Dr. Sarah (00:02):
Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.
(00:41):
Welcome back to another episode of Beyond the Sessions. Today I’ve got Dr. Rebecca Hershberg with me. How are you?
Dr. Rebecca (00:51):
I’m great, Sarah. How are you doing?
Dr. Sarah (00:53):
I’m doing well, doing well. So today’s episode is a little different. This isn’t a listener question, but it was something that I thought I wanted to pose because I think it’s very prescient at the moment right now. But with Princess Kate’s recent heartfelt video message about her cancer diagnosis and her need to take time to explain this to her children in a thoughtful manner, I thought it would be helpful to kind of divert from our usual format a bit and focus on this topic which touches a lot of people’s lives, which is discussing a cancer diagnosis with your children. So I know you and I both understand the weight of this conversation, so it’s going to be probably a little different tone than maybe some of our other BTS sessions, but I think how do you feel about tackling this today?
Dr. Rebecca (01:57):
I think it’s important and I think it’s common. And I think first of all, I just want to say upfront and be transparent about the fact that I do not, nor have I ever had cancer. My husband has thankfully taken care of with surgery and whatnot, but we did actually have to talk to our kids about it when they were young. So I come with that personal experience. I want to start, I think by just saying, especially in the context of that the word cancer, which is actually one of the things we said to our kids, means so many things. And so a kid might hear the word cancer and it’s like, but so-and-so’s grandpa died of cancer, and just to be recently a friend got a cancer removed from her face and it was a 10 minute outpatient. So just being really clear that telling your children that you have cancer can mean a million different things. And I think, correct me if I’m wrong, Sarah, that today we’re going to talk about how to frame that with your kids initially and not about how to frame with your kids that you might have terminal cancer and or are going to be very sick or dying, which is a separate conversation and certainly even heavier.
Dr. Sarah (03:21):
Yeah, yeah. I mean, like you said, cancer in our age of advanced medical technology, more and more frequently cancer diagnoses are becoming less terminal. Obviously there’s a huge spectrum, like you were saying, it could be something really, really quick and sort of outpatient. It could be something that is an incredibly long process to fight it with good prognosis. And of course there are lots of situations where it’s prognostically, it’s going to be terminal. And I think when we’re having the conversation about a terminal cancer diagnosis with our child, we’re really talking about helping our child understand and prepare for something much, much bigger than cancer in and of itself. We’re really talking about processing death and loss. I think for us right now, this episode, and we could tackle that for sure in another one, but I feel like just in and of itself, helping your child understand that you have cancer or another serious medical diagnosis is a very different conversation than a death and dying conversation. And I think that’s okay. I think it should be.
Dr. Rebecca (04:48):
And I think getting a cancer removed from your face doesn’t even have to be a conversation with your kids. I mean, I think none of this is to take the place of your own judgment about what merits. My guess is if you’re thinking about how to talk to your kids about a diagnosis, it’s something somewhat substantial. I can only go back to my kids where it was daddy’s going to be overnight in a hospital having surgery and there wasn’t any chemo and there wasn’t any radiation. But that’s a different thing. And I think also really being clear, and this has come up with other questions as well about the age of your kids is going to play a huge role in how you talk about this. But I’m going to just sort of start and jump in and say, the first thing I would say to my kids is, have you heard of something called cancer? I always want to start that way when I’m talking about big things that can be scary is to just start with are they familiar with the term and what do they know about it?
(05:56):
Because it just gives you a sense of, now if my kid was three or four, would I start that way? I don’t know. But certainly five and up. And then the three guide posts that I use, and I talk about this in my book for talking about hard things with kids or one, you want to be straightforward and honest. I went to the doctor and it turns out I have something called cancer, and here’s what that means. In my case, you want to be developmentally appropriate, which is of course hard for parents to necessarily know. And so we can talk about that a little bit. And then the third piece I think is always talking about how there are grownups and experts that are helping and that they can have any kind of feelings that they want, but that it’s not. So in the case of cancer, I am seeing the best doctors. I am seeing experts who know so much about this to really provide some reassurance that’s not dishonest, and I’m going to be great if I don’t know that that’s true. I may not say that, but I’m going to work so hard to stay healthy and I’m going to do everything I can. And I’m working with absolute experts who know this cancer and how to, and really build up that kind of reassurance piece in an honest and connected way.
Dr. Sarah (07:24):
And I think that’s really hard, but also kind of critical, this idea of we might really want to rescue our kids from uncertainty and fear because we also want to be rescued from uncertainty and fear. And those are really uncomfortable feelings for us to have to hold for us to see in our children. And how do we provide presence and comfort and reassurance without necessarily promising something that isn’t a promise we can keep? And I think that’s very hard to do. And you mentioned at the beginning your own self-disclosure. And mine is, I’ve never had cancer and I haven’t actually personally lost anyone incredibly close with it, so I haven’t experienced this. I do remember when I was really little, a very, very good friend of mine. We were in first grade, his father died of cancer over a good long period of time, and he was very close with my parents and we spent a lot of time with them when it was happening.
(08:36):
And I remember just being really, I don’t think I had a really, I’m sure my parents explained it to me to some degree. I don’t really remember that conversation, but I think we understood after a certain point that it wasn’t going to get better. And again, in first grade I was seven, but just really spending more time with that family and being present for it. And it almost brought us all much closer to together. And I don’t remember that time in looking back as a scary or sad time, and that was just my anecdotal experience with it. But I do think as parents, our fear is this is going to scar my child or this is going to be impossibly difficult for them to bear. And I think what’s more important is that we can hold space for the feelings that will emerge and not push them away or try to rescue everyone from them or keep them out of the space because that actually can, it’s okay for them to come and they come and they go, or at least that’s the idea is we want to have the ability for our emotions to come and go and we safeguard against them. That’s harder.
Dr. Rebecca (10:04):
Well, and I think that’s so true. Our kids need to experience feelings in order to learn that feelings alone can’t kill us. I also think the importance of honesty can’t be overstated because I think another instinct precisely because we want to rescue and shield our kids is just not to tell ’em. And I’ve worked with families enough to know that this is actually not uncommon that people with cancer might tell their kid, I have a booboo, and yet they’re going to a different state every week to get treatment, and it’s not commensurate with what’s actually happening. And kids get really anxious or they act out behaviorally or they just hold it all inside and they’re quote perfect. But either way, the impact can potentially, nothing is a done deal but can potentially be so much more harmful for kids when this is happening to them and it’s in their world and they’re not being told about it. Or they might overhear a phone call in whispered tones and the word cancer is used. And then they say, what were you talking about? Oh, nothing. And their imaginations run wild.
(11:25):
When a parent has a diagnosis of cancer, that’s going to be a big deal in some way or another. Your child is part of your family and your child has the right to know what’s going on. Again in a way that you are very intentional and mindful about spoonfeeding ’em. And I’ve seen far too many situations where that hasn’t been handled that, and there’ve been negative ramifications for the kids, although I want to absolutely say to anybody listening who’s in that situation, none of this is not reversible. It’s all understandable how you would land that way. I’ve worked with families where it’s like we never meant to not tell her, but here we are. It’s understandable. There’s no judgment. And yet I would say quite strongly as a child psychologist, it is important to address that and reverse that if that’s the case.
Dr. Sarah (12:20):
Yeah. Well, it goes back a little bit to what we were talking about developmentally appropriate communication. And so just like we want to be able to talk about it in a developmentally appropriate way, we also have to understand that it’s developmentally appropriate for a young kid to be very ecocentric in their view of the world and also very, very acutely attuned to the emotional shifts in their parents’ demeanor. That’s at a developmental stage that’s a really highly wired for them. So because we understand their developmental proclivity or tendency to be super attuned to the adult’s emotions and changes in those emotions including anxiety or sadness or all these things, and also their cognitive developmental tendency to see things as through this very egocentric lens, which means did I cause this? Am I making this happen? And also a tendency towards magical thinking, which means maybe it was because I stepped on this crack, or maybe it was because I didn’t finish my vegetables or whatever the thing or because I fought with my brother.
(13:46):
So we have to remember that kids, they fill in the blanks and they fill in the blanks with whatever kind of skills they have to fill in the blanks, which are pretty rudimentary and usually pretty egocentric or magical. And so understanding that can help give us a context of why it is so important to fill in those blanks for our kids with information that they can digest so that they aren’t filling in the blanks because they will, they will. And if this is true of anything that we’re not talking to our kids about that they sense is happening, that’s making us uncomfortable or anxious or depressed, this comes up a lot with perinatal mood and anxiety disorders when a parent has a postpartum depression episode after having a new baby, this comes up a lot too. We talk a lot about helping a older sibling fill in the blanks of the story of mom’s change in her mood so that they don’t think they caused it.
(14:49):
And so I just think it felt important to, when we’re talking about developmental appropriateness, which I think is what you and I are here to provide information on, is if you understand why a kid is going to potentially be at risk of interpreting this if they’re left to their own devices in a really kind of scary way, it might motivate you more to push through the discomfort, the very understandable discomfort of having these really tough conversations because ultimately it is better for their mental health, I think to be able to tell the story, to make sense of what’s going on in a way that’s accurate.
Dr. Rebecca (15:29):
And I think you so nailed it right there with just that last phrase, which is the goal of that conversation is to help your child make sense of what’s going on, not for them to feel like everything’s great, to make sense of what’s going on, and to feel like they’re not alone in it, that their grownups are there with them. And so you might have what this conversation and your child might say, I’m really scared. And you might say, yeah, me too. We’re scared together and we’re going to do everything we can to get through this and whatever. That’s going to be so much more reassuring to a child than, oh honey, I said, there’s nothing to be scared of because your child feels scared and your child feels scared for a reason and it’s okay. And that’s actually a pretty appropriate reaction. So hold them while they have that reaction and let them know they’re not alone in it. And again, that you’re doing everything you can and it’s a hard dance, but I think it’s so healing and helpful for kids compared to some of our instincts, which would be to do those other things.
Dr. Sarah (16:48):
Yeah, and what you said made me think of this other piece, which is you might tell your child…
Dr. Rebecca (16:53):
Also thank you for telling me, sorry to interrupt. I just also thank you for letting me know that I love when you tell me how you feel, right? Because if they say, I’m scared and you say, oh, don’t be scared, or There’s nothing to be scared of, or whatever. What you’re saying is, please keep that to yourself as the grownup can’t handle this. And so you’re implicitly saying, which is the exact message, you don’t want to give, need to take care of me through this.
(17:21):
I can’t handle you being scared. Please keep that to yourself, and that’s where you see the potential kind of seeds of anxiety or isolation or whatever else. If you can have ongoing and open communication with your kids around this, then you’re in such a better spot in terms of the health of your family and the health of your kids. And if it is too much for you, if you’re in a very fragile place because you have a cancer diagnosis and you actually can’t handle that, then it can become a conversation with your partner or with a close friend or with a resource of, my child’s having a lot of emotions about this. Where can we help them express them and how can we help them express them? I can’t actually do it right now.
Dr. Sarah (18:05):
Which very well may be the case. And that’s why I think it’s also good to have those conversations with yourself and or your adult family members before you talk about this with your kids, so you’re ready to kind of know what your bandwidth is and where you might need some support and having these conversations. It might not be you that’s able to have this conversation, you know what I mean? It might be your partner or grandma or somebody else because you aren’t in a space and maybe you’re there just being present for it. Maybe you’re not. Because again, your ability to sort of be that secure base and anchor for your child in this moment is kind of important. And if you can’t be it, it’s okay to not be the person who has this conversation. This other thing though that we were talking about that I want to circle back to was you might tell your kids, and they might not have that reaction. They might be like, okay, I’m going to go play Lego now. They might want to just really not engage, which I think is okay too, and especially younger kids.
Dr. Rebecca (19:19):
Absolutely. What’s for snack? I have cancer. What’s for dinner? And along those lines, it’s not a one and done. If this is something that’s happening to you and happening to your family, it’s a jumping off point for a lot of conversations to come.
Dr. Sarah (19:39):
Yeah, the reality is we’re going to have to revisit this pretty regularly. It doesn’t need to be the sole focus of our family life either, which is another thing to think about is how do we maintain a sense of normalcy as much as we can in the face of all of this, while also understanding that things will be different, but that we trust our kids can also be able to revisit this conversation and aspects of this and have more opportunities.
Dr. Rebecca (20:07):
I sometimes there’s this illusion, or based on family movies or something, that these conversations should be held around the dining room table with everybody making eye contact and everybody being present. And that’s not often the best way kids take in this information. It may be really important that you have this conversation while they’re drawing or in the car where they don’t actually have to look at you. Or I have, one of my kids is always when we talk about something serious doing something else, and my instinct is to be put that down. Look at me. This is important. And I’ve had to train myself. It’s like, no, because this is, he can’t quite, this is what he’s doing to soothe himself, to kind of be able to take it in at his own pace. It’s not a sign that he’s distracted or doesn’t take it seriously or isn’t paying attention.
Dr. Sarah (21:01):
Yeah, it’s an external regulator. And I think that’s really important. I think there’s so many more things we could talk about, but I feel like just to recap, these feel like the really kind of key points, which is process it on your own first or with your adult family members or professional supports to figure out what your bandwidth is to have as conversation and how can you be sort of this secure base when you have the conversation, have it in a way that works for you and your family and your child, so that it doesn’t always have to be this big, like you said, Thanksgiving table moment. But also to be able to say the things that help our child make sense of what is going on in a way that is accurate, developmentally appropriate and reassuring about what is known and true, and not necessarily with the goal of making them feel good, but feel not alone.
(22:03):
And to be willing to kind of revisit and iterate and continue to check in with your kid and yourself as you go through this process. So it’s tough. This is a tough topic, and I’m sure if people are listening who are going through this right now, it might be really hard to hear all of this. And if you are facing this challenge and you need support, please don’t do this by yourself. Reach out. There’s so many mental health professionals and other types of people that really support families going through this, kind of talking about this with kids, but just always feel free to send us more questions. We can follow up. But thanks, Rebecca. It’s good talking with you.
Dr. Rebecca (22:58):
It was a really good conversation. Thanks, Sarah.
Dr. Sarah (23:03):Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in this new series Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.
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