PolskiWhen Duchess Kate sat down in front of the camera to tell the world about her cancer diagnosis with remarkable poise, it was her words about her children that caused the most excitement. She admitted that she and Prince William took time to break the news to George, Charlotte and Louis in a way that was “appropriate for them.” This confession has touched thousands of women. Because while most of us don’t live in palaces or escape the lenses of the paparazzi, when faced with illness we face the same paralyzing dilemma: how do we tell the little ones? We talk to Beata Czerny – a psychologist, psychotherapist and psycho-oncologist from the GENEZA Clinic in Tychy– about emotions, courage, communication pitfalls and how not to forget ourselves in times of crisis.
Editor’s note: The world held its breath when Duchess Kate boldly confessed: “I have cancer,” immediately emphasizing that the biggest challenge for her and her husband was talking to their children. But before a parent can sit on the edge of a child’s bed, he or she must face the first wave of shock themselves. What emotions of patients do you most often encounter in your office in those first, critical days after receiving the results?
Beata Czerny (GENEZA Cabinet Tychy): The moment of diagnosis is a real earthquake. In the office, I see in patients first of all a powerful shock, disbelief and overwhelming fear – not only for their own survival, but for the fate of the whole family. Often there is a strong sense of helplessness and a natural defensive reflex that is, “I won’t tell them, I don’t want to worry them.” Adults think that by remaining silent they will build a protective wall around their children. Meanwhile, it is the prolonged silence that intensifies the fear, causing the little ones to start creating their own, often much more frightening scenarios in their heads, blaming themselves for the tense atmosphere at home. Therefore, it is crucial to sort out one’s own emotions with a specialist before entering into dialogue with a child.
Editor: What exactly happens to a child’s psyche when he senses that “something is wrong,” but adults keep quiet or dismiss it with half-words?
Beata Czerny: Children are brilliant observers. Their radars unerringly pick up changes: they see reddened eyes, hear interrupted phone calls or sudden changes in the daily schedule. When adults ignore this and repeat that “nothing happened,” the child loses confidence in his own senses. He may begin to fantasize that the illness is punishment for his bad behavior, that he has infected a parent , or that the situation is so hopeless that even adults are afraid to talk about it. It is not uncommon for this to manifest itself through sleep problems, withdrawal from the peer group and, in teenagers, escaping into rebellion or taking on the role of adult caretaker of the home. Open and age-appropriate conversation cuts off this destructive fantasizing.
Editor: In your practice, you use Rational Behavioral Therapy (RTZ) and Simonton Therapy, among other methods. Based on such methods, how should a parent “sort out” his or her own emotions, regain minimal calm and prepare himself or herself for this most difficult conversation?
Beata Czerny: This is a very important question, because we don’t pour from an empty jug. Simonton therapy teaches us to focus on the “here and now” and to build a healthy hope that allows us to enjoy life, but without becoming obsessively attached to one guaranteed outcome. Rational Behavioral Therapy (RTZ), on the other hand, begins by identifying thoughts that exacerbate stress, such as the belief “my family can’t cope without me.” This stream shows that emotions follow beliefs, not events. Before going to the child, a parent must separate medical facts from his or her own catastrophic interpretations. A simple question helps: ‘Do these thoughts make me feel the way I want to feel, and do they help me solve the problem?’ If not, we learn to restructure them in the office. Once a parent quiets his or her own mind, he or she passes this calmness on to the child. A change in perspective, for example, replacing a catastrophic thought with real information, reduces tension and allows you to look at the situation with more detachment.
Editor’s note: What minimum information should fall at the very beginning? How to say “I have cancer” in simple language, avoiding dry medical jargon, but also infantile generalities?
Beata Czerny: It is best to stick to the facts, stating them in a gentle way. The key is to name the disease and the word “cancer” or “neoplasm” must fall, otherwise euphemisms will make the child feel cheated. We should point out where in the body the disease is located and assure them that a team of wise doctors is doing everything to help. For the youngest, a metaphor that we can use to say that there are unruly cells in the body that behave like “uninvited guests” or “weeds in a beautiful garden” works great, and the medicines have to get them out of there. We always add two rescue messages: it’s not your fault and this disease absolutely cannot be contracted.
Editor: How do we talk differently to a preschooler, differently to an early school-age child, and how do we talk to a teenager who can independently “google” our diagnosis?
Beata Czerny: A preschooler needs short, concrete messages and physical proximity; his main fear is whether someone will pick him up from kindergarten, so we focus on providing a sense of security. School-age children are already asking a lot of questions. They may also have misconceptions that any cancer is a judgment. They need to be patiently explained the treatment process, desensitized to changes in appearance, and answered according to medical knowledge. Conversely, a conversation with a teenager must be an absolute partnership and honest to the point of pain. They will find information online anyway, often the worst. Instead of banning, it is better to analyze reliable sources together, for example, ask: “Have you read anything about this? Let’s talk about what you were able to find.”
Editor: Children can ask brutally honest questions: “Will you die?”, “Is it my fault?”, “Who will take care of me?”. How to respond to them wisely?
Beata Czerny: Let’s be authentic. Let’s never deny when a child fears for our lives. When asked about death, it’s worth answering, “I understand that you are afraid. Cancer is a serious disease, but medicine has great possibilities. We focus on step-by-step treatment. Whatever happens, you have people around you who love you and you will never be left alone.” However, let’s not make empty promises. It is important to admit ignorance. Saying: “I don’t know what it will be like, but I promise I’ll tell you everything,” teaches the child that uncertainty can be endured if you have support.
Editor’s note: The Princess of Wales strongly emphasized that her family needed space “in the privacy of their home” to tame the subject before informing the public. We don’t make statements on the BBC, but we have neighbors, employers, social media. How do we set boundaries for the environment?
Beata Czerny: Duchess Kate’s approach is a model of caring for the welfare of the family, first we protect our own nest, then we inform the world. Women after diagnosis very often waste energy on being “polite” to nosy friends or co-workers. We have every right to decide to whom we entrust our story. It is worth assertively but calmly saying: “Thank you for your concern, but at this stage I need to focus solely on the treatment and peace of mind of my children. I don’t want to discuss it.” A very helpful tool is to designate one trusted person in the family (e.g., a sister or friend) who will become a kind of “spokesperson” and relay ongoing information to the rest of those around her, taking this burden off the patient’s shoulders.
Editor: What communication pitfalls, or those arising paradoxically from the best intentions, do parents commit most often?
Beata Czerny: The main mistake is to trivialize the seriousness of the situation, i.e. the famous “Don’t worry, it’s just such a small procedure,” which deprives the child of the opportunity to prepare for real, visible changes in mom’s appearance. The second trap is the so-called ” conspiracy of silence” in the family, when adults secretly whisper in corners. The third, extremely harmful mechanism, is burdening the child with his or her fears to the point where he or she enters the role of adult caregiver (parentification), or forcing the child to “pull on his or her tongue” when at any given moment he or she simply needs to be silent and play.
Editor: Soon there is a new daily reality: hospital visits, hair loss, days when mom just doesn’t have the strength to get up. How to talk about it?
Beata Czerny: It is necessary to prepare the child in advance. Announce that the drugs hitting the cancer cells are so strong that they will also damage the hair follicles, but they will grow back. Explain the change in the division of roles at home in a very task-oriented way: “For the next month, dad will be the one making breakfast, and mom will sleep more so that the body has the strength to fight.” Concrete facts alleviate uncertainty. However, it’s worth preserving inviolable rituals, even if it’s just to hold hands in bed together for 15 minutes while reading a book? This stabilizes a child’s world.
Editor: Studies show that children in such situations tend to be very quiet, smiling and don’t want to cause trouble by hiding their emotions. How can a parent break through this wall of silence?
Beata Czerny: Children do this out of immense love, not wanting to cause additional pain to their suffering parents. Psycho-oncology teaches that an adult must model showing feelings. When mom feels powerless, she can say, “Today I’m crying and angry about this disease. You also have the right to be angry that we canceled the trip. Every feeling you have is important here.” It’s a good idea to encourage the child to express his emotions by drawing or writing a diary in which he can shout out his sorrows.
Editor: What about the school and the peer community? Involve the teachers or is it just our private business?
Beata Czerny: We should definitely include educational institutions. The teacher and school counselor must know that the child is experiencing an existential crisis at home. He may have worse grades, be aggressive or on the contrary sink into himself. It is not a matter of revealing the entire medical protocol, but informing that “the health situation in the family is very difficult, please pay special attention to my child.” Alerting peers will also protect the student from insensitive questions based on childish ignorance.
Editor: There are dramatic situations, the disease is incurable, we are entering the palliative stage. How do you convey such painful information, giving support?
Beata Czerny: At this stage, the principle of clarity is even more important. Avoid words such as “mommy has fallen asleep” or “she’s gone,” because in young children this creates an immediate fear of falling asleep or a false hope that mommy will return soon. In the face of the inevitable, it is worth saying gently but firmly: “The doctors have done everything possible, but the drugs are no longer working. I will be with you as long as I can. And then, although I won’t be able to hug you physically, the people with whom we have agreed on what your life will be like will stay here.” Such a conversation can sometimes be tearful, but it gives the child a chance to enter the process of saying goodbye.
Editor: At what point do home talks stop being enough and we should ask for support from a specialist? What alarm signals in a child should worry us?
Beata Czerny: I invite you to be vigilant when you observe prolonged withdrawal, somatic problems (abdominal pain, bedwetting), strong aggression, self-stimulatory behavior or when destructive thoughts appear in older children . Just as importantly, adults themselves should also seek help when they feel that anxiety is completely paralyzing them. A consultation at a psycho-oncology clinic is not capitulation, it is the highest act of responsibility and conscious management of the crisis, both for the patient and the so-called “second-round patient” – the family.
Editor’s note: Seeing public figures such as Duchess Kate, who, with perfect makeup, speak calmly and perfectly about their struggle, “ordinary” female patients can feel the pressure. Do such stories help or drive women into complexes?
Beata Czerny: Each of us is only human and has the right to our weaknesses. Such speeches do a great job of removing the taboo from cancer, making people aware that cancer does not choose, but they also carry the risk of “toxic comparison.” The Duchess had the support of an entire image staff. The statistical patient in Poland is often overwhelmed by the logistics of treatment, financial uncertainty and is at home alone with this. Let’s take the media confessions as an inspiration to be brave enough to break the silence, but give ourselves the absolute right to have tears, sweatpants, tumbled hair and fatigue at home. What is important is the love and authenticity of communication, not the setting.
Editor: Imagine a reader of our portal who has just received the most difficult diagnosis of her life. In an hour she will return home, where her children are waiting for her, and in her mind she has only one thing: “I won’t be able to tell them.” What three small steps should she start with today?
Beata Czerny:
- Give yourself the right to oxygen: Before you step into the role of mother be patient for a while. Cry it out, sit in your car in the parking lot or call your partner or a friend to scan the initial shock and “ventilate” your emotions.
- Get the hard, simple facts: Find out from the doctor the name of the disease and what the first, next step in treatment is. Children at this stage need to know only what is happening “here and now.”
- Choose the right moment: Don’t talk about it at the door or on the run. Arrange a quiet space without a phone. Remember that you don’t have to say absolutely everything in that first conversation. You can end it with the words: “This is what we know for now. When I find out more, I’ll tell you right away. And now let’s just stay together.”
Editor: Thank you very much for this supportive and knowledgeable conversation.
Beata Czerny – psychologist, psychotherapist, psycho-oncologist. On a daily basis she supports oncology patients and their families at the GENEZA Clinic in Tychy. Interview conducted for Gentlewoman.eu portal
