by Karen J. Miller, MD
Developmental-Behavioral Pediatrician and Symposia Medicus faculty member Dr. Karen Miller shares her insight on ways healthcare professionals can help parents address behavior or conduct problems with their children.
Did you ever wish there were magic words? Actually, there are. I have been a Developmental-Behavioral Pediatrician for more than 30 years and my heart still skips a beat when a parent blurts out, “But how do I make her stop doing __!” When I first started doing behavior counseling, I would jump in and start listing things they should do. Eventually, they would leave and I would feel good about my evidence-based advice. I don’t know how the parent felt. Probably worse.
Then I started using the “Magic Words.” I learned to pause, make eye contact with the exasperated parent, and lean towards them expectantly. When they finished their tale there would be that moment of silence. Then I would say, “So, what I hear you saying is, it feels really aggravating (upsetting, disappointing, etc.) when you tell them something and they don’t do what you ask.”
If you captured the feeling, they will say, “That’s right” and their body will be a bit more relaxed. If you missed the point, they will say, “that’s not it, it’s that …” You wait and then repeat the magic words, “Oh, so what I hear you saying is…” and you validate the feeling. You have listened with empathy. Why is that magical? Because people cannot listen until they feel heard.
I bet you are thinking, “I don’t have time to deal with this!” I have a surprise for you—you have already made a difference. By being fully present and by showing that you have really heard them, you have established a therapeutic alliance. You have just increased your credibility and their receptiveness to any advice that follows. My advice is: avoid giving advice. Hand the problem back to them.
Often at this point, I will turn to the child who is listening uncomfortably to this exchange. “So, what I hear is that it can be really hard for you to listen the first time, remember to use kind words, etc. I hear that from a lot of families.” What you have done is validate the child’s experience without blaming them and modeled including the child in the conversation. You have normalized the situation for both the parent and the child. Now you can move on to helping them solve their problem.
You have three choices: confer, defer, or refer. If you have a little bit of time, you can confer with the parent and the child and facilitate their problem-solving. You can model being inquisitive or coach the parent now that they are less emotionally aroused. Try the phase, “I wonder.” You might ask the child, “It sounds like some mornings are difficult at your house. I wonder what you think your Dad might do to make things easier.” Coach Dad to use the magic words, “What I hear you saying is …” instead of defending himself. See if you can get them to agree on ONE thing to try for ONE week. You have handed the problem back to them.
What if you don’t have time right then? You may want to defer to another time. “This is important to talk about and I’m glad you shared this with me. Let’s schedule another appointment to talk about this.” You may want to give the parent a “homework assignment” in empathizing first then giving a directive. For example, “It is hard to stop when you are having fun. It is time to…” Children love when you give homework to their parent.
What if you need to refer for counseling by someone else? Some practices have found that having a mental health professional co-located, seeing clients in the same office space, increases the acceptance and success of the referral. Know your local resources. Have a short list of referrals that you can print out. Circle two of the names and recommend that they “start here.” Write down what they should ask for, such as, “advice on improving bedtime.” Did you know that simply writing anything on a handout increases its impact?
So what I hear you thinking is, “It can’t be that easy.” If you don’t believe me, try it. I think you will find that listening with empathy really is magical.
Ask an expert! Dr. Miller will continue the quarterly column, Behavior Matters on Symposia Spotlight. Please send your questions for Dr. Miller to firstname.lastname@example.org.
Dr. Miller is a Clinical Professor of Pediatrics and Developmental-Behavioral Pediatrician at the Center for Children with Special Needs, Tufts Children’s Hospital (formerly the Floating Hospital for Children), Tufts Medical Center in Boston, Massachusetts. She lives in Brookline, Massachusetts.