a few seconds to gather your thoughts or change the direction of what you were saying. Nobody has to know you’re struggling.”

If all else fails: Netflix.

If, in the course of cutting someone’s hair, Ms. Zion has exhausted all her conversational gambits, she falls back on the one thing she can count on to get people talking: what shows they’ve been binge-watching while stuck at home.

“TV has probably been the biggest sparker of conversation with anyone this year,” she said. “You start with that and you can go anywhere.”

Holly Burns is a writer in the San Francisco Bay Area.

Food, a Place to Sleep and Other Basic Patient Needs

Earl Wilson/The New York Times

“Doc,” my patient said, his voice a mix of amusement and irritation. “I ain’t got food to eat or a place to sleep. Took me two hours and three buses to get here. And you’re tellin’ me about some numbers?”

He had a point. Though, in my defense, these numbers — his cholesterol and blood pressure — were important ones.

As I tried to persuade him of their relevance, I thought of another number, his ZIP code — or lack of one, since he lived on the street — and how that was a far more important factor for how long he might live than his cholesterol.

What’s remarkable about our conversation isn’t that it happened, but that it doesn’t happen enough. Many of my patients are not forthcoming about their challenges, and when I probe, I’m often surprised by how many struggle with basic needs like housing, food and transportation.

I recently discussed starting insulin with a patient to control his diabetes. He hesitated — his concern not the syringes needed to inject it, but rather not having a refrigerator to store it. Another patient recently called to cancel her appointment. She was moving into a new apartment — again. Her son’s asthma had flared up, and she thought the mold and cockroaches in their current home were making it worse.

These situations highlight what we’ve known for decades: that patients’ social and economic circumstances powerfully influence their health and well-being. But until recently there’s been relatively little effort to systematically address these factors.

The Center for Medicare and Medicaid Innovation, a government organization established by the Affordable Care Act to test new ways to deliver and pay for health care, is trying to change that. It recently announced a pilot program to help health systems close gaps between medical care and social services in their communities. The program, known as Accountable Health Communities, will invest $157 million over five years to study whether helping patients with social needs in five key areas — housing, food, utilities, transportation and interpersonal safety — can improve health and reduce medical costs.

“Clearly we’re not the first to understand that social factors are important,” said Dr. Darshak Sanghavi, the innovation center’s director of preventive and population health care models. “But these efforts have been fragmented. They haven’t been studied in a way that can be nationally scaled.” As the world’s largest purchaser of health care services, the Centers for Medicare and Medicaid Services can help address that, he said.

The Accountable Health Communities program will award grants to 44 organizations around the country to build partnerships among state Medicaid agencies, health systems and community service providers to identify which strategies are most effective for linking patients to the services they need.

There’s good evidence that dedicated attention to social support can improve health and cut costs. Research suggests nutrition assistance for low-income women and children reduces the risk of low birth weight, infant mortality and developmental problems — at a cost that’s more than fully offset by lower Medicaid spending. Other work suggests providing elderly patients with home-delivered meals can help them live independently and prevent expensive nursing home stays. Research also shows that providing housing for low-income and homeless people can substantially reduce medical costs. A housing initiative in Oregon, for example, decreased Medicaid spending by 55 percent for the newly housed; a study of a similar program in Los Angeles found that every $1 spent on housing led to $6 saved on medical costs.

And local efforts around the country can serve as models for change.

Hennepin Health in Minnesota, for example, is an organization that serves low-income patients, and emerged as a partnership between local social service, public health and medical leaders. These groups share data and funding to ensure patients have access to services like housing, utilities, job training and behavioral and substance abuse counseling. The program’s efforts have lowered emergency department use, reduced the need for hospitalizations, improved chronic disease care — and saved money. Other innovative organizations, like the Camden Coalition in New Jersey and Health Leads in several metropolitan areas, have likewise recognized the challenges vulnerable patients face outside the hospital, and tackled them in inspiring ways.

But we haven’t yet done enough to collect, examine and scale these insights. There’s been no concerted national effort to ease the social problems that drive poor health, and consequently, little financial incentive for medical practitioners to collaborate with social service providers. Until now.

“I think what’s most important is the signal we’re sending,” Dr. Sanghavi said of the Accountable Health Communities initiative. “We recognize that hundreds, potentially thousands, of communities have these needs. We can’t meet them all right now. But this sends a broader signal to other innovators out there — be they private, public or philanthropic: Social determinants are important. We want to learn from their efforts. We want to spark that flame.”

Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.