Lorraine* came to me with a heavy heart and a problem:
"I don't want to write reports like this anymore."
Lorraine is a pediatric neuropsychologist and a triathlete. She is also the mother of Rylan*, an energetic 6 year-old with a smile that lights up a room.
Rylan joined Lorraine's family when he was 13 months old. His first year had been difficult, full of chaos and challenges, but he had bright eyes, a strong heart, and a bubbly laugh. Lorraine and her husband quickly enrolled him in all the right therapies for his medical and developmental needs. Rylan thrived and made amazing gains.
With kindergarten right around the corner, Lorraine sought out a neuropsychological evaluation. Rylan had learning, motor, and social-emotional delays and would need support at school.
After some searching, Lorraine found a neuropsychologist she trusted. Dr. A came highly recommended. She had trained at the same high caliber program where Lorraine had been a post-doc, which was reassuring.
The evaluation itself was a positive experience. Dr. A was warm and friendly. The intake was thorough. Testing went smoothly. Rylan was tired yet enthusiastic when testing was over - the exact combination Lorraine strove for when she tested a child. She felt relieved.
Then came time for her and her husband to attend the feedback and read the report. As Lorraine later told me over Skype:
"This is when my heart broke."
As we processed her grief, Lorraine clarified the feedback and report were not awful. Far from it. In fact, the evaluation was comprehensive. The diagnoses were appropriate. There were pages and pages of test interpretation and recommendations.
It was all just... missing something.
None of the thousand things Lorraine loved about Rylan was in Dr. A's report. She couldn't find any trace of her son's fiercely loving, silly, and resilient personality in the words. Nothing about his compassion, or courage, or eagerness to please. Nothing about the joy he brought his family. No hint of the way his teacher's eyes lit up when she heard his infectious laugh trilling down the hallway.
In fact, the whole report left Lorraine feeling cold.
Dr. A described Rylan's deficits in exhaustive detail. His strengths were skills that were "intact", as if he were an egg that could crack with too much pressure. When Dr. A recounted Rylan's goofy behaviors when tests were too hard, Lorraine felt like he'd done something wrong.
When Dr. A's report included 28 detailed recommendations, Lorraine worried she'd failed her sweet son.
What brought Lorraine to me was not a clinical problem. She had shared Dr A's report with Rylan's school, where the detailed test results informed his IEP. Lorraine also followed some of Dr. A's recommendations, and signed Rylan up for extra social skills groups and OT.
Instead, what Lorraine had was a professional problem.
"I realized I write reports in exactly the same way as Dr. A," she said. Lorraine is a caring and compassionate professional. She was heartsick that her values were not translating into her reports.
"I focus on deficits. I include pages and pages of recommendations, even when parents are doing everything right. I use words like 'intact.' I pay lip service to the child's strengths, adding them in a sentence at the end like an afterthought."
She paused, then confessed:
"I make parents feel like this every week."
What she wanted, Lorraine decided, was to inject her reports with empathy.
Empathy is a bit of a "hot topic" right now, and there is no shortage of info on the topic. Lorraine and I dove into the research. We learned about different types of empathy, ways to define and express empathy, and even arguments against empathy.
I forwarded her some Brene Brown quotes, and she replied back with some quotes from Daniel Pink. We immersed ourselves in empathy.
Quotes and research are great, but Lorraine needed a roadmap.
She needed strategies for assessing the empathy of her reports and tracking her improvements. We needed to operationally define what empathy looks like in a neuropsychological report.
I shared with her a simple formula you've surely seen all over the internet. It's so ubiquitous that it borders on cliche. It's also the best way I know of to test if what you have written will be something the reader can hear: the THINK model.
The THINK model
This model has been floating around for a long time. It is often attributed (incorrectly) to sources such as Buddha, Rami, Socrates, and Abraham Lincoln. Poems and sermons from the 1800s refer to it. Eleanor Roosevelt reportedly used it. The model is similar to tests for speech used by the Quakers (the Three Sieves) and Rotarians (the Four Way Test). The idea is simple. Before you say something, you ask yourself, is it:
(The internet is a bit squishy on what the 'I' stands for. Sometimes it's "inspiring", sometimes "important." Sometimes it's left out all together.)
The acronym is "T.H.I.N.K. before you speak." In other words, if what you were going to say meets all 5 criteria, you can say it. If it doesn't, you don't. You keep it to yourself, or you find a way to rephrase it.
The Thunk Model
I love almost everything about the THINK model. I love acronyms, systems, and empathy, so this model is a Venn diagram of goodness for me. Except for that squishy "I" -- surely not everything you say can be inspiring or important. And the THINK model leaves one thing out. Something we've been talking about a lot in these WBR posts so far: Clarity.
If you missed them, you can go back and read through all my posts on readability and it's so essential. Or, you can just read this 6 word Brene Brown quote to get the main idea:
Empathy, as Daniel Pink told us, is listening with someone else's ears and reading with someone else's eyes. It's knowing how a phrase will sound to them, and feeling what they'll feel when they take in our words.
So when we write something our reader won't or can't understand, that's an empathy failure.
It's a time when we forgot to think about our reader, and to connect with his or her experience. Writing with empathy means writing with clarity. For me, clarity is essential enough to get it's own letter.
THCNK is too hard to remember, so I use the THUNK model.
The 'U' is for "Understandable."
Before I write something in a report, I think through if it is:
If what I want to say meets all those criteria, it goes in the report. If it doesn't, I leave it out or I think of a new way to say it.
Now that we have a model to guide us, in our next few posts, we're going to dive deep into what THUNKing actually looks like. I've been pondering how many phrases we in "traditional" reports fail to be true, helpful, understandable, necessary, and kind. I've been looking at disciplines like medicine, communication sciences, and marketing for ways to enhance empathy in our reports.
In particular, I've been looking for practical tips and real questions we can ask ourselves to up the Empathy Quotient of our reports. I'm excited to share what I've learned.
In the meantime, what tips have you found? Share them in the comments below. Let's figure out this empathy thing together.
Note: This post is written at the 5th grade level. There are 129 sentences (average sentence length of 10.1). Seventeen of the sentences are "hard to read." Zero of the sentences are "very hard to read." There is one use of the passive voice.
* = Not their real names and many details changed for privacy reasons.