Basically, good listening can be divided into two parts – the physical part and the psychological part. A lot of the most awkward gaps in communication are due to not knowing a few of the simple rules which help people to talk freely.

This is important, and it is worth taking time to get it right at the beginning of the conversation:

• get comfortable,
• sit down,
• try and look relaxed (even if you don't feel it),
• try and signal the fact that you are there to spend some time (for instance, take your coat off!),
• switch off your mobile phone to signal that you won’t be interrupted.

Keep your eyes on the same level as the person you're talking to – which almost always means sitting down. As a general rule, if your friend is in hospital sitting by the bed is better than standing.

Try to keep the atmosphere as private as possible. Don't try to talk in a corridor, or on a staircase. That may seem obvious, but often conversations go wrong because of these simple things.

Generally there should be a comfortable amount of space between you and the person you are talking to; a longer distance makes conversation feel awkward and formal, and a shorter distance can make the other person feel hemmed in. This can be more of a problem if they are in bed and cannot back away. Try to make sure there are no physical obstacles (desks, bedside tables and so on) between you. That may not be easy. However, you could always say something such as ‘It's not very easy to talk across this table, can I move it aside for a moment?’. This may help both of you.

Maintain eye contact with the person while they are talking and while you talk. Eye contact is what tells the other person that the conversation is solely between the two of you. In some cultures it is natural to look directly into someone’s eyes. In other cultures this can be felt to be invasive. Be aware of how the other person feels and do not maintain eye contact for so long that it feels as though you are staring at them.

If, during a painful moment, you can't look directly at each other, at least stay close and hold the person's hand or touch them if you can and it feels appropriate.

It may be that they are simply not in the mood to talk to you that day, or their treatment or symptoms may mean that they don’t feel well enough. It's also quite possible that they may want to talk about quite ordinary 'little' things (such as television programmes or sports events or other everyday subjects). Try not to be offended if that is the case. Even if you are mentally prepared for a major conversation with your friend, try not to be put off if they do not want that at this particular moment. It may still be very helpful to them if you simply listen and pay attention while they talk about everyday matters – or perhaps don't talk at all.

If you're not sure what your friend or relative wants you can always ask ‘Do you feel like talking?’ which is always better than going straight into a deep conversation (such as ‘Tell me about your feelings’) if they are tired or have just been talking to someone else.

People with cancer often find that their moods change from day to day and they may want to talk on one day, but on the following day may not feel like talking. So, you do not need to feel that it is your fault if the person with cancer suddenly decides that they do not want to talk.

When your friend or relative is talking, it is important to really listen to them instead of thinking about what you are going to say next, and also to show that you're listening.

To listen properly, you need to give your full attention to what your friend is saying. It is important not to be thinking about how you are going to reply. You are not really listening to them if you are rehearsing what you are going to say next. It is also very important not to interrupt. While they are talking, don't talk yourself but wait for them to stop speaking before you start. If they interrupt you while you are saying something with a 'but' or 'I thought' or something similar, you should stop and let them carry on.

Good listening doesn't mean just sitting there like a running tape-recorder. You can actually help the person who is ill talk about what's on their mind by encouraging them. Simple things work very well. You can try nodding, or saying things like 'Yes', 'I see' or 'What happened next?'. These all sound simple, but at times of stress it's the simple things that can help.

You can also show that you are hearing, and listening, by repeating two or three words from the person's last sentence. This helps the person who is talking to feel that their words are being taken on board.

You can also repeat back to the talker what you've heard – partly to check that you have got it right, and partly to show that you are listening and trying to understand. (You can say things like ‘So you mean that...’ or ‘If I've understood you, you feel...’)

If someone stops talking, it usually means that they are thinking about something painful or sensitive. Wait with them for a moment – hold their hand or touch them if it feels appropriate – and then ask them what they were thinking about. Don't rush it, even if the silence does seem to last for a long time.

Another point about silences is that sometimes you may think ‘I don't know what to say’ (as James did in the example on page 5). This may be because there isn't anything to say. If that's the case, don't be afraid to say nothing and just stay close. At times like this, just being there, a touch, or an arm round a shoulder can help more than anything you say.

Sometimes, non-verbal communication (communicating in ways other than words), such as the way a person holds their body or how they move, tells you much more about the other person than you expect. Here is one example from a doctor's experience:

‘Recently, I was looking after a middle-aged woman called Gladys who seemed at first to be very angry and uncommunicative. I tried encouraging her to talk but she kept very 'wrapped up'. During one interview, while I was talking, I put my hand out to hers – rather cautiously because I wasn't sure it was the right thing. To my surprise, she seized it, held it tightly and wouldn't let go. The atmosphere changed instantly and she instantly started talking about her fears of further surgery and of being abandoned by her family.’

With non-verbal contact, it can be helpful to try it and see what happens. If, for example, you touch the person with cancer and they pull their hand away or look uncomfortable, you can draw back and give them space. This doesn’t harm either of you.

You are allowed to say things like ‘I find this difficult to talk about’ or ‘I'm not very good at talking about...’ or even ‘I don't know what to say’.

Acknowledging feelings that are usually quite obvious to both of you (even if those feelings are yours rather than your friend's) can help your conversation. It may reduce the feelings of awkwardness or embarrassment that we all feel from time to time. This can improve communication between you.

If you are sure that you understand what your friend means, you can say so. Responses such as ‘You sound very low’ or ‘I imagine that must have made you very angry’ are replies that tell them that you've picked up the emotions they have been feeling while they were talking. But if you're not sure what they mean, you can ask: ‘What did that feel like?’, ‘What do you think of it?’, ‘How do you feel now?’ Misunderstandings can occur if you assume that you know how they are feeling. Saying something like ‘Help me understand what you mean a bit more’ or ‘I'm not sure that I know how you feel’ can be useful.

If your friend wants to talk about how dreadful they feel, it is important to let them. It may be distressing for you to hear some of the things that they are saying. However, it can really help them if you are able to stay with them and just listen while they talk. If you find it too uncomfortable, and think the conversation is too difficult for you to cope with at that moment, you can say so and offer to discuss it later. You could say something very simple, such as ’I am feeling a bit emotional at the moment and it is hard for me to talk about this now – but I would like to talk to you about it later.‘ Don't simply change the subject without acknowledging the fact that what your friend is talking about is very important to both of you.

When you friend brings up the subject of their cancer, don’t immediately start talking about someone else you know who has, or had, cancer. This moves the focus away from the person you are talking to – it is important to keep them as the focus of your attention.

Ideally, no-one should give advice to anyone else unless it is asked for. However, this isn't an ideal world and quite often we find ourselves giving advice when we haven't really been asked. Try not to give advice early in the conversation, because it stops two-way discusion. If you can’t stop your self giving advice, it's often best to use phrases like: 'Have you thought about trying' or 'A friend of mine once tried'. Those are both less bold than: 'If I were you I'd', which makes your friend think (or even say) 'but you're not me', which can really stop the conversation.

Many people imagine that there cannot possibly be anything to laugh about if you are seriously ill or dying. However, they are missing an extremely important point about humour. Humour is a very helpful way of coping with major threats and fears. It can allow us to deal with or get rid of intense feelings and to get things in perspective. Humour is one of the ways that human beings deal with things that seem too impossible to cope with.

Generally, the most common subjects of jokes include mothers-in-law, fear of flying, hospitals and doctors, sex and so on. None of those subjects is funny in itself. An argument with a mother-in-law, for instance, can be very distressing. However, arguing with the mother-in-law has been an easy laugh for stand-up comedians for centuries. This is because we all laugh most easily at the things we find most difficult and distressing. We laugh at things to get them in perspective, to reduce them in size and threat.

One woman in her early forties needed to have a catheter (tube) in her bladder as part of her treatment. While she was in hospital she carried the drainage bag like a handbag, and used to say loudly that it was a shame nobody made a drainage bag that matched her gloves. Out of context that may sound ghoulish. However, for this particular woman it was a way of dealing with a very distressing problem. It showed her bravery and wish to rise above her physical problems.

Laughter can help people to feel they are more in control and able to deal with their situation. If your friend wants to use humour – even humour that to an outsider might seem grim – it is helpful to go along with it. It's helping them to cope. This does not mean that you should try and cheer them up with a supply of jokes: this won’t work. You can best help your friend by responding sensitively to their humour, rather than trying to set the mood with your own.

Many people think that being positive can help to cure cancer and are afraid that feeling sad or having negative thoughts or emotions may slow their recovery or make the cancer grow faster, or be more likely to come back. This is not the case. It is natural for people to feel frightened, upset and sad when they have been diagnosed with cancer or are having treatment.

Although the development of cancer may be influenced by our thoughts, feelings and attitude, it is also influenced by many other things such as our environment, our diet, and our genetic make-up.

It is important to remember this, because if you believe that your friend needs to be positive to get rid of the cancer you may think, if it comes back, that it is their fault because they were not positive enough. People sometimes put unfair pressure on their friends or relatives by saying that if they fight hard enough they can overcome cancer. If their cancer does come back or cannot be cured, it is not their fault: it is because cancer is a very complicated illness and modern treatments cannot cure all cancers.

Even when people have finished treatment, they will still have times when they feel very sad and worried, and find it difficult to enjoy life. Being positive does not mean feeling happy and cheerful all the time. It is actually a very positive thing for you to acknowledge with your friend that they will have times when they feel tired, anxious, depressed or angry.

It is important to allow your friend or relative to say if they feel low or tearful, and to be willing to talk about difficult topics such as the chance of the cancer being cured or making a will.

It can be tempting to try to cheer them up by saying things like ‘Oh, don’t worry it will all be OK’ or ‘Of course, the cancer won’t come back, try and be positive’, but this is actually stopping them from being able to discuss how they really feel and it is better to acknowledge their emotions by saying things like ‘I can understand you feeling low, it is very difficult to go through all this treatment and I can imagine that you must be very tired’, or ‘I know, it is very hard to look ahead when you are not sure what will happen’.

If your friend cries, don’t try and stop them, but say something like ‘It’s OK, it's fine, it's good to cry’. Tears are a natural response to distress – they may be a very important release for your friend. Although you may find it upsetting to see your friend cry, it is important to remember that all feelings and thoughts pass, and they will feel better at some time in the future.

Sometimes when people are very ill, beliefs they have had all their lives may start to be challenged. If you feel that you are not able to deal with your friend or relative's religious or spiritual concerns you can get them to speak to a religious or spiritual advisor. If they are in hospital or a hospice, there should be a chaplain or spiritual advisor available for people of most religious or spiritual beliefs.

To summarise, the aim of sensitive listening is to understand as completely as you can what the other person is feeling and to tune in to their thoughts and feelings as fully as possible. You can never completely understand another person but the closer you get and the more you understand them, the better the communication between you and your friend will be.