Step 5: Building healthy narratives: what conversations might look like
Parents have often told me that while it’s helpful talking about what to do, they often struggle with what to actually say. Below, the first two examples present parents who are quite successful addressing their child’s needs and feelings while also helping construct healthy narratives. But let’s be real here. Everyone screws up and says the wrong things and tries to recover after stumbling. So I’ve included a third example that portrays a parent as he struggles and slips up before finding his way.
James: building healthy narratives over time
The scene: three-year-old James needs to have some blood drawn. His mom holds him still while the nurse unsuccessfully searches for a vein. After a number of pokes, the nurse calls for a phlebotomist who specializes in taking blood from small children. James and his mother wait for the phlebotomist to arrive. James has been crying and his mother tries to soothe him.
Parent:
I know, I know. This has been really scary. And I’m so sorry I’ve had to hold you real tight. I know your arm hurts and that you’re still scared. I’m here, and I’m going to make sure that you’re okay. [The phlebotomist enters.] And now here’s someone different. I know it will hurt again, but only for a short time, and I’m here to make sure you’re okay.
This mom is in a tough position. She can’t actually protect her child from more needle sticks. Appealing to James’ intellect—for instance, explaining what’s happening and why—certainly won’t help because James is too upset. And voicing James’ emotions at this point probably won’t do much either. The only thing she can do is reassure him. They just have to get through the blood draw and hope the phlebotomist is good at finding a vein.
Later that day or the next—when the mom feels James is recovered a bit and open to talking—she’ll need to revisit the scene.
Parent:
Remember this morning? How the doctor needed to look at some of your blood? I want to tell you more about that. I know it hurt you and that it was scary. And that I had to hold you tight. But you did it, right? You got through it. Now, look at my arm for a second. [She shows him her arm where there is a subtle vein at the crook of her elbow.] See that bump? That’s a vein. Veins help our blood go all around our body. My veins are big, but yours are small. The nurse had trouble finding your small vein. And so it hurt each time she used the needle. [James starts to look scared.] We’re not going back. There’s nothing to worry about. We’re just talking, we’re not doing, so no need to be scared. [James looks a little relieved.] It doesn’t hurt anymore. It’s like when you scrape your knee. It hurts for a little bit, but then you’re better. You’re strong that way. [James reaches up for a hug, suddenly needing reassurance.] And I was there, wasn’t I? I’ll always be there when you need me. I’ll always make sure you’re okay.
Here, the mom first speaks to James’ feelings, then gives him information about what happened and why. It’s not surprising that as she talks, James remembers the event and becomes afraid as he relives it. Seeing this, his mom reassures him and speaks to this fear. She also reinforces an important, related narrative: talking is safe and separate from the actual event; talking will not physically hurt him. She not only recognizes her son’s feelings, she builds a narrative around his ability to manage the pain and the fear because he’s strong. Interestingly, James reacts to this by needing a hug. Not only has he hit the limit of what he can absorb, he seems to be telling his mom that he still needs her, as if his own strength might make his mother unnecessary. He’s not ready for this kind of independence and, recognizing this sentiment, the mom reassures him that she’s not going anywhere.
The next night, James adamantly refuses to open his mouth to let his mom brush his teeth. She tries cajoling, and when this doesn’t work, she’s about to try humor, but then stops herself. Something feels off. He’s never had issues with tooth brushing. This behavior is not only new, it feels sudden and intense. Then something occurs to her.
Parent:
Wow, you don’t want me to brush your teeth, but maybe it’s that you don’t want me to put the toothbrush in your mouth. You want to have control over who puts things in your body. That’s okay. It’s your body, and you get to control a lot about it. But when it comes to health and safety, because I’m your mom, sometimes I have to be in charge of your body. Like when I held you and let the nurse draw some of your blood.
James:
[makes a pouty face] Bad Momma!
Parent:
I know. You were mad at me. I can understand why. I let them do something that scared and hurt you.
James:
Bad, bad Momma!
Parent:
It’s okay to be mad at me. I was helping the nurse, and it didn’t feel like I was helping you. That was confusing, because moms are supposed to help and protect their kids. It’s hard to understand right now, but I was helping and protecting your body even though it didn’t feel like it. Now, how about you hold the toothbrush with me so that you get to decide which teeth we brush? You show me where and we do it together.
Something important happens at tooth brushing. When James protests, his mom understands the protest in context of the recent trauma. Had she missed this and insisted James let her brush his teeth, she would have reinforced a narrative that James is helpless and has no agency over his own body. Now, just as James didn’t want a needle going into his arm, he doesn’t want a toothbrush going into his mouth. To adults, this doesn’t make much sense intellectually—needles into arms does not equal a toothbrush into the mouth—but James is using an emotional logic here. The two acts feel the same. His fear of tooth brushing also suggests a forming narrative in James’ mind: I don’t want anything going inside me, he might decide.
Addressing his emotions before his intellect, the mom first voices James’ need for control before explaining that with health and safety, she needs to control things. Then she confronts the elephant in the room—the blood draw—so that James can vent his feelings, and she can demonstrate how she accepts them. She also acknowledges how she colluded with the nurse: “I let them do something that scared and hurt you,” she says, adding, “I was helping the nurse.” She keeps her messages very short, quickly emphasizing a few narratives—I accept your feelings, you’re usually in charge of your body, and I’m helping and protecting you even though it may not feel like it. Then she pulls James back to the present task. By offering a creative solution in which James can direct the tooth brushing, she helps him feel that he has some control over his body.
Twice in the next week, the mom briefly brings up the blood draw to get James’ response. Both times she acknowledges how mad he was that she had to restrain him. Now, two weeks after the doctor visit, James no longer seems angry at her, though he remains scared of needles. At bedtime one night, after reading a book about a girl who braves a winter storm, James seems particularly receptive.
Parent:
Remember at the doctor’s when they needed to get some of your blood? You were really strong and brave. Just like the girl in this book. You did something that was scary, but everything turned out okay. It’s like when you’ve gotten shots at the doctor’s. They hurt, too, but the hurting goes away and you’re fine. I wonder if you’ll be as scared the next time we have to get a shot at the doctor’s? You’ll know that it hurts, but you’ll know that it doesn’t hurt too much, and that the hurt goes away. I think that means you’re a strong kid.
Here the mom links the blood draw to getting future shots at the doctor’s. It’s a subtle way of telling James that he can expect more shots, but now he knows he can manage them. Rather than develop a narrative that needles and doctors are scary and overwhelming, she encourages James to see how his strength helped him manage a scary, painful experience.
A month later, James is nervously climbing five feet up into a tree as his mom stands beside him, ready to catch him if needed.
Parent:
Wow, you’re doing it! I could see how scared you were to try this but you really wanted to climb the tree. You did something you didn’t think you could do. But you’re strong that way. It reminds me of when you had your blood drawn. You were scared and you didn’t think you could do it. But I was there, just like right now. I’m standing here if you need me. [James reaches for a branch above him so that he can fully stand. He smiles, proud.] Hey, you did it! That’s got to feel really good!
The mom is finding a way to link James’ success with climbing the tree—something he’s choosing to do—with something that was forced onto him. In both cases, the mom is creating a narrative of success and strength. She’s also doing something a little unusual here: she’s not telling James that she’s proud of him, but is instead encouraging him to be proud of himself, saying, “That’s got to feel really good.” In this way, she helps him base his self-esteem on his recognition of himself rather than on another person’s view.
Related Posts
Medical Trauma, part 8: Building Healthy Narratives, Example 2
A parent tackles a tough one here: helping his son prepare for surgery on an undescended testicle.
Medical Trauma, part 6: What Parents Can Do, Steps 3&4
Talking about the facts and reviewing the procedure afterwards
