“Parents who are going through a divorce really want to believe their children are OK,” said Lisa Blum, PsyD, a licensed clinical therapist on the faculty of The REACH Institute’s CATIE program. “They’re terrified that they’re hurting their kids. So if Sally is doing her homework and Johnny isn’t acting out, the parents think, ‘Whew, good, they’re fine!’ But often they’re not fine.”
Though divorce rates in the US have been declining for years – including, according to early reports, during 2020 – the rates are still high. Each divorce or separation brings loss, disruption, and pain to any children involved.
A Pediatrics article on divorce notes that children of all ages may go through behavior changes in the first year of separation. Most recover within two or three years, though some continue to experience adverse effects.
The support children receive as their parents separate makes all the difference in their ability to rebound. As a pediatric or family primary care provider or social worker, you are in a strong position to make sure children get that support.
For both parents and children, you have two main messages:
Dr. Blum outlined five tactics you can use to reinforce those messages and help families weather divorce or separation.
“A kid who looks like they’re adjusting well may not be,” said Dr. Blum. “They might be in shock. They might feel they don’t know what’s going on, and they don’t know what’s safe, so they just get small and quiet. Or they’re hiding – they see their parents’ distress, and they don’t want to add to it.”
Parents may encourage – and be encouraged by – superficial signs of “okayness.” You can dig deeper.
Ask the patient a question that gives permission to talk about their feelings, like “What has been hard about this for you?” If the child is old enough and you have an established relationship with them, you may want to ask if they want the parent to step outside while the two of you talk.
“External support can be the difference between a parent who’s a wreck and a parent who can let go with another adult and then pull themselves together to be there for their child,” said Dr. Blum.
Point out to the parent that what they’re going through is really hard, suggested Dr. Blum, and then ask where they get their support. Even if they have a strong network of family and friends – and especially if they do not – you might encourage them to see a counselor.
“Tell them that getting support for themselves will help them be available for their child,” Dr. Blum said. “That will make it more permissible if they have any stigma around mental health.” Besides, your authority as a physician helps to validate the decision to accept help.
Even if the parent doesn’t act on your recommendation now, they may be in enough distress later to pull out the phone number you gave them.
Destigmatizing mental health care is also important when encouraging parents to get their child into counseling. “You want parents to understand that this is a good and helpful thing they’re doing for their child,” said Dr. Blum. “It’s not that they’re damaging their kid; they’re doing something positive, like taking them to the dentist before they get cavities.” Again, your authority and relationship with the family is likely to carry some weight.
With older children, ask about their support system: “Your parents are having trouble right now. What other adult can you talk to?” Dr. Blum pointed out that the teen may not really have thought about it until you ask. “Then they’ll say, ‘Oh, I can talk to Aunt Susie about anything,’ or ‘This counselor at school keeps wanting me to visit.'”
To encourage both patient and parent to follow through on your mental health referral, normalize the need by pointing out that divorce is hard and that everyone needs extra help to get through it.
Give the parent a 30-second rundown of signs of emotional distress. Encourage them both to notice and to ask questions like “How has your sleep been this week?” Uncovering issues may take some probing when children don’t want to show parents what they’re feeling.
Parents and children both are mired in their present situation. You can give them the longer view. Reassure them that, if they get the help they need and stay connected to family and friends, they will come out safe and whole on the other side.
Families who cannot afford mental health services can register for the Open Path Psychotherapy Collective, of which Dr. Blum is a member. Open Path therapists offer in-person or virtual sessions at below-market rates.
Helping Children and Families Deal with Divorce and Separation from the American Academy of Pediatrics offers valuable clinical and legal advice.
Children and Divorce is a solid online article you can recommend to parents. Dr. Blum also suggests having books on divorce in the waiting room.
“The opportunity to learn information to help me manage psychiatric conditions in my patients in this time where demand clearly outweighs supply of services, is going to be excellent for me as a PCP in my community.”