This week on the blog, I wanted to share some wisdom from a therapist who works with children who are struggling with transitions. Kelsey often works with children who are dealing with a new medical diagnosis or experiencing changes in their family due to trauma or other difficult events. Given the state of our country and the world right now, this seems like a timely topic, since many children may experience losses in the near future, including loved ones, the loss of opportunities, or other changes from social distancing. 

Kelsey is a Certified Child Life Specialist and Licensed Professional Counselor who specializes in working with those impacted by illness, injury, and grief. She is specifically trained to coach caregivers on language and techniques to use when parenting their child through medical diagnoses, family life transitions, and traumatic loss. 

With her dual degrees and specialized experience with illness and grief, Kelsey incorporates cognitive behavioral therapy techniques, play-based interventions, and a strength-based approach to personalize clinically appropriate interventions that reduce potential fear, distress, and anxiety. She is also a skilled parent coach and has expertise in treating children and adolescents from 2-22 years with generalized anxiety and social issues. Her interventions focus on helping clients to develop more effective coping and communication skills, to nurture their relationships, and to build a stronger sense of self. In addition to offering individual and family therapy, Kelsey is also available for school and community consultation when there is an ill or grieving child, an ill parent, or a community tragedy.

Delivering Difficult News: From Adults to Future Adults, by Kelsey Mora, CCLS, LPC

Parents are often faced with the challenge of if, when, or how to deliver difficult news to their children. As a parent, you may have thought “no news is good news” or been told “they’re too young to understand.” However, all children can sense emotions and change regardless of their age or development. Therefore, children tend to cope more effectively when provided with honest information and included in significant family events. Whether it be an upcoming move, a relative’s illness, a divorce, or a local tragedy, there are techniques that can support children at various developmental levels.

Honesty Really is the Best Policy

When children are forced to come to their own conclusions about what is happening, their imagination may create something far worse than the reality. Follow your child’s lead by assessing what they already know before providing or correcting the information. It is important to use simple, clear, and honest language and know that this may need to be repeated over and over again.

Avoid euphemisms. Even though terms such as cancer, dying, and divorce may seem harsh, they are less likely to lead to misconceptions later. You can always clarify terms along the way but starting with the real words is recommended. For example: “dying means he will not come home; his body no longer works” and “divorce means we couldn’t get along any more, we have decided to live in different houses but we both love you very much.”

Find an appropriate setting. Find a private, quiet, and comfortable setting preferably outside of their safest place (for most children, their bedroom). Consider the living room or dining table. You can start by giving a warning shot. For example: “I have something sad or difficult to tell you.”

Finally, it’s okay not to know what to say or how to answer their questions. Try saying, “I don’t have all of the answers but as soon as I do, I will tell you.” This builds trust and is still honest. Help them to at least know what will happen next and what they can expect. Once the discussion has taken place, give your child or adolescent time to adjust. You can acknowledge “I know this was not what you expected to hear” and provide empathy and reassurance that you will be there if they have more questions, concerns, or feelings. Young children may need time to play and older children may prefer their peers. Both responses are developmentally appropriate.

When in Doubt, Keep Things Normal

Children benefit from structure and clear expectations. However, it can be very hard to maintain routine for children when disruption is taking place. When this is the case, try your best to prepare them for anticipated changes. If they are able to attend their extra-curricular activities or playdates but will be picked up by a friend or relative instead of their parent, make sure this is communicated to them. Similarly, if bedtime routine or school drop off will look different, just make sure they know who and what to expect. Children are resilient but do best when prepared for change.

Find ways to include them. Children may benefit from having a role or a purpose. They could be responsible for packing a bag or making a card. Try giving them choices when possible to give them a sense of control and mastery during a time that feels out of their control.

Expressing Feelings is Healthy

Therapists have heard it time and time again: “I have to be strong for them” and “I can’t let them see me cry.” However, children who grow up in a home that is shielded from feelings may inadvertently learn to internalize feelings. 

Parents, caregivers, and adults have the potential to teach children about healthy expression of all emotions: the good, the bad, and the ugly. It is inevitable that children will experience heartbreak, disappointment, and upset throughout their life trajectory. When faced with these circumstances, it is imperative that they learn how to identify their feelings and express them safely and effectively.

Name your own feelings. Try telling them: “I feel sad because your grandpa is in the hospital.” “I feel worried about everyone’s safety.” Follow these I-feel statements with plans. “But I am going to do everything I can to help you feel safe and cared for during this difficult time.” This encourages children to express their own feelings safely and effectively; to feel comfortable asking questions when they have them because they know it is now okay to talk about the situation.

Kelsey practices in Skokie, Illinois. She is currently seeing clients through telehealth. If you are interested in learning more about her or reaching out to her, you can check out her practice website at https://illnessnavigation.com.

References:

https://elunanetwork.org/site/resources_pdf/1056/ https://www.today.com/parents/how-talk-children-about-shootings-age-age-guide-t59626 https://www.theloop.ca/break-bad-news-kids-without-breaking/ https://www.nebraskamed.com/sites/default/files/images/Child%20Life/kids-worry.pdf https://www.nebraskamed.com/sites/default/files/images/Child%20Life/tell-the-children.pdf Vital Talk (2017). Spikes for breaking bad news.