Lost in translation? Creating dialogues, not monologues. (Mis)communication in child and adolescent psychiatry
- Goda Tikniūtė
- Jan 2, 2018
- 5 min read
Interview with Gintautas Narmontas, MD
When thinking about (mis)communication in psychiatry, the context of child and adolescent psychiatry inevitably comes to mind. This is not only because psychiatrists often have to act as interpreters between children, parents, and other specialists and institutions, but also because we can understand various psychiatric symptoms in young people as the language of unmet needs that emerge when conventional means of language and communication are insufficient.
In addition to his academic and clinical work, Gintautas Narmontas is a public speaker on topics related to mental health, advocating for greater awareness and understanding in both professional and public spheres. He maintains a private psychotherapy practice in Vilnius. He has been actively involved in the Lithuanian Cognitive Behaviour Therapy Association, where he served as a board member and secretary. His interests span psychotherapy, psychiatry, and neuroscience, and he is particularly engaged in integrating scientific knowledge with clinical work.
In your opinion, where are the most important sources of miscommunication in your work? What different "languages" come together here?
I would like to start by saying that miscommunication is the most common cause of conflict. And we often fail to communicate because we misjudge other people's desires and needs. I would like to ask a question for reflection: how often do we share our impressions of the day, talk about the challenges that have been on our minds lately, hoping for advice from a loved one? Hoping for an explanation of what to do? I think rarely. Perhaps our most common need is to feel seen, heard, understood, and ultimately important to another person.
We experience this lack of understanding and the disappointment that follows from childhood. For parents, a child's problem is yet another task in a busy, hectic day, compounded by fatigue and chronic sleep deprivation (about half of parents don't get enough sleep). When you are tired, the best thing you can do is to solve the problem as quickly and efficiently as possible, to take that extra weight off your shoulders as soon as possible. But if we look at it from the child's perspective, the same goals take on a different meaning—parents will try to solve what the child is talking about, rather than understand what the child is experiencing. Sometimes you have to respond to emotion with emotion.
What would you rather remember? That your parents explained what to do, solved your problems, or that they listened to you and made you feel understood? In my opinion, the most common source of miscommunication between children/adolescents and their parents is skipping the step of validating emotions. I would dare to say that most "problems" do not need to be solved. With attention, positive evaluation, and listening, children are able to solve the difficulties that correspond to their stage of development on their own.
In other words, children and adolescents often "speak" with emotions, while adults speak with logic. Not doing well in math class? You need to study harder, maybe take extra lessons. Logical. However, if we remain only in the world of logic, we will only react to the tip of the iceberg.
In life, we suffer not because of the situation itself, but because of our emotional reaction to it. At the same time, suffering is caused by the rejection of emotions and various attempts to fight them. In a psychotherapeutic context, one of the key goals is to help the patient accept their emotions rather than fight them. We learn this from childhood through regulation, through everyday experiences when a loved one is with us and our emotions.
How different are these "languages" and, if they are different, how compatible are they?
Looking at the same sources of misunderstanding from the other side, we see a conflict between different needs. Parents' desire to protect and control the situation clashes with children's desire to be accepted and their need for autonomy and independence. Parents try to take care of their children's future. They think about what needs to be done today to make tomorrow brighter, where the efforts made now will pay off. Children, meanwhile, live in the here and now. What matters to them is how I feel today, whether I am supported, whether I can be myself and feel accepted. In other words, they communicate about their state of being, while adults often respond to plans. So it is not just a matter of different "languages," but also different dimensions of time.
However, they are compatible. Unconditional acceptance without caring about the future of children can turn from validating emotions into harmful collaboration. There is a huge difference between accepting that a child may feel hopeless and agreeing that the situation is hopeless. In order to reconcile these important aspects, acceptance and concern for the child's future, active listening, slowing down, emotional empathy, and awareness are needed. The realization that "being there" is sometimes more meaningful than "solving" is important.
In your opinion, what should be done, what direction should we take to increase communication not only between specialists and institutions, but also between your patients and those who are part of their world? Is this our responsibility as psychiatrists?
In my view, this is not only our responsibility as psychiatrists, but also our responsibility as human beings. When it comes to the role of professionals, the most important step is to take on the role of interpreter. Between children and parents, between patients and schools, between emotional language and medical discourse.
To make this possible, we need more inter-institutional flexibility, more effective ways of exchanging information, and simpler, less bureaucratic contacts between specialists. Psychiatry should not be an isolated island. I believe that initiatives such as Open Dialogue, in which the primary treatment is carried out through meetings involving the patient together with his or her family members and extended social network, offer flexibility and appropriate access to people's needs.
Communication is not a given - it is a skill that is developed and nurtured. We must learn to create dialogues, not monologues. We must teach parents, teachers, and children to listen to each other, not interrupt, and refrain from making quick decisions before hearing the whole story. This is not easy to apply in everyday life. The pace of life has become extremely fast in recent times. The days of both children and adults are filled with rushing and an abundance of information. This is compounded by the current culture, where productivity and adaptability are positioned as values. If we take a closer look at how these values are implemented, we often find rushing. Thinking about this, I remember the Lithuanian proverbs I heard from my mother and grandmother when I was a child: "Haste makes waste" and "He who rushes, rushes twice." I believe that other languages have similar proverbs. Their essence is not new, but has been known for a long time. I believe that it is precisely the attempt to slow down the pace of life that enables people to choose rather than react.
Thank you so much, Gintautas! □
