Clinical Instructor in Pediatrics, Harvard Medical School
Founder, Children’s Emotional HealthLink (CEHL)
Co-leader, Pediatrician-Parent Communication Training Program
Continuing Education Committee, Harvard School of Public Health
Co-author, Routine Screening for Domestic Violence in Pediatric Practice
Contributor, The Trust Crisis In Health Care: Causes, Consequences, and Cures, edited by David Shore of the Harvard School of Public Health
While our project will be for one year, the total time we have to work with each other is only 42 hours. Our most important learning will be what we learn from the parents in our practice, when they trust us with “their story”. That’s why the case presentations are important. But we will also learn from one another, from our professional insights, as well as from the empathy and resilience, which are part of all our lives.
“Trust” is crucial if parents expect to feel comfortable sharing intimate details of their lives, including family secrets, as some of them work through the shame and anxiety brought on by certain family experiences. But will we have trust for one another? We may be able to accelerate that trust, if and when we feel comfortable sharing some relevant aspects of our personal and professional lives.
You may discover such opportunities, if and when you choose to convey to others how you got to this point in your life, both personally and through your work with families.
I could hardly expect any of you to consider being so sharing, if I was unwilling to be candid with you as to how I got to where I am now. But beyond what it might encourage you to share or not share, there is an additional point, which is worth considering. I would suggest we may become more competent in the course of interviewing parents, when we decide as to what type of information to share with parents (and with each other) and what is not appropriate to do so, in the service of maintaining good boundaries.
Howard King, age 77. I live at 34 Agawam Road, Waban, MA 02468. My home telephone number is 617-244-3806. My preferred e-mail is email@example.com. I have been married for 50 years. My wife, Phyllis, is a clinical social worker. We have two married sons, Ricky and Josh. My older son, Ricky, has four children, one of whom has autism.
I received a one-year NIMH fellowship at Children’s Hospital before I started to practice, to help me become familiar with issues of emotional behavior in children. The most important part was learning how to listen to parents and their stories, and overcoming some of those personal blocks that inhibited my ability to listen, non-judgmentally.
Were there negative outcomes from that experience? One might have been an unrealistic view that I could help everybody, if they only sat down and shared their story. I learned, despite my enthusiasm, that not everyone is ready to be helped, at least not in the way I was prepared to do so and at that time. I became acquainted with what is referred to as psychological mindedness, i.e. patients or parents change only when they are ready. The challenge for us is not to push them to change prematurely. They need to be comfortable sharing with us some of those personal barriers that inhibit change.
Perhaps a second negative outcome was the belief that all I required was how to take a good history along with acquiring a parent’s trust. Over time, I discovered that something else was needed. That was self-awareness. I needed that, in order to listen empathically, and avoid the attitude of telling them what to do “for their own good”.
The second training experience was obtaining an MPH at the Harvard School of Public Health, while in full-time practice. The most important concept I learned was that a child with a problem was actually an agent for change for his or her family. By compelling parents to bring the child with his problem to a physician’s attention, the child, in fact, was often initiating a process of change that was important for the entire family system.
I discovered that parents had the capacity to become allies, and with increasing trust, were often able to address future issues that arose, not only with their children, but also with other family members.
My last formal educational experience occurred while attending a yearlong seminar at a school of social work, on issues of alcoholism, i.e. in terms of diagnosis and intervention. I was the only physician present. Why did I take this course?
In meeting with families over the years, I discovered that when there was a problem in the child, there often coexisted a family secret. These secrets sometimes accounted for how the child became the “identified patient” in the family. Sometimes that secret seemed to be a history of alcoholism in some member of the family, sometimes going way back in time. That effect of that secret was passed on, one way or another, through interactions between family members.
That course became a turning point in my understanding how family secrets could have a powerful effect upon the children and parents for whom I provided care. Many families are influenced by such secrets, which they may be able to share with us, as their health professionals, if they trust us sufficiently.
Was there a particular life experience that motivated me to reach out to families with various emotional issues?
Our first son was born overseas, when I was an air force pediatrician. When I returned, while I was doing an NIMH fellowship at Children’s, my wife became pregnant for the second time. Unfortunately, she developed a hydatid mole during her pregnancy. The NIH was studying the use of methotrexate to see if such moles could be reduced in size in order to preserve the uterus. She remained at the NIH for several months. The treatment was successful and several years later, she gave birth to our second son.
How did this affect me? To make a long story short, I began to “lose things”, right and left – keys, important papers, etc. A friend suggested that I consider psychotherapy, which gradually evolved into psychoanalysis.
I became aware that my losing things, i.e. fearing that I might “lose” my wife, was a recapitulation of the fear of losing my father, who had been seriously ill when I was five years old. That illness had a profound impact upon me, and my family. I had repressed my feelings about that experience until my wife’s mole (and the fear of her loss) reawakened those memories.
In addition to helping me come to terms with that issue, the analysis provided me with the familiarity with the process of “associations”, i.e. many statements patients (or parents) express may have hidden meaning. We often ignore or are unaware of those associations, or choose not to acknowledge them. But being attentive to a parent’s history may disclose periodic, seemingly inadvertent associations. If we are mindful of them and parents are able to elaborate upon them, we may discover important insights.
Over time, you will discover the usefulness of associations in taking what seems like a routine history. Two things are a prerequisite for discovering those associations. One is a willingness to provide parents with sufficient time to tell their story, and their not feeling rushed by us. The second is a genuine curiosity for the human condition and a respect for parents’ role as storytellers. If we want to learn, they will teach.
In summary, the discoveries from those two experiences, one derived from my childhood, the second from coping with my wife’s illness, contributed to my ability to reach out to parents, if and when they were willing to share key issues in their own lives.
Was there some turning point in my professional life, which motivated me to work with the psychological issues of children and families?
If you have the time to look at the first page of “Alcoholism and Family Secrets”, on the website (www.cehl.org), I would cite that experience as an important turning point in my professional development. That was when I first became aware of how parents can unconsciously describe how they seem to pass on memories of their own personal experiences to their children.
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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center, and the families of my medical practice.
I hope you find this site useful and encourage any comments.
- Dr. Howard King, M.D.