Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Very often on this podcast, we address the unique needs of the sandwich generation. That's the generation that's working, raising children, caring for itself, and potentially also caring for elders.
In the middle of that, we're also developing and maintaining friendships. While these friendships can be the very thing that help to keep us feeling supported and connected, they're very often what falls through the cracks—often because of poor communication, life changes, or even creeping resentment.
Today we'll explore this layered topic of friendship, communication, and emotional health. We'll ask tough questions like why jealousy may creep into friendships and how to spot the warning signs that a slow drift is turning into a silent goodbye.
We'll explore practical tools drawn from individual therapy and group workshops to inventory and acknowledge changes in ourselves and changes that might be happening in our friendships.
We'll also talk about methods for engaging our friends in moments when we might have potentially previously ghosted them or let the relationship fade away. And we'll identify potential shifts in our cultural scripts to establish and maintain a supportive community of friends as we age. To walk us through this topic is Lia Love Avellino.
Lia Avellino is a licensed clinical social worker, modern love therapist, writer, commentator, and community organizer. Lia is the Director of Head and Heart at The Well, a global ecosystem for wellness. Lia is also the host of the Unprocessed podcast. Welcome to the WebMD Health Discovered podcast, Lia.

Lia Love Avellino: I am so glad to be back with my WebMD family.

Pathak: So I'd love to hear about what you are hearing in your work when it comes to women in this generation and how their friendships are changing and shifting over time.

Avellino: Yes, this is a topic that people bring into therapy and support circles a lot, and I think friendship is complex for a few different reasons. As we inch towards midlife, the first thing that people are reporting is caregivers are very taxed right now. We have responsibilities for our elder parents, especially as people choose to have children later in life. We have young children, we have jobs, and what typically happens is we tend to prioritize the "have to’s" over the "want to’s."
So we're so focused on all the things we need to check off our lists because anxiety tricks us into thinking, If I get through this list, then I'll finally feel better. However, as I'm learning—and many of my patients—we never get through that freaking list. It just continues to grow.
So these "want to’s," these more optional, quote-unquote, things like friendships, tend to go to the wayside.

The second reason is there is no contractual obligation for platonic friendship. So unlike those who choose to get married or have a job, there's a commitment that's required. And so sometimes we show up even when we don't want to because we have to. But again, some of these things—where there is no code of ethics, there is no defined agreement—it can get a little bit messy as our circumstances change and our needs change.

The other thing is that even while we're experiencing all these life demands, what we're learning from the data is people are very lonely. Sixty-five percent of parents report feeling like they don't have connection, that they're isolated, and they feel lonely most of the time—or sometimes. Forty percent say they do not have support in the parenting role.

And what we're learning from social trends is typically people feel like they need to rely on their partner. We have this idea in our society that our partners should meet our emotional needs, and all of our messiness should be dumped on our romantic relationships. Friendships are the thing that should remain easy and untouched—this should be fun all the time—but that's a major misconception.
Our needs need to be distributed across multiple people and sources. And friendships, if you're doing them right, I'd venture to say, should be messy.

Pathak: I'd love to kind of build on that point because you describe midlife friendships as essential. So getting to your point around having so many demands on us, that this is sometimes an outlet for us where we can feel supported but also fraught. So tell us a little bit about what makes this life stage uniquely challenging for women's friendships compared to what we're thinking about in our teens or early twenties.

Avellino: So a few different things happen socially and culturally. Midlife is a huge reflection point. It's a time where many of us look back and we realize, Wow, we're getting towards half of our time on this planet—if we're lucky.
And we did all the things right. We may have picked the partner, picked the job, had the kids, followed all of the societal rules.
And because we did that, we're now at a developmental inflection point where we can say, Wait a second—who am I? What's happening? Why am I spending time with these people? What the hell do I actually want?

And so midlife in psychology is often compared to adolescence because it's this time where we notice we have an increase in needs because we feel more lost, we feel more uncertain—but we're also ambivalent about how we feel about that.
A part of us is like, Ugh, I don't want to have these needs. I don't want to have to fall apart. I don't want to have to be moody all the time in this perimenopausal, angry state, right?
And so we're having an increase in needs, and the old ways of being no longer work for us—but we also have all these demands on us. So we don't really have time to negotiate all of this.

And what I find happens in these midlife friendships is sometimes people just withdraw. We've punted on the coffee date, or we've had unfulfilling conversations, or the jealousy has built up. And because there's so much of the implicit that hasn't been made explicit, we just sort of retreat rather than lean into that conflict.

The second trend that's very different is: when we're younger, there's way more predictable spaces for gathering. So, for example, if you go to an institution like college, you're meeting on the quad, you're having those lunches—it’s sort of expected in this exploratory time of life that your friends are part of the center of your world.

As we get older, we take varied paths, and many of us learn that closeness is dependent on sameness: that moms should be friends with moms, that 20-year-olds should be friends with 20-year-olds, that we should stay in the bubble we know.
When really, I'd venture to say that closeness has nothing to do with sameness. It's just about how the differences get negotiated and addressed—how the needs get communicated about.

Pathak: How do you best encourage people to think about ensuring that they make the time for friendships? And then we’ll get to the second piece of that: how to make that time high-quality time with their friends.

Avellino: I love that you said that second piece, 'cause I think sometimes that's why the first piece doesn't happen, right? So if someone's asking me to hang out and I keep delaying it, there's often a reason why. Sometimes it's the realities of my life, but sometimes it's because there's something in that connection that just doesn't feel so good.
So the first thing to do is look at what you value. One thing I notice about people is they'll often say to me things like, I value connection, and then I'll ask a question: So how much time do you give towards connection in a week? And what we find is they gave to their dog, they gave to their kid, they gave to their exercise.
They didn't give to that nurturing connection. So really getting curious about what do I value, and am I living my life in accordance with those values?
The second thing is asking yourself, what is getting in the way? If I'm not, is it a belief system where I prioritize my partner's needs and my children's needs over my own?
Is it that my relationships no longer fit as I've gotten to midlife and I've just been avoiding that because it feels too hard to grieve? Is it because I'm in a different life stage than many of my friends?
So I often hear, for example, that people without kids remain connected mostly to people with children and then feel isolated. And that's an opportunity to not abandon the people with children, but also add people who are living life in a similar way.
So really getting curious about what's getting in the way, and then figure out how to tweak what feels misaligned and prioritize it in a way that does feel aligned.
So for example, at this time in my life, nights are really hard. I don't sleep very much. I, you know, I notice my energy is really low at night.
So when I'm prioritizing my friendship, I know it's gotta be after a workout class for an hour. I know it's gotta be a 7:00 AM Daybreakers dance party. I know if it's a dinner, I need a month in advance.
So I'm really realistic with myself about what my capacity is, and then I'm really transparent about communicating that capacity so my friends don't take it personally.

Pathak: So then there seems to be a piece that's also taking an emotional inventory. So you've made the time, you've made space in your day, but how do you sort of then take an inventory of yourself to feel out who's going to be, or what part of your life is gonna really add that quality connection that's gonna make that hour that you're gonna spend meaningful for you?

Avellino: That's a beautiful question, and one thing that I find that gets more complex in midlife is we really start to differentiate and feel the difference between socialization and connection.
And socialization is something that we have a much bigger bandwidth for because we have less demands on our time when we're younger.
But as we get older, if that connection doesn't feel worth it, it often doesn't get prioritized.
So one question that I work with my community around is: Does this friendship feel right for this time in my life? And if it doesn't, what do I wanna do about it?
And there are choices. We are a culture, which you and I talked about at another ending, that's very ending-phobic.
So sometimes friendships really do have a beginning, a middle, and an end, and that that friendship has run its course and that that needs to be addressed.
The second piece is that sometimes this is just a reevaluation point. Maybe there's jealousy that has creeped in or envy. Maybe there's some way that that other person is living that brings up something you want, and that because you haven't shared that, you're retreating from that person.
Maybe you're experiencing something called intrapsychic grief, where you were on the same path as your friend, and now you're really grieving and letting go of the way you thought it would be—where they had a child, or they got married, or they got a big job and they're no longer available.
So their transition was a loss for you that you never got to grieve alongside them.
So I think if it's not feeling quality, it's getting curious about why. And oftentimes we wanna withdraw from those uncomfortable conversations because we believe that friendship should be fun and easeful.
But those are actually the moments that you should lean in, in my opinion—that if you don't address that discomfort, it will surely lead to an ending. It's not about if, it's just when.
Whereas when you address the discomfort and normalize it, that's when new opportunities can happen and you can ask yourself: Does this friendship actually have a second shelf life?

Pathak: So can you talk to us then a little bit about how to have this conversation with your friend? Because just like you say, you may have certain expectations of what a friendship should be in terms of being light and just sort of a place where you go to find support, and it should be easy.
Your friend may have that same sort of construct of what a friendship is and what time together is. So how do you suggest having this type of conversation?

Avellino: So the first thing I would pay attention to before you have it is what's going on inside of you.
So getting really clear on your own data points. Are you feeling resentful? Are you the one that's always bending, always reaching out to make plans, always flexible? Are you feeling envious? Are you feeling bored?
So just getting curious about what my experience is.
'Cause oftentimes when we're hurt by someone or feeling disconnected from them, we focus more on their behavior than getting clear about what's real for us.
So start with you.
The second thing is, oftentimes by the time a friendship doesn't feel good, you've been swallowing your feelings for some time.
So what that means is that you might wanna share with that person everything that's been on your mind and the 10 things that they've done wrong and really like feel so invigorated.
So before we do that, really get clear on: What is my bottom line? What do I really wanna communicate to this person?
And then ask them when they have space to have a conversation about the friendship, and put out your most important point: I'm feeling like the friendship isn't feeling good anymore. I haven't been feeling close to you. So much has changed, but we haven't really talked about that.
So really using I voice, being clear about what you feel and what you need, and making space to ask what the other person feels and what the other person needs.
And be aware that oftentimes we have assumptions. We might think someone doesn't wanna hang out with us or is not feeling connected to us because of something personal.
Meanwhile, they're going through a dark time in their life and they've just been too embarrassed to share.
So just really go in with an open heart and mind.

Pathak: And can you talk a little bit about the intrapsychic grief you were mentioning before—where being aware of this change or this shift, being able to go through a grieving process if things are changing, even if you're still maintaining that friendship, it may have changed?
How do you think about dealing with that grief?

Avellino: Unnamed grief is one of the biggest destructions of women's relationships. I've done therapy between friends before, which is a really beautiful practice.
Oftentimes people think they just have to come in with their couple, their partner, but you could bring your friend in to work through these challenges too.
And so when we experience a life change that's exciting or new—like getting married or getting a new job—our friend experiences a loss.
And that is something that we need to make space for because as our circumstances change, our needs change.
And if that grief doesn't get expressed, it often leads to distance.
So having a conversation that normalizes: I'm so happy for the wonderful things in your life, but I'm so sad that we're not having drinks every Friday at 6:00 PM anymore. And that when I'm with you, you have a baby strapped on your chest, or your attention is different, or your availability is different.
So naming it actually allows it to soothe and act as a balm for the relationship.
Not naming it is what leads to the disconnection.
So we talked in a past episode, Dr Pathak, about a good goodbye, and I believe we have to honor our past selves in our relationships—I'm not who I was, and you're not who you were.
Can we try to figure out who we are now and what we need from each other in a mutually respectful and beneficial way?

Pathak: I think that's really powerful, and it brings me to another question, which is when it does get to the point of you are recognizing in yourself, or the other person is recognizing in themselves, that this is time for a good goodbye—that this might be a friendship that had its beginning, had its middle, and perhaps it is sort of ending.
You know, we've also talked about ghosting in friendships and relationships.
So do you need to have a good goodbye in these situations because it's gonna be helpful to you in the future with other friendships, with your own feelings?
What is the reason for trying to close it more formally than perhaps just recognizing that a drift has happened and you've sort of just moved along with it?

Avellino: That's a great question. So oftentimes if a drift has happened and we've moved along with it, right, there's been enough distance in the relationship for one or more of the parties to be accepting of that fact. However, if this is a more long-term relationship, having a good goodbye and really ritualizing that ending allows us to feel better about it.
Ghosting at the end is often because we feel some guilt. So if you're retreating from a friendship and you're feeling guilty, and that's the reason why you're not honoring it and saying, "Hey, this doesn't fit for me anymore. This is what I appreciate about our time together, but I'm gonna go off on my way,"
That's allowing you to have a connected no. It's something that Priya Parker, who focuses on gathering, uses—that term of saying, no, I don't want this, but I'm gonna do it in a way that really honors the relationship by saying, I'm connected to you and I value you. I just don't want to continue this path with you.
But before we get to that ending, I like to go to and through an inventory of, have I tried? If the relationship is long-term, it can be possible that this is just a stage of distance. For example, there was a time in my life where I was having multiple babies and I had a friend that was having multiple miscarriages, and we decided to take a break.
There was mutual love there, but the relationship was very painful for her. So there's all different types of endings. There's breaks, there's pauses, there's full endings. There's open-door endings, there's closed-door endings when there's been more harm or hurt. And so I think it's okay to sort of check in with yourself and ask yourself: Have I invested what feels appropriate to the type of connection we had in this goodbye?
And if not, when I look at my future self, how will I feel if I look back at this relationship as ended? Do I think my future self will be okay with that?

Pathak: You know, as you're talking, what I am thinking about is really introducing vulnerability into your conversation as well. You just don't know necessarily what the future of this friendship is going to be, so I think sometimes thinking that you're going to say goodbye in some ways might be hard, whereas you may be just sort of opening with vulnerability—that I'm feeling sad, or I'm feeling like I have a lot going on in my life right now that I'm struggling with.

Pathak: Allowing your friend to see that. And then if you feel like this might be a time to just sort of take a pause or a break because of what you are going through, I would love to hear a little bit more about your thoughts on how to have this conversation.

Avellino: Yes. I love your idea of leaning in with vulnerability and starting with the "I," because every dynamic is co-created. So as soon as we change the way that we are showing up, the dynamic changes—and that has room for possibility.
So starting with how you feel and advocating for your needs can be a determining factor if that relationship has a longer life, right? Because oftentimes we don't advocate for what we need, and then we just end it because we believe that that person should anticipate our needs. They've known us for 10 years. They know what a hard time we're going through, right?
But we've all got our own internal world and demand. And while I believe that it's our right to have those needs met, it's also our responsibility to own them.
So the "it's not you, it's me" allows us to say, this is what I need. I don't know if you can meet those needs, but I'm gonna put that out on the table because this relationship feels worth fighting for.
And what I found as a couples therapist is not all needs need to be met, but all needs need to be stated and understood—because that's what leads to resentment. When we keep it back, keep it back, keep showing up, and then suddenly we don't wanna hang out anymore.

Pathak: Can you talk about some of the external factors that can also put pressure on a friendship, whether that's cultural or social expectations?

Avellino: Yes. I think this is really important because oftentimes when we're blaming the person, what we're not doing is looking at the system that's bearing down on the relationships—that are making the conditions.
So for example, we live in a country that really prioritizes the nuclear family. We're separated out into individual homes in many communities. We are incentivized by the state to marry. We get plus-ones to weddings, and the assumption is that you bring your romantic partner—not a friend. And so all of this has led to us deprioritizing friendship in many ways.
And it might also make people with kids feel like they're the ones that don't have to be flexible.
So looking at those forces allows us to get curious about what's maybe not individual fault, but what's an absorption from our culture that we can interrogate together—which reduces blame.
We also live in a culture that really promotes independence, right? I've been a therapist for 10 years, and it is still shocking to me how hard it is for us as humans—because of our early experience with dependency, and it maybe disappointing us—to really own that we need people. That healing happens in connection, and pain thrives in isolation.
So living in an individualistic culture may make it hard for us to pick up the phone and be like, Hey you, I need you. Get in your car and come here. I just had a breakup. No ifs, ands, or buts, right?
And really owning that need can be hard in a state of individualist values.

You've also written about the jealousy-shame loop, and you mentioned earlier, we can have some envy in our relationships, and that happens with all of us. It's normal sometimes to recognize, oh, they went on this vacation, or oh, they got this job promotion.

Pathak: But how can you make sure that you're checking in with yourself—that that feeling is not becoming something that is toxic, that might poison your relationship? Can you talk a little bit about that?

Avellino: I love this question because envy is something that people bring into therapy with a whisper. They don't wanna admit that they feel it, right? And we get this—it's one of the seven deadly sins. Whether you're religious or not, you've been probably raised with this idea that envy is not good, right?
But the way that I look at it is that anything that we feel shame about is gonna have a more destructive edge to it. So if you feel shame about your envy and you conceal it, you don't investigate it in yourself—so it doesn't point you to what you need to get from it. And you also don't talk about it with your friend, which creates that chasm.
So envy to me is an indicator of something you want, something that you are longing for, and oftentimes we position that envy in the person that has the thing that we want, and we start to develop negative feelings about them.
But if you bring envy back to you and get curious about it rather than shameful, it is an invitation to not settle for things the way they are—to advocate for change in your own life.
So really having a more positive attitude towards envy allows you to do something with it, continue to go towards and fight for the things you want.
It also can feel like a huge relief to name it out loud. So for example, when I was having a hard time conceiving my second kid, I named to a friend like, Oh, I'm just so envious that this was so easy for you. I'm so happy for you. And I just, I really wish that I was on that same path. And she gave me a huge hug and I cried and I felt closer to her.
So again, leaning in rather than away from these sort of dirty, negative, quote-unquote shameful things actually has the power to increase our bonds.

Pathak: Just such a great conversation. So finally, if a listener takes away sort of one script flip that could make their friendships more resilient in the way that you've been talking about — through vulnerability, opening up, naming some of those dark feelings that we're having through life’s next big transition — what would you want that script flip to be?

Avellino: So the script flip would be that friendship takes work, renegotiation, transparency, leaning into that discomfort. And if we do, we reap huge benefits for ourselves, our family, and our community.
And there's an amazing book that I love called The Other Significant Others that really catalogs centering female friendship in your life rather than romantic relationships and all the benefits about that.
And what I would want to invite listeners to do is allow yourself to just fantasize about repositioning friendship at the center. What if you shared your credit card bills with your friends? What if you shared parking or car responsibilities with your friends? What if you shared nighttime bedtime routines with your children—with your friends?
And again, this isn’t to say that you should, but just allowing our mind to start to think of things in new ways creates new possibilities.

Avellino: And really owning and leaning into that need, rather than shying away, can create some amazing connection.

Pathak: Thank you so, so much for being with us today. I really appreciate the conversation.

Avellino: I loved being with you as always, and I'll see you next time.

Pathak: My key takeaways from this discussion are that friendships are essential for our emotional health and wellness. Most of us recognize that. They're not a luxury or an afterthought, even though most of us probably also don't invest as much time into our friendships as we should.
If we don't say the hard thing, it may inevitably erode a friendship, so it's crucial to make the implicit explicit.
We invest in our friendships when we check in with ourselves—our reactions, our resentments, our needs—and communicate those effectively with our friends.
And it's important to remember that our needs need to be renegotiated as our circumstances change throughout our lives. Relationships are meant to be dynamic and evolve as we grow and change.
So, really important that we give ourselves and our friends grace as things shift.

To find out more information about Lia Avellino, make sure to check out our show notes.

Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform.
If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered Podcast.