The "difficult" parent

Overprotective parents require an adjusted approach.

We must cater to their need for security by providing orientation.

The over-protective parent struggles to partner with me. Their inner storyline might be something like: “I do not trust your care for my child.”

Overprotective parents need help with their fears

How does this impact the consultation?

This distrust makes it very difficult for me to gain the trust of the child.

During the precious first 7 seconds of our interaction, the child will check in on the parent for clues, whether I am trustworthy or not. When the child sees the hesitation of the parent, the child will refrain from being open towards me. In this case, the parents require an adjusted approach from me.

Overprotective parents need help with their fears

Why do they act this way?

Overprotective parents come with a significant “background-noise” to the consultation.

I typically see the following 4 types of parental “background-noise”:

Parents of children with complex needs: “professional parents”
Parents with negative previous experiences and unprocessed trauma: “traumatized parents”
Parents sabotaging positive interactions with overprotection: “needy parents”
Parents from deprived backgrounds, who expect that they need to fight even for basics: : “deprived-tiger-parents”

A closer look at parents in detail:

1. “Professional parents”

Overprotective behaviour is sometimes seen, in parents, often mothers, of children with complex needs. Although, they are best equipped to “read” their child, they typically experience that their view is not taken seriously.

Their opinion about their child’s needs are dismissed and that they frequently feel side-lined in the medical process. As a consequence, they have learned to be very verbal with their opinion. This can feel very draining for the doctor.

The solution would be to welcome the parents to the treatment team. We would need to acknowledge their active role as partners of the process. I do that, by indicating, how valuable their input is to my medical judgment. I am the medical expert, they are the experts of their individual child. We are not competing here, we are complementary. These parents are an asset, as they will flag up any unusual changes, when they are empowered to do so.

Overprotective parents require help with their fears: here is the fear to be sidelined and their child to be failed.

2. “Traumatized parents”

Another group of parents might have had negative experiences for themselves or other family members. They tend to mix their history with the expectations for the coming encounter for their child.

In this situation, we are dealing with two stories at the same time, the patient’s story and the backdrop of previous (family/parental) trauma. This can come along in statements like “I don’t want my child to experience the same trouble as I had to.”

Here we need to clarify the separation of those two stories. When I notice this dynamic, I pause briefly and verbalize my observation. When it is necessary, we divert in our conversation from the child to the adult’s needs. As long as their needs are not identified, this “background-noise” will distort any meaningful consultation, as they hear what they hear, and that is not what I said.

Overprotective parents require help with their fears: here is the fear, that the past will repeat itself.

3. “Needy parents”

Some parents go to the extreme that when I approach them, they snatch their child from the ground and pulling them in their arms, for “safety”. This happens then, just at the time, when I try to connect with the child. The child receives the clear non-verbal message that “this person is a threat”. The parent’s non-verbal sign speaks of fear and distrust.

In some cases, the reason for this action is the parental need to control any situation. These parents need to be the “Number One” of the situation and struggle to see the doctor building a direct link with their child. Their fear might be to be side-lined, even for a brief moment, in that case. They assume that their role is to be the spokesperson of their child, their advocate, their intermediary. This can go to the extreme, that for any question I ask the child I might get an answer from the parent instead, silencing the child in the process.

In this situation, we need to acknowledge, that the parental fear of loss of control runs deep. Again, the solution lies in taking a step back from the consultation and to directly ask how they see their role. The aim is to clarify our different roles: doctor = medical expert; parent = child’s support and expert; child = expert of his or her body, feelings, expectations.

Overprotective parents need help with their fears: here is the fear of losing control

4. Parents from deprived background

Working in Glasgow has exposed me to one more category of parents. I call these mothers (these are almost always mothers) “deprived tigresses”.

These mothers enter the encounter with me in an aggressive, demanding way. For these mothers life is very hard, nothing comes free, everything is an uphill battle. With this “background-noise” they enter the consultation with the expectation, that this will be more of the same.

Instinctively, I would withdraw from these encounters. I do not like particularly to encounter hostility. But I have learned, that when I listen open to their needs and when I verbalize, that their child deserves the best care possible, these mothers just melt. I see my role here in providing reassurance for the best care possible, rather than getting muddled up in petty fights.

Here as well the solution could lie in an active inclusion of the parents, for them to become part of the team: they are experts of their children and as such their views and assessments matter a lot. The offer would be for them to have a choice in the way the consultation is performed, as well as a clearly shared responsibility for the outcome.

In a nutshell:

Overprotective parents require an adjusted approach.

For over-protective parents, it needs to be obvious that their opinions matter and that we together take care for the safety of their child.

Different concepts of reality

Flipping the perspective works

The backdrop of change: Cognitive dissonance

Inner storylines of the (paediatric) patients