Parents and the Five Stages of Acceptance
Recently I received the following email from a fellow therapist:
"I have a little boy who just turned 2 and is not talking, babbling, or vocalizing in any way shape or form. I have educated the mother repeatedly regarding having his hearing checked and the possibility of other diagnoses and need for evaluation at our Children's Hospital. She is in denial over the whole thing and says her brother did not talk until he was 3 years old and she wants to wait and see if her son will one day start talking. He also has eating issues. He does not present with signs of autism, so I am concerned about severe apraxia. I wasn't sure if you had run in to cases where you have a child who the parents think is just a "late-talker" and you continue doing language therapy but you suspect something else is wrong. Is there a way you've helped the parents to see that something is really wrong?"
I thought this was an important email to share with both therapists and parents who may tune into this blog from time to time. I have often worked with parents who were basically in denial about the severity of their child's delay and/or disorder. What I have learned as a therapist, is that you really cannot rush the process. Parents will come to understand and accept their child's disability in time and sometimes it happens AFTER they leave the Birth-3 program.
When I was in school studying to become an SLP, we learned about The Five Stages of Grief/Acceptance created by Elizabeth Kübler-Ross, who wrote about it in her 1969 book, On Death and Dying. Although the environment in which we work does not often deal specifically with death and dying, for many parents, they are learning to accept the death of a dream, the dream and vision they had for their child. We, as EI therapists, are there in those early stages to help them along with as much education, support and compassion as is appropriate.
Below is a brief summary from Wikipedia explaining the Five Stages of Acceptance. I have added some commentary to show the connection with parents involved in the EI process.
- Denial—"This can't be happening, not to me or my child."
Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of the situation.
- Anger—"Why me? It's not fair!"; "How can this happen to me, my child, my family?"; "Who is to blame?"
Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person can very difficult to talk to due to misplaced feelings of rage and envy.
- Bargaining—"I'll do anything for a ‘normal' child".
The third stage involves the hope that the individual can somehow change the situation. Usually, the negotiation for an improved situation is made with a higher power in exchange for a reformed lifestyle. Psychologically, the person is saying, "I understand my child isn't talking yet, but maybe it's because he is just delayed, he'll catch up".
- Depression—"I'm so sad, why bother with anything"
During the fourth stage, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the parent to disconnect from you, other family members and maybe even their child. It is not recommended to attempt to cheer an individual up that is in this stage. It is an important time for grieving that must be processed.
- Acceptance— "It's going to be okay."; "I can't fight it, I need to handle this situation."
This final stage comes with peace and understanding of the reality of the situation.
Please read next Tuesday's post for a continuation of today's topic and how you can help families who are struggling through the acceptance process.