WBR: Secret Questions, Part 2

Mike* sat across from me, his arms crossed defensively over his chest. His steely gaze seethed with anger. The air buzzed like a drill.

"This report," he said, gesturing dismissively with a hand clenched around a stack of crumpled up papers, "is trash."

"Total trash."

My report, apparently.

He added, "This isn't Izzy."

Izzy is Mike's daughter. Izzy's mother Janice brought her in for an evaluation last month. She was concerned Izzy wasn't making friends, was only interested in reading about horses, and struggled with transitions.

Janice and Mike have been divorced for 8 years. Mike consented to Izzy's evaluation and completed rating scales, but chose not to attend the intake or feedback sessions.

During the intake with Izzy's mother Janice, I'd listened for Janice's secret questions. I'd heard Janice's worrieds that Izzy's challenges weren't being taken seriously. She felt Izzy was "falling through the cracks," and that others didn't see the same problems she was seeing. She wondered if she was over-reacting to her daughter's struggles. "Maybe this is all normal?" she'd mused during the intake. Another time Janice wondered aloud, "Am I just that 'crazy mom' who thinks something's wrong when it isn't?" Janice wasn't a crazy mom.

Izzy was struggling. We did the evaluation, pinpointed her strengths and weaknesses, and made a plan to help her at the feedback session. A few weeks later, I mailed Izzy's report. When I followed up with Janice to see if she had more questions, she sounded relieved. I asked how it had felt reading the report. "It was so helpful, and spot on," she said. "It confirmed a lot of things I was worried about, yet also made me feel hopeful." She surprised me by adding, "And hearing about all her strengths made my heart sing." She added, "But...." I waited out the long pause. "My ex has problems with the report. He wants to talk to you." It turns out "problems" was an understatement.

Mike picking which outfit he wanted to wear to our meeting.

Mike didn't agree with one word of the report. He felt it didn't capture his daughter, exaggerated her problems, and gave her a label she didn't need. Mike's brother had been given the same diagnosis as a child, he told me, and the diagnosis had "ruined his life."

Mike did not tell me these things politely. He practically threw the crumpled report onto the floor at my feet.

If you're reading this blog post, you know exactly how I felt during this conversation. You've had feedback sessions like this. You've talked to parents who felt this upset by evaluation results.

You also know how easy it is, this moment, to roll right past defensive or frustrated, and right into outright blame and dismissal. You know how tempting it is to write Mike off.

How easy it would be to say Mike is "in denial" or "doesn't know what he's talking about" or "is not psychologically sophisticated." Or to go even further, and speculate about his character or social skills. Or to wonder about his interest in "getting back" at his ex, or his knowledge of what's really going on with his daughter. Or maybe, in a slightly kinder direction, to think "well, he's just having a bad day" (or month or year).

But the hard truth of it is that Mike's reaction was entirely predictable.

I hadn't answered his Secret Questions. I wrote a report Mike couldn't read because of a failure of empathy.

Not all "failures" are preventable. You can't show empathy that you don't know someone needs.

I couldn't have heard Mike's secret questions during the evaluation, because he wasn't there for me to listen to. I could hear and answer Janice's questions, and hopefully I did. But I was effectively deaf to Mike's questions, and that made me write him a tone-deaf report.

I could hear Mike's questions now though. Loud and clear. A swirling mixture of pain and uncertainty, wrapped up in an angry, protective shield. Questions about fear and loss. Questions we needed to try to answer before our time together was up.

Those secret questions about hope, fear, and loss are some of the hardest to hear. By which I mean, both the hardest to detect, and most emotionally difficult to listen to.

In future posts in this series, we'll talk more about how to listen for these Secret Questions, especially ones about hope, fear, and loss and some of the other hard ones. But here's my first tip, taught to me by Mike, and dozens of other parents through the years:

Listen for what makes you mad.

Secrets are hard things, aren't they?

Secrets eat us up inside, but still we want to keep them hidden. We do strange things in our effort to keep our secrets close. We hide the truth even from ourselves. We tell lies, or we tell our secrets to everyone except the person who most needs to know.

We start fights to throw people off the scent. We're prickly and defensive with people we've only just met. We project our secrets onto others, blaming them for what we're most afraid is true of us.

This means, when a parent you're working with is making you angry or defensive, there's a fair chance it's because they have a Secret Question.

If a parent is testing your boundaries - maybe asking you to do something most other parents don't ask for - check for a secret question. If they're not respecting your time or expertise, that hints at a secret question. If they are dismissive or rude to you or impolite, ask yourself if that's a sign.

If they disagree with everything you say - even when you're just repeating what they said - that's another clue. If they are talking about their child in a way you can't fathom, see if they are telling you more than they realize about what they're afraid of.

And if a parent tells you your report is trash, well... that's another indication.

As we talked about in Part 1, I've been making a list of parents' Secret Questions as I hear them. Last time, we covered secret questions about Stories & Roles, Overwhelm, and Shame & Guilt. Next time (?), we'll look at questions around Navigating the Modern World, and Healing. For this post, here are some questions I've heard about Hope, Fear & Loss:

Hope, Fear, and Loss

Help Me Have Hope

There's a famous quote by Elizabeth Stone about how becoming a parent is to "decide forever to have your heart go walking around outside your body." The only reasonable way to manage this exquisite vulnerability is to have hope. Hope that your child will be safe, and healthy, and happy. That she will have enough, and be enough, and not want for too much.

Sometimes, families come to us when they need a new infusion of hope. They may have very concrete fears: Will he be able to hold a job? Learn to read? Graduate? Have a family? Move out of our basement some day? Follow in his father's footsteps and pursue this specific career? Other times, their fear is more vague. They may be seeing their child's challenges mount, and worrying about what my colleague Lorraine called "the rocky path ahead."

Often you can elicit these types of secret questions by figuring out, "Why are we doing this evaluation right now?" Janice brought Izzy in as she looked ahead to middle school, concerned about what fresh hell the social demands of seventh grade could bring. But an important flip side to this question is :"Who isn't on board with an evaluation now?" Whoever might be rejecting an evaluation might also be saying they are holding on to their hope with both hands, and they're worried an evaluation might take that hope away from them. I could have heard Mike's seeming disinterest in Izzy's evaluation this way - as a way to shelter himself from the terror of his walking heart facing a future of insecurity or unhappiness. I could have wondered if he needed some protection from his fear.

Help Me Banish Ghosts

The family in front of you is often only part of the whole family system. Each parent has his or her own family of origin, and a lifetime's worth of relationships. All of those memories may be in the room with you. The secret questions might be about ghosts from the past, like a fear that the child will turn out "just like my mom." Or, parents might fear the child will have the same awful experience with a specific treatment or diagnosis that someone else had 30 years ago. Sometimes these worries are specifically informed by trauma. A man who was terrorized by a violent mother or wife may be triggered when his daughter is aggressive. Sometimes the ghost in question affects the parents more than the child. For example, a woman may worry she is "becoming her emotionally-distant father" in the way she reacts to her son's emotions.

Help Me Discover the Truth

Sometimes a parent senses there is a true, deeper secret behind their child's pain. We've all sat with parents and had that tingle of awareness that says there's more going on than anyone is telling you. That feeling you get when something's left unsaid and untouched. Sometimes it's a terrible awareness of a dark hole at the center of the child's life, where trust and safety should live. That's when you know the secret will be about a trauma or ruptured attachment. Other times it's the child's or family's fear that there's something "different" about the child - maybe her gender identity or sexuality - that could disrupt the family system or larger social order. Often, the parent is asking you for help in gently coaxing out and processing the secret. Sometimes, the parent is asking you to help them put an emerging secret back into the family vault.

Help Me Process My Grief

This question is one of the most common Secret Questions that arises during an evaluation. In this case, though, the 'secret' is not usually unknown to the evaluator. It's a secret to the parents themselves. Often, parents are not aware that they are stuck somewhere along the twisting path of grief. They may not even have allowed themselves permission to have something to grieve. Or they may be denying their first feelings of grief (or even that something is wrong). Or they may be anywhere else in the shifting, non-linear stages of grieving.

This is a big topic, to which whole books have been dedicated (here I refer you to Rita Eichenstein's exceptional Not What I Expected: Help and Hope for Parents of Atypical Children). We'll come back to this question again when we talk about how to write a report for families who are processing their grief. For now, it's enough to note that may parents come in for an evaluation with secret questions or grief or worry that perhaps:

• Their child is not the child they expected, or does not have the attributes, traits, or abilities they wanted them to have, or

• Their child won't have a "typical" path, or the path the parents wanted or expected, and/or

• They were not able, as parents, to protect the child from the problem, or to spare them the pain associated with the problem

Let's go back to Mike. Which secret questions are you hearing? How would you have answered them?

If you're curious how I managed my conversation with Mike, here's what I did. I borrowed techniques from two of my favorite resources:

First, I borrowed an approach from Therapeutic Assessment. Specifically, I picked a technique for with clients who don't trust what we say. In TA, these clients are conceptualized as struggling with Epistemic Trust. These clients lack the ability to see us as basically trustworthy, and as having their (and by extension, their child's) best interests at heart.

With these clients, you join with their skepticism. You ask them to hold on to it, until they believe we have proven ourselves worthy of their trust.

Here's a video of Steve Finn talking about Epistemic Trust and demonstrating the technique (hat tip to Raja David PsyD, a TA assessor in Minneapolis who first pointed me to this video):

I explained to Mike that the evaluation process is designed to "turn the volume up" on any problems the child might be having, so that I could see them during the evaluation. This makes sure I don't miss a child who needs help. It makes sure I can see everything that is - or even could be - going on.

But this "turning up the volume" process also means sometimes problems get exaggerated. And sometimes children do get over-diagnosed. I explained to Mike that I also sometimes have to make a diagnosis mostly to make sure a child gets services, because "that's the way the game works."

I agreed with Mike that he was right to be skeptical. I asked that he especially push back on anything that didn't sound at all like "Izzy with the volume on her problems turned up." I phrased it,

If this doesn't sound like "Izzy with the volume turned up," even a little bit, that concerns me. If you don't think she'd be helped at all by the services this diagnosis provides - even if we don't fully think she has some kind of disorder - I definitely want to hear your thoughts.

Then, I borrowed from my favorite parenting book of all time, Adele Ferber and Eliane Mazlish's How to Talk So Kids Will Listen and Listen So Kids Will Talk. The communication and problem-solving techniques in this book are not just for kids!

One technique I discovered in this book and find particularly valuable with all ages is to "Give Them Their Wishes in Fantasy." In this approach, you hear a person's emotions and wants, and imagine with them a way you could give them everything they wanted to fulfill that emotional need.

In this case, I can't reasonably write a new, separate report for Mike. And I'm not sure I could actually write one that truly spoke to his questions and was also professional. But I can, in fantasy, give him a report that responds to his fears and concerns. This might meet him where he's at just enough so that he can read the report I wrote without being flooded by feelings he needs to protect himself from.

That is, I can try to write him a better report without changing the report at all.

I said to Mike,

"I wish I could have written you a different kind of report. The kind that would say what you and I know is true, and that could still get Izzy what she needs. I wish I could just say, 'This girl is amazing, full stop, and here are some things I think would help make her life easier.' If I could have just written that for you, how would that have sounded?"

How I would love to tell you this little speech turned everything around. I'd love to say Mike completely heard me, and we agreed on everything, and the feedback session ended with a bright shiny bow wrapped around it.

Of course, that's not what happened. Mike still disagreed, he still glared at me, and still told me he thinks psychology is all a load of bull.

But as he was saying that, he reached down and picked up the report. He smoothed out the crumpled pages in his hands. And he took the report with him when he left.

Pictured: Not Izzy. The asterisk at the beginning of this post is because I've combined a few different families I've worked with and still changed all names and some details to protect patient privacy.

Note: This post is written at the 7th grade level. There are 183 sentences (about 14.3 words per sentence). 30 of the sentences are "hard to read" and 11 are "very hard to read."