25 January 2006
Talking with Children:
The Tough Conversations
David Waters, Ph.D., Family Medicine, UVA
Catherine Casey, M.D., Family Medicine, UVA
While parents might say the most difficult discussions with their children are about sex, for health professionals and hospital chaplains the tough conversations tend to be, not surprisingly, about illness and injury, suffering and death, loss and grief. There are no simple algorithms for responding to a child's questions and concerns about such things, but there are better and worse ways of handling them.
David Waters has been in Family Medicine at UVA since 1975 and is the longest-standing member of the Department. He is a psychologist with a life-long interest in family dynamics and family therapy, which is how he initially became interested in Family Medicine.
In 1978, he invented the Family Stress Clinic at UVA as a way of teaching residents how to understand and work with family systems. The clinic is a part-time entity within the Family Medicine Department where couples, families, and individuals can be seen for help with a wide variety of problems. Therapy is conducted by residents and Family Stress Clinic staff behind a one-way mirror, which allows active supervision and help as needed. In this way, Family Medicine residents can get direct, hands-on experience with family interventions of the kind they may well make as a practitioner, with the luxury of direct support and teaching. Many cases are referrals from within the practice, which allows very direct collaboration with the Primary Care Provider for the family; others are self-referred or referred from other places in town for short-term treatment.
The Family Stress Clinic has been a very successful and enjoyable part of the Department and has taught numerous residents. Most importantly, it has helped many families and individuals over the years. It has been copied by other Departments around the country who have wanted to emulate what it offers for resident training.
In addition to the Family Stress Clinic, Dr. Waters teaches in the Department via a number of other formats and tries hard to keep the psychosocial aspects of medicine foremost in practice.
Catherine Casey is a resident in the Division of Family Medicine at UVA.