Reprinted Courtesy Paul &Amy Herscu from The New England Journal of Homeopathy – Spring/Summer 1997.
I love treating kids. They are a treat for me and the babies are the sweetest treat of all! Although children represent about 20% of my practice in Seattle, I put a fair amount of thought into how I am going to treat them—not just homeopathically.
I am going to discuss some of the ways in which I work with children, and especially about how I set and maintain boundaries. I am not going to speak of parent/child dynamics nor how to understand, manage and work with these—it is the skin around the consultation that I am going to focus on in this article.
My aim is to create a respectful, cooperative relationship with each child that comes to see me. To create a safe enough space that children can relax and feel a certain level of trust—and reveal themselves—if they are old enough to do so. A space where children can have a positive health care experience, one they might want to repeat! We do this through the physical space we offer (the consulting room), through our verbal and non-verbal interactions with the child, through effective treatment (our skills and competency) and through a measurable demonstration that we care.
Setting the Scene
The first homeopathic consultation is a long one for a child and I suggest when the parent calls to make the appointment that they bring in favorite toys or a drink and a snack (one that doesn’t make crumbs!!) and that if the worst comes to the worst (with, for example, hyperactive children) I can always gather information at a later date over the phone.
I ask parents to write down anything they do not wish to speak out loud in front of their child (about the kid or the family etc.) and to give that to me at their first appointment. I ask them to be specific and give examples if they write about an aspect of their child’s character or behavior.
Time is a precious commodity with children because there is so much to pack into such a relatively short space of time. I have wondered why I take less time with children and over the years I have increased the time I give to a first consultation with a child so that I now reckon to spend an hour and a quarter, to an hour and a half with each new child patient.
This means there is enough time to answer parents questions about homeopathy, about their child’s health, about how to manage their child’s acutes and especially the fevers, and how I can (or can’t) help as and when their children fall ill. More importantly, it means that I do not run late for my next patient!
After saying hello to the parent or parents I greet children at their level. By name and by height! I literally squat down to say hi to children that are standing on their own two feet and introduce myself by my first name … and invite them to come and play with my toys! And I say hello to babes in arms with a gentle touch after I have greeted the parent.
A month or so ago I went out to my waiting room to greet a new patient, a two year old who had come with her mother to talk about recurrent ear infections. This was her first visit to a homeopath. As I opened the door she stepped forward and had no hesitation in shaking my hand or looking me straight in the eye as I squatted down to say hello. I invited her to come and play with my toys and she marched past me into my consulting room without looking back at either me or her mother. The first word I wrote in her notes after all the boring stuff—name, address etc.—was “bold.”
While I am creating a welcoming atmosphere for my patients, they too are creating an atmosphere of their own and I am keen to pick up as many of their cues as possible.
Some children hide behind their parents, their eyes shining with fear. Is it because they are afraid of strangers, or doctors … or what? Some have brows and eyes furrowed with anxiety. Again, why? Are they worried because this is a new situation or is it something else? Some refuse to speak at all and glare at me with suspicion. Why are they hostile? Some won’t look at me at all and look to their parent in confusion for guidance every time I speak to them. Are they passive, dependent and/or shy? Or is the parent critical and/or dictatorial—or worse, abusive—and has made the child afraid to interact directly with other adults in their presence.
Another child (nearly three years old and someone I had seen a couple of times already) greeted me openly with arms outstretched for a hug and the words “I have nightmares that wake me up at night.” On sitting down in my consulting room she repeated the exact same words once again—with the same gesture—and I realized that her greeting had been rehearsed. It is likely her mother told her what to say to me.
These waiting room opportunities are where first impressions begin and are a potential gold mine. I listen to the first word that pops into my head as I meet each child. And as I listen to the overt verbal responses and the overall quality of our interaction, I am also picking up non-verbal cues as well as information about the relationship between the child and the parent. All this will help me to direct my case-taking more effectively and not to waste valuable time.
I never forget that first impressions go both ways and although I am gathering information like crazy, so are my patients, including the children who will be watching me carefully—whether they appear to be or not.
A Safe and Friendly Space
The following may seem obvious but I thought I would mention them anyway as they may act as helpful reminders. Just writing this article spurred me on to buy safety plugs for the electrical outlets in my consulting and waiting rooms. They had been on my List of Things To Do for almost a year! I want my room to be safe for children of all ages. I don’t want to have to say no repeatedly to children, or make parents feel they have to be extra vigilant in a room that isn’t child-friendly or child-proofed. There are no (fragile!) knick knacks, no exposed electrical outlets in which toddlers can electrocute themselves.
My toys are generally appealing and designed (hopefully!) to occupy a child quietly so I can talk to their parents for certain periods of time. I have jigsaws (for all ages) that enable me to assess a child’s dexterity, and paper and crayons that can help me understand some unconscious workings of that child’s mind, as well as building blocks. A wooden train set is always popular, amazingly with children of all ages. A basket of rattles and interesting objects for babies is a nice touch. Paints are too messy and end up on walls and carpets far too easily. Books are for the waiting room only—it is a nuisance to have to interrupt a homeopathic consultation to read to a child! One day I would like to have a basic doll’s house. For my patients of course.
I suggest that parents get on the floor and play with a kid who is whiny or too young to play alone. Most parents need permission to do this and are grateful to be offered it as an option. I remind them that we can carry on talking—so they don’t forget the purpose of their visit!!
It is important—to the child—to have adults communicate with them at their level. And this usually means at their ‘eye’ level.
Virginia Satir (family therapist extraordinaire) championed the cause of children in the world and stresses the importance of eye :
“When images and expectations of one another are being formed, eye-level is essential between adults and children. First experiences have a great impact, and unless something happens to change them, those experiences will be the reference points for the future.” 1.
I will often join them there and this is where I can gather important information about the child—through interacting with them, once the guard is down and the parent and child are no longer on their ‘best behavior’.
Maybe this is the place to make mention of the ‘thing that happens’ when both parents are present. It is remarkable how differently they can perceive both the child and/or their symptoms. I always enjoy those moments of diametrical opposition with regard to a fundamental characteristic symptom and use it as an opportunity to affirm both parents viewpoints. I hope to model a healthy acceptance of different perceptions—and make this a safe place for parents also—rather than encourage them to fight over their children. At the time I pick up and note any tensions between the parents over their child and explore these further if necessary (for the purposes of the homeopathic case-taking).
I offer to take responsibility for maintaining the boundaries in my consulting room. This takes the pressure off the parents who are mostly grateful for the break.
I engage directly with the children who come to see me—who are old enough to understand—and talk to them about my room, about which toys are mine and which are theirs. I tell them that my toys may be available to them but they have to ask me first. In other words they cannot play with my pens, books or computer etc. without talking to me first. I make a deal, a contract, by asking whether they agree to my terms. I check with the parents that it is OK with them if I negotiate directly with their child. A child’s responses (verbal and non-verbal) give me a lot of information about them. And their subsequent behavior is also revealing … whether they use this as an opportunity to demonstrate their disobedience for example.
Some kids will slowly creep up on me, looking at me all the while to see how I am going to react. He or she will then reach out a hand and let it hover over one of my ‘toys’ (usually the computer keyboard) while continuing to look with increasing intensity at me. The tension mounts.
Sometimes at that point I will say “Would you like to play with my keyboard?” The eyes widen in disbelief and the child nods a yes…lets the hand drop and moves forward to see what will happen next. Slowly. I contemplate the rubrics ‘curious’ and ‘cautious’.
Another child steps forward more assertively and the hand hovers over the keyboard for a second. He or she touches it with a mischievous look in their eyes. Another child ends up ‘in my vicinity’ having restlessly bounced around the room and ‘finds themselves touching it’ without apparently planning to do so. Their look is challenging. The rubric ‘defiant’ comes to mind.
When I am obliged to respond to a blatant push to my boundaries I will say quite firmly but not harshly, “No. These are my toys, you have to ask me first if you want to play with them.” And those who are sensitive to reprimand will look hurt and run back to mom or dad, or burst into tears. Others will laugh and stand their ground. Others grit their teeth in and look at me with anger.
I then check with the parent whether their behavior is typical and characteristic and if it has caused any problems.
Setting the Scene
I ask children who are old enough to understand what I am talking about whether they know why they have come to see me. I then ask them whether they know what a homeopath does and explain in age appropriate terms who I am and what I do and make reference to the complaint they have which has brought them in to see me.
I tell them I am going to ask a lot of questions … and that I shall be talking about them with their parent/s. I then check whether that is OK with them. This an interesting moment. And an opportunity to see whether this child is able and willing to negotiate … to find out how stubborn they may be! Mostly the child nods but not very enthusiastically. So I carry on with some reassurance by asking them to step in at any point if they feel uncomfortable with what is being said or disagree with it.
They may never have been given a choice about whether it is OK to talk about them. Occasionally, I have a child who refuses to have a particular topic discussed in front of them. I have to be congruent and follow through with my agreements! I am creative about their options, choices that are also respectful of their boundaries. I have suggested that I talk to their parents later, or asked an older child to put their feelings down in writing and send them to me, or suggested that the child wait in the waiting room (with a good book or toys) while I talk to their parents alone.
I follow up on this at regular intervals during the case-taking, especially if a sensitive issue arises, to check it is still OK to talk about them … and to ask for their opinion. Some children look anxious, upset, sad or angry when parents discuss sensitive topics. I check in with the child at this point to find out what they are feeling and whether it is alright to carry on. Also to find out whether their perspective matches their parent’s account.
Interacting with Children
This is one of the ‘perks’ of my job. To connect and interact with the little ones. I do a fair amount of verbal and non-verbal mirroring: to make , to gain trust, to build rapport, to understand the nature of the little being in front of me, to encourage that person to tell me about him or herself by making them feel seen and heard.
Neuro Linguistic Programming (NLP) is the therapeutic system that has examined these patterns of relating and teaches therapists—including psychotherapists and health care professionals—techniques such as mirroring and how to use them to be more effective in their work. These techniques are invaluable for developing rapport, and enable us literally ‘to put ourselves in another person’s shoes.’
“To the extent that you can match another person’s behavior, both verbally and non-verbally, you will be pacing (or mirroring) their experience. Mirroring is the essence of what most people call rapport, and there are as many dimensions to it as your sensory experience can discriminate. You can mirror the other person’s predicates and syntax, body posture, breathing, voice tone and tempo, facial expression, eye blinks, etc.” 2.
Verbal mirroring takes the form of using similar words, word patterns or sentence structure, modifying the tone and loudness of your voice to match theirs … being quiet or noisy, whispering or laughing or giggling etc.
Non-verbal mirroring takes the form of matching their whole body posture or just a part—an arm or a crossed leg for example, facial expressions, and even breathing patterns. For short periods of time of course, and never to the point where it seems that we are mimicking them.
We all mirror anyway. Especially with children. We might as well make it an overt, conscious skill that we develop and use with care and consideration, as children are particularly open to making with adults who ‘be like them’ without pretending or being patronizing.
It is important to be respectful and appropriate with regard to how you touch children. Some children are more tactile and affectionate than others. This does not necessarily give us license to be more physical with them. Although I remember one particular little girl (about 2 or 3 at the time) who took her clothes off and climbed into my lap for to cuddle and then kissed me. The mother told me this was her usual behavior and it quite worried her.
If I need to examine an eruption or a sore throat I always say ‘please’ and ‘thank you’! When children do not wish to be examined I do not make any assumptions. If children are reluctant I explore why they don’t want to be examined. Is there a fear of doctors, or maybe they don’t want to be touched or is it because their throat hurts when they stick their tongue out. And so on.
When I do look at them I ask them to show me their nails and hold my hands out so they can place their hands on mine. I take this opportunity to feel the quality of their skin and touch: are their hands hot and dry, cold and clammy, dry, rough, hard or soft. I get a feel of them from an energetic point of view and say thank you at this point as well as make some statement about the strength and vitality of their little bodies—in language appropriate to their age. I let them get a sense of me too.
Projecting on to Children
However much I enjoy the children I see, it is important that I keep a healthy distance, that I do not allow myself to get too close because it is then that my powers of observation and my ability to perceive will be compromised. As they would if I got too close to an adult.
If we have strong feelings towards a child, if we ‘like’ or ‘dislike’ a child strongly it is likely that we have projected on to them—either some part of ourselves that we like and know, or a part of ourselves that we don’t like and have disowned. Consciously. Or maybe, a part of another child we have known closely (maybe one of our own) which we either like or dislike.
Having a sense of when children have pressed our ‘buttons’ is important. Even if we don’t have an answer, just being able to ask ourselves whether this child has stepped into our shadow will help us to do our work. For me this is like having inner bifocal glasses, where I am aware of the near and the far distance at a glance. I can see the child in front of me as well as check out my own inner child situation to make sure I am not over-involved and vulnerable to distorting the information that comes my way. These inner bifocal glasses are so important, to be able to discriminate when we are projecting on to our patients, and children are not immune to this phenomenon.
I am reminded at this juncture of one of my favorite anecdotes. A friend of mine tells a story about her children which amuses—and is somewhat instructive with regard to the relationship that children have with their doctors. My friend was taking a drive with her two children Florence, age 8 and Alfred, age 6.
At one point Alfred piped up “Mom, what’s aneegle?” (It helps to say this out loud!) The mother gave a lengthy response about eagles going into some detail about the bird and—because she is an American—talked about the eagle as the national emblem of the United States, and so on and so forth.
She exhausted her topic after about five minutes, during which time Alfred said not a word. Finally she asked “Why did you want to know?”
“Well,” says Alfred, plainly puzzled and rather confused, “ … my friend James went to the doctor and he got aneegle in his arm.”
“Oh!” said the amused and somewhat contrite mother, “You mean A neeDLE.”
At which point the older child, Florence—Who Knows Everything—enthusiastically interjected: “Yes, a needle … you know, when you go to the doctor and you get an infection.”
You have to bear in mind these are homeopathic children who have never visited the allopathic doctor, have not been vaccinated and have never seen or experienced an injection. And yet I do not want the children who come and see me to say “You know, when you go to the homeopath and you get a little white pill.”
Marcel Proust is said to have complained that:
“for every disease cured by doctors they cause a dozen others, by injecting patients with the most virulent agent of all: the idea that one is ill.” 3.
We are ambassadors for holistic medicine in general and for homeopathy in particular. The relationships I make count a great deal. I hold the future in mind with those relationships I build with children. My intention is to infect children with the idea that they have strengths of their own (as well as to acknowledge their Achilles heels) and that they possess a doctor that resides inside of them. My goal is to consciously pass on an awareness that the homeopathic medicines are designed to help that inner healer to get to work.
Healer as Teacher
There is a package deal to consider with every child who visits. To begin with there is, of course, their health, and then there are the parent’s issues around their kid’s health, the relationship between the child and their parent as well as any general family dynamics. All these factors come into the consulting room to be offered up and dealt with. We can do so much more than Give The Right Remedy if we hold an awareness of this larger picture.
We have a responsibility to give our patients a different experience of health care professionals … one that takes the whole person into account. Part of my motivation in building trust is so that as that child grows and matures they may think of me as someone they can turn to when, for example, they hit adolescence and or young adulthood.
Children get the impression from their visits to the doctor (and even the alternative doctor) that they are sick because all questions and discussions involve a detailed exploration of their pathology, their dis-ease/s.
I name the healthy parts out loud and affirm the parts that work, to both them and their parents. This can be difficult with children that are, for example, very sick and it is hard to see any area of activity that is functioning in a healthy way. In those situations I may admire the parents fortitude. I may also name ways in which the parent is being effective as they too may be used to only hearing criticism with regard to their parenting activities.
At the end of every consultation I express a genuine appreciation to the child who has come to visit me … I thank him or her for being so patient, or for drawing such a beautiful picture, or for talking so openly etc. I believe it is important to name these appreciations, to speak the words out loud. No big deal. Just a little thank you at the end. Direct and heartfelt.
Working with families is a joy and an honor. Being the family homeopath can be so rewarding: seeing the visible difference that homeopathy can make in a family’s life … the increase in vitality … the freedom from suffering … the potential for health and creativity and expression that manifests on every level … this is what keeps me hanging on in there and working so hard when the going gets tough.
- The New Peoplemaking by Virginia Satir (Science and Behavior Books, 1988)
- Frogs into Princes by Richard Bandler and John Grinder (Real People Press, 1979)
- Medicine for Beginners by Tony Pinchuck and Richard Clark (Writers and Readers, 1984