But I Don't Want to Talk About It! The Importance of Honest Communication
By Foster Cline MD and Lisa Greene
Death, dying, illness. These are some issues that we don’t want to talk about. Maybe we hide from them. Maybe we change the subject or avoid them. And sometimes such reactions in given situations that can’t be changed may be healthy. Denial and a wish not to talk can serve important purposes. And denial in the face of certain unchangeable situations may be a person’s acceptable way of coping. We have found that the wish not to talk about death or dying may simply be the ill person’s way of protecting the healthy person.
Sometimes, though, problems that are not addressed can grow, cause misunderstandings, and isolation. In Foster’s medical practice, he found that dying patients wanted to talk about their feelings and their thoughts of death. But often family members cannot handle such discussions, so they are carried out with strangers. And on the cancer ward, children faced their deaths with more straight-forward bravery than many of their parents.
Medical adherence can be impacted if a child doesn't receive honest communication about the possible consequences of poor self-care. On the web, parents of kids with diabetes commented, "I refuse to use the threat of blindness or the loss of a limb to scare my child into compliance!" And we agree. Threats and scare tactics are not appropriate. However, children do need to know the truth presented in a caring, age-appropriate, and matter-of-fact manner so that they can be empowered to make good choices.
Frequently, we don’t communicate with each other about difficult issues because “I don’t know what to say!” or “I don’t know how to say it!” Chapter Seven in Parenting Children with Health Issues thoroughly discusses seven important considerations when talking about really tough subjects whether they are the death of a loved one, illness or an impending divorce:
1. Before you give answers, ask yourself: whose needs are you addressing - yours or your child’s?
2. Consider whether you are giving more information than the child wants or needs to hear.
3. Be open to your children talking with you about anything and everything.
4. When you are not sure how to give the answer, ask more questions.
5. Recognize that sometimes your child is trying to “protect” you.
6. Show acceptance even when you can’t show approval.
7. Every answer dealing with life-and-death issues should leave room for hope.
Now, let’s deal with the “I don’t know what to say” issue. Surprise!! You don’t need to know what to say! The average therapist doesn’t know what he or she is going to say before they see the client. And yet most are very helpful.
We don’t mean to make light of the fact that every situation is unique. But having said that, there are some steps that may help guide you:
1. Start with a general question: “How are you feeling?” Then follow the key word from your child’s reply with another question.
2. Show real interest and/or curiosity with your second question by again following the key word.
3. If the first two questions lead no where or are not productive, try one door opener to the difficult subject: “Sometimes people in your situation worry (think about, etc.) about…”
4. If the person still doesn’t want to talk about the looming issue, death, or dying, respect his or her wish.
Here’s an example of how this approach might sound. The key words are in italics:
“So Ricky, how are you doing?”
“Oh, okay, I guess.”
“Um……. What’s the ‘I guess’ part?”
“I don’t know.”
“Maybe you know but you’d rather not talk about it. I can understand that.”
“…I just think I worry a lot…”
“Worry? How’s that? Like if you won’t be getting better, that type of thing?”
“Well, that’s understandable in your situation. When you worry, do you want to tell me what you think?”
Notice the mom or dad, brother, sister or friend didn’t say, “Oh, don’t worry” …
Generally if you show a willingness to talk about the difficult issue, you will be rewarded with conversations that will bring you closer, lead you to be even more compassionate, and help you grow as you, too, must face ultimate questions.
From the book “Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Special Healthcare Needs” by Foster W. Cline, M.D and Lisa C. Greene.
Dr. Cline is a child psychiatrist, author, and co-founder of Love and Logic. Lisa is the mother of two children with cystic fibrosis and a parent coach. For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com.
Copyright 2009 by Foster Cline MD and Lisa Greene. All Rights Resrved.
Foster Cline MD and Lisa Greene