Coping rooms

The Royal Children’s Hospital has the impressive tradition of what they call Grand Rounds, a lecture open for all hospital employees. It goes from 12.30-1.30 on Wednesdays and is a forum to meet and learn. This Wednesday’s lecture was given by Professor David Pelcovitz, a U.S. expert in post-traumatic stress disorder. He didn’t really give a lecture – he told stories. I have been giving some thought to good lecturing so I listened to him in a double kind of way: I heard the stories and was just as troll-bound by them as everyone else, by I also tried to analyze his technique and style. Using stories during lectures is of course a very strong way to convey messages that speak to the emotional/limbic, rather than the rational/frontal part of the brain.

The trick is to find the right balance between the stories and the points you are trying to make. Most lecturers with a researcher background, including myself, do too many bullet points and too few stories. By contrast, most lecturers with advocacy backgrounds do too many stories without helping you get their exact messages other than the cause being a good one. To mix these things in an effective way is an art, something the TED lecture series has proven is possible to cultivate big time. I strongly recommend you to read the article by Chris Anderson, “How to Give a Killer Presentation” in the Harvard Business Review June 2013 issue , on how they coach their lecturers at TED. I certainly made great use of that when I gave my first lecture at Almedalen – a typically Swedish phenomenon of open political, advocacy, industry, media, and research forum going on for a whole week in the summer. This is where you do not want to be staring at your fifty-eight bullet points on the screen, while competing for attention with more than hundred current events.

Trauma is part of life – more so for some. For me, the bottom line of Professor Pelcovitz’s lecture was that every person is entitled to deal with their traumas in whatever way they find best. Unless it is destructive, of course. However, if you are a health professional, you have to move away from your own preferred coping style and help the person or family you are dealing with in a way that suits them. Professor Pelcovitz told us a story about an Israeli summer camp leader who had to brake the news of a beloved teacher killed in a terror attack (offsite) to the adolescents in the camp. He offered them five rooms to use during the day for coping with this event: the writing room, the talking room, the art room, the music room, and the prayer/quiet room.  Although it seems like common sense to let every person pick whatever coping form suits them best, it is only recently that we have come to realise that immediate debriefing, as the one-size treatment that would fit all traumatised people – has actually caused severe damage for some.

Both adults and children have their preferred coping styles. Professor Pelcovitz gave the example of younger children who are somewhere on a scale between highly engaged or entirely disengaged during painful procedures. The point is – don’t try to distract the highly engaged kids with toys, games, or promises of gifts, but respond to their information needs. And don’t force unwanted procedural information on kids who are more than happy to have a go on an iPad while you are firing away with your needles.

The professor also reminded us of the well-known fact that children do everything to protect their parents by not disclosing painful information if they do not feel the adults are ready to hear it. So parents need to listen. The first time a child discloses a significant or strong feeling about something it won’t sound that strong. In fact, it is what in medical communication language is called “empathic opportunity” and the unaware parent or professional might use an “empathic opportunity terminator” (Suchman, Markakis, Beckman, & Frankel, 1997).

It might sound something like this at the dinner table:

–       I was so annoyed with the boys in class today. They were being such jerks with Marty just behind my back! (Empathic opportunity)

–       Oh, that’s a drag! Good of you to have focused on your work, though. Would you like some more salad? (Empathic opportunity terminator)

OR

–       I was so annoyed with the boys in class today. They were being such jerks with Marty just behind my back! (Empathic opportunity)

–       Oh, that’s a drag! It sounds like their behaviour upset you? (Empathic opportunity continuer)

–       Yeah, they keep doing that to Marty, they’re so mean!

–       Do you mean they are, like bullying him? (Offering words to put on the situation)

–       Yeah, they call him names and steal his stuff and when they don’t think anyone sees they’ll knock him over on the school yard and then laugh at him.

–       That sounds really serious! I can see why that upsets you! (Validation before moving on to action proposal) Does the teacher know?

–       No, they’re blind or something.

–       Do you think we should talk to the school or his parents, I am really concerned? (Offering your own interpretation)

–       Yes, but I want to do it. I’ll talk to the teacher tomorrow!

This did actually happen. I got lucky, it’s not like I am always the perfect listener. But maybe there was something in the tone of her voice that stopped me for the moment needed to open my ears. So keep listening to kids! By the way, I promise we’ll get back to the architecture of bullying, the serial killer of self-esteem.

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