Addressing Caregiver Concerns in Pediatric Therapy: 4 Communication Strategies

You’ve been working with Casey, a two-year-old boy with Down syndrome, for the last two months. Casey is not walking yet, and the family is frustrated. Unfortunately, they’ve directed this frustration at you.

Earlier today, they angrily confronted you, demanding answers as to why Casey has not made the progress they expected.

How can you defuse this situation? You want to continue working with Casey, and you know that he’s made considerable progress given his needs, but at the same time you need to acknowledge his parents’ anger and manage their expectations so they understand what kind of progress is reasonable. These communication strategies can help.

Strategies for Managing Expectations

Casey’s mother has just entered your department, angry and upset. When you approach her, she says, “Why isn’t Casey walking yet? He’s been coming to you for two months, and he should be walking by now! What’s going wrong?”

You consider your options for addressing her very real concerns from the following list of strategies:

1) Using “I” Statements

If you were to respond using a “you” statement, the parent may feel defensive. An “I” statement flips the focus, allowing the parent to feel heard and empathized with: “I understand that you are concerned that Casey is not walking yet.”

2) Restating, Reflecting, and Clarifying

When you restate, reflect, and clarify what Casey’s mother is saying, she knows that you hear and understand her concerns since you are summarizing what she has said to you.

“I know you are concerned that Casey has not walked yet even though he has had two months of therapy.”

3) Acknowledging, Validating, and Empathizing (AVE)

This strategy demonstrates that you are sensitive to the feelings Casey’s mother has expressed to you. When you can put yourself in the parent’s shoes, it’s easy to do this. Parents don’t have the same knowledge you do about how therapy could or should progress. They’ve also probably invested considerable time and financial resources at this point and feel there should be more to show for it.

You express your understanding by saying, “I know that you are upset that Casey has not walked yet, and I understand your concerns and your feelings. I know it’s difficult because you hoped that Casey would be walking by now. I can assure you that Casey is progressing toward walking; in fact, both his posture and balance have improved, which are both crucial steps toward walking.”

4) Describing, Explaining, Suggesting, and Making Concluding Statements (DESC)

Once you have built rapport with AVE, you can now suggest other possible outcomes that might be reassuring to the parent. For instance:

“Since Casey is not walking yet, I know this is upsetting to you and I understand your concerns. I suggest that we speak after each future therapy session so that I can take some time to better explain Casey’s therapy, the progress he’s making, and how that’s helping him move forward toward walking. I can also provide you with additional activities so that you can also help Casey at home.”

These simple and practical communication strategies will help you continue providing patient-centered care to your patients, even in challenging situations like the one described above.

If you would like to learn more about how to use these strategies, more information is available in my MedBridge course, “Enhancing Communication and Rapport Through Patient-Centered Care.”