Professionals need to recognise the difficulties parents face when seeking advice on child behaviour issues, say psychologists from the Anna Freud Centre
Parents' interaction with professionals begins before their child is born. After a birth, the role of midwives, health visitors and GPs is to reinforce and support the parents' care. Their advice and views on health and normality are as valuable as their ability to diagnose and treat illness.
As children grow older, they begin to participate in a wider world and more professionals become involved. The role of the nursery worker and teacher becomes very important, because they have ongoing and close contact with the children in their care.
Parents need to feel comfortable with the people caring for their child and trust their skill and judgement. Parents look forward to hearing about their child's activities and behaviour at the end of the day. A sensitive worker points out the positive achievements of the child and takes good care when mentioning any concerns, so as not to cause undue alarm. If there are problems, parents will feel more able to co-operate if their views are taken into consideration and they are included in the discussions and decision-making.
Hostile feelings
Sometimes parents and professionals experience hostile feelings towards one another. Parents may feel they are not treated with respect. Professionals, in turn, may complain that even though their expertise is sought out, the parents do not listen to their opinion and ignore advice.
It can be difficult and painful for parents to seek help and advice for problems with their children - it implies that they have not been able to solve the problem themselves. They might feel exposed to the criticism of the professionals, leading to inadequate and humiliated feelings. This breeds resentment, and might well be the reason why sometimes parents ignore the advice they desperately need.
It is important for professionals to take into account how vulnerable parents may feel in front of someone who is perceived as knowing more than they do about their child's problems. They must be aware that parents may feel anxious and uncertain about their child's problem, not knowing how to address it or if it will ever be solved.
In control
Suggestions and advice must be given in a way that enables parents to retain hope and feel that they can be involved in doing what is best for their child. This occurred in the case of four-year-old Sophie, who has leukaemia. Her parents had difficulties with the health professionals treating her. Hospital visits involved time off work, a long journey, and often a long wait. The parents felt that the hospital workers ignored this, requiring the family to come at short notice and not planning the visits to make sure that everything was done at the same time.
It became clear that the parents were in contact with too many professionals, which was confusing. The parents did not feel that any one person understood and kept in mind their situation and Sophie's condition.
Eventually, the family managed to get the hospital to arrange for a team at a more local hospital to take on some of the treatment. They were relieved when one nurse became the main contact person. They also became more actively involved in administering and monitoring medication.
Once they felt that the situation was more manageable, they could feel grateful for the excellent medical attention Sophie had received at the first hospital and stopped resenting the staff, whom they had perceived as impersonal and cold.
Under threat
To help reduce conflict while addressing a situation, professionals should try to understand why a parent is interacting with their child or behaving in a certain way. This occurred when a toddler group leader became concerned about the way in which a mother was controlling and restricting her son.
Gail, the mother, actively prevented Andrew, her 14-month-old son, from putting objects in his mouth. The leader explained that children explore many things by putting them into their mouths, and that it is normal behaviour at his age. Gail was adamant that she would not allow it. It was clear she was anxious that Andrew might get an infection.
Gail was also overly concerned about what her son ate and drank, insisting on bringing her own bottle of water for him, and becoming upset if he drank the fruit juice offered at snack time. On special occasions when a cake or biscuits were served, Gail found it difficult to restrict Andrew and at the same time expressed her displeasure that he was eating something with sugar in it. Andrew began sneaking other children's drinks when his mother was not looking, and began to stuff himself with excessive amounts of food at snack time.
The leader thought that Gail, through her anxiety, was creating a problem for her son and herself, and was not letting Andrew have a more ordinary experience of exploration with toys and food.
When Gail played with Andrew, she would often tell him the 'correct' way to use a toy and not let him play more freely. Gail seemed to have fairly rigid ideas about what a toddler should do and she could not bear it if Andrew did not fit that image. If the leader or the assistant suggested that he was enjoying his own exploration of the toy, Gail would withdraw and become tense, ignoring what had been said.
Gail also felt threatened at the thought that Andrew might become fond of the leader or the assistant. Several times he approached one of them with a toy and Gail quickly took over. If Andrew showed signs of wanting to climb on their laps, it was clear that Gail opposed this, while trying to mask her jealous feelings. Once, when Andrew couldn't get out of a toy car the leader tried to help by picking him up and Gail got angry, telling the leader to put him down. Underlying the conflict was a sad history of miscarriage. Understandably, Gail was very protective of her son. However, she was in a painful dilemma - wanting him to have as good an upbringing as she could provide, while attempting to control everything in his environment and so impeding normal development. Gail felt that her authority and her confidence in being a good mother were under threat when there were disagreements with the leader. She was unable to consider what the leader said. At the same time, Gail often asked the leader about developmental milestones, treating her like an 'expert', and wanting her help and advice.
Professionals unwittingly take on the role of the 'adults' or 'parents' who know and can give advice about things. Parents, when they are feeling vulnerable and uncertain, can take on the role of being the helpless and dependent 'children'. For the children to be properly and lovingly cared for, it is important for practitioners to recognise how parents may fall into these roles. Practitioners should aim to reassure parents and help them to recover their more competent adult selves.
