A few weeks ago, I did an intake in the dark. That's not a metaphor. A storm knocked out the power in my building, leaving me with only a trickle of light coming in through my office skylights. It was too late to cancel the intake, so we decided to hold it by phone.
It was so dark in my office I couldn't even see to take notes. I could only listen. This parent had my complete and undivided attention.
I was listening so hard the woman on the other end of the line could feel my focus, almost like it was something she could touch. I could tell because she kept saying things like "This is so helpful" and "Everything you're saying makes perfect sense", even though I was barely saying a word.
Sometimes I forget how helpful just listening with your complete, full presence can be.
Towards the end of the call, as we were wrapping up, the parent said, "Great. I just have a few questions for you." She paused, then added, "Well, I really only have one question."
This is the moment I most love during intakes. The moment where the parent comes right out with their Secret Question.
"Dr Nelson, how often after testing do you say 'Look, there's nothing wrong with your kid. You're just a shitty parent.' How often does that happen?"
Can you hear the sound of my heart breaking?
We hear some version of this question from parents a lot during intakes, don't we? Sometimes expressed this frankly, and sometimes hidden beneath layers of anxiety and ambivalence.
No matter how often I hear it, it hits me in the gut every time.
Secret Questions like this remind me why I do this work. These questions shape how I complete an evaluation, and how I write a report.
Because if I don't answer this Secret Question with my testing and in my report, nothing I say will matter. If I don't answer the Secret Question, the parents won't be able to hear or take in any of the other answers I have.
If we don't know the Secret Questions, it's also hard to answer the questions we raised in last week's WBR post. If you don't have a clear idea of what the parents really want to know, how can you know what's True, Helpful, Understandable, Necessary, and Kind?
For example, if I don't know that this mother is worried she's a failure, or is too exhausted to be the parent she wants to be, I'll struggle with suggesting parenting strategies in a way she can embrace.
When Dr. A didn't know Lorraine's secret questions about her son Rylan, she wrote a report Lorraine could barely read without crying. So when Lorraine and I started thinking about how to add empathy to her reports, we started there. I asked her, "What were your Secret Questions?"
Lorraine looked at me like I was crazy, and said, "What do you mean?"
"Well... what was the 'reason for evaluation'? Why did you take Rylan in for testing?"
She answered, like any good pediatric neuropsychologist, "Diagnostic clarification and treatment planning." When I asked for more, she added, "I wanted a good understanding of Rylan's challenges, and to make sure he gets the support he needs. "
So I asked, "And what did you really want to know? What did you really want to hear?"
"I wanted someone to tell me everything is going to be okay. I wanted to hear I'm doing right by him. I wanted someone other than me to see how far this amazing boy has come, and to help me smooth out the rocky path still ahead of him."
Those are what I mean by Secret Questions. I mean those questions you listen for in the intake with your inner ear. The questions that tell you the parent's hopes, dreams, wishes, and fears. The questions that wake them up at 3 AM. The questions they don't really want to say out loud if they don't have to.
I'm not sure where I came across this idea of listening for the Secret Questions in the intake. Sometimes it's hard to trace where we learned what we know.
Therapeutic Assessment certainly involves eliciting questions during the intake. While I don't think they explicitly use the phrase "secret question," in Judith Armstrong's chapter in Collaborative/ Therapeutic Assessment: A Casebook and Guide, she talks about a client's "Burning Question."
The TA book In Our Client's Shoes introduced me to Control-Mastery Theory, an empirically-supported psychodynamic theory. This theory posits clients seek psychological help when they want to disconfirm pathogenic beliefs they hold about themselves. Examples of such beliefs are that they are broken, unworthy, or unlovable.
[I also googled "Secret Questions" to see if I could further jog my memory. I found a blog post by Sonia Simone with a similar idea from Seth Godin, a prominent blogger who writes about internet marketing. I don't think I've ever read anything directly written by Godin. However, his ideas are all over the internet so who knows if that's how the Secret Question concept found its way to me. ]
Lately, I've been making a list of the Secret Questions I hear in intakes. I've noticed they cluster around certain themes. I want to share my list with you, and ask you to share your list with me. The more Secret Questions I know, the more I can trust my intuition will recognize the implied or half-whispered question when I hear it.
In this post I'm going to share the first 3 themes on my list. In Part 2 (next week?) I'm going to add 3 more themes to the list. We'll also talk about how to listen for these Secret Questions. In later posts, I'd like to expand on each theme in turn. We can look closer at the specific questions parents ask in each area. We can also talk about how we can answer them with our reports.
Here's the first three themes on my list, with brief explanations for each sub-theme:
Stories and Roles
Help Me Change This Story
Families come in to our evaluations with a story, or a way of understanding what is happening or what the problem is. Often, that story is one they do not like. It's a story they wish could change but one they fear cannot be. Maybe the story is something like "I'm a bad parent," or "My kid is just lazy." These stories are stuck stories, because they leave everyone feeling hopeless to address the problem. Unless these stories change, the problem cannot be solved. The part of these questions that is secret is that families often don't know these are just stories. These are the "what ifs" and fears that sneak in at 3 in the morning.
Help Me Change My Child's Story About Himself
Kids also often have stories about themselves. The child might want to change his story, and be looking to adults to help. Or, his parents might desperately wish I can change it for him.
An example might be changing a struggling learner's story from "I'm dumb" to "I learn a different way." Or maybe changing the story means helping a child see something that's different about her as "unique" rather than "wrong." Sometimes the most secret part of questions about stories is how negative the stories can be. Parents may even fear that by speaking these stories out loud, they could make them come true.
Help Me Hold On To A Story That's Changing
Sometimes, families quite like the story they have. However, maybe someone or something else is challenging their story. Perhaps a child who is supposed to be "gifted" in learning is struggling in school, or didn't test into the gifted program. Or perhaps a family who thinks everything is "fine" is being told by a teacher or therapist that something is actually wrong. Perhaps a parent is beginning to mourn a dream they held for their ideal child, and they need to clear that out so they can make room for the wonderful child they actually have. What's often secret about these questions is parents don't want to tell you how afraid they are that things will change.
Help Me Know or Change My Role
Sometimes secret questions hint at helping family members figure out "How does this family work?" These questions are about boundaries, roles, and identity. Parents may want to know which of their two differing parenting styles are "right." Perhaps a mom wants to know how she can be her child's best friend and her parent at the same time. Maybe a father is are struggling with how to be a good dad when he did not see positive parenting growing up. Or perhaps the whole family can't figure out why "only" this child has a problem, when everyone else in the family is doing "just fine." These secret questions hold a hidden agenda or implicit belief about how families are supposed to be.
Help Me Understand
Sometimes parents come to us and they already have a long list of diagnoses. Their child has been diagnosed with ADHD, GAD, SLD, and SPD, with reports and recommendations for each diagnosis. I've found myself wondering, "What more could they possibly need from me?" when I see these families, which makes me realize I'm missing the secret question. I've found these intakes include a plea for a roadmap, or "big picture" view. These parents want me to turn an incomprehensible laundry list of letters into a picture and a path. Or they want to understand something from a past evaluation, but are ashamed to say they didn't understand it.
Help Me Help Her
Sometimes the secret questions are about priorities. Even if the parent knows what the problem is, there may be so many options or ideas for how to help. Some parents are afraid to say they are overwhelmed by all the books full of suggestions, the reports with 20+ recommendations, and the advice from in-laws and neighbors. They're ashamed to say they don't want every night of the week taken up by a different type of therapy or support. Parents may also be wrestling with some hard choices they are secretly too afraid to consider, like placing their child on a powerful psychopharmocological medication.
Shame and Guilt
Help Me Stop Carrying This Shame, Guilt, or Isolation
Parenting is so hard. It's so easy to feel you are not the parent you want to be. Or that you're failing your child (or your spouse, or your work, or yourself) as you try to do this parenting thing. Sometimes parents let you know they secretly need some relief from this unrelenting pressure. Other parents ask questions that show you they blame themselves for causing the child's problem, or for passing a curse on to them. Many parents are crushed with secret guilt, thinking they should have found and fixed the problem earlier. Some parents feel they're the only ones who are struggling, and are quietly worried they'll always feel this lonely and alone.
Help Me Know Everything's Going to Be Okay
Some parents, like Lorraine, mostly want to know it's all going to turn out all right. They may be afraid to ask for this reassurance directly, or may fear you won't be able to give it to them. Maybe they're worried about some dreaded outcome that to them means failure or defeat. Many parents wonder - but cannot always bring themselves to ask directly - if their child will get a job, go to college, have friends, get married, have children, or ever move out of their house. Other parents may be too afraid to ask about a worse case scenario, like when their child might have to go to the hospital to keep him safe.
Help Me Save Face
Sometimes the secret agenda of the evaluation is for the parent to find a way to understand a problem without destroying their world view. They may need a "reason" why a child is not meeting an expectation, such as a very subtle learning disorder that explains academic under-performance. Or they may need a medical explanation for the child's psychological problems. Some parents need someone or some situation to blame, or confirmation that they did everything they could have done. The secret questions here are about telling the parent as much of the truth as possible in a way the parent can hear.
Help Me Take a Step Back
Some secret questions seek permission. Parents may need the okay to stop worrying about something. Or to stop doing some of the things they are doing for their child. This could be as small as working with him on math facts at home even though it leads to tears every night. Or something as large as managing his entire life for him. Some parents need permission to step back and let their child try it herself. Or they may need help letting others take over for a while. These are questions people can have a hard time asking when they feel like they "should" be doing everything they are doing and more.
In Part 2, we'll talk about the themes of: Hope/Fear/Loss, Navigating the Modern World, and Healing.
Until then - what questions are you hearing? Are you hearing these questions in your intakes? What questions did I forget? Leave a comment below with the Secret Questions you intuit most often.
Note: 7th grade reading level, 10 "very hard to read" sentences.
And if you're wondering how I answered that question during the intake, I said something like, "Never. That never happens. By the time parents get to me, they've tried everything they can think of and they're still looking for help. That's how I know they're not shitty parents. That doesn't mean I'll be making a diagnosis for your kid, because that might not actually be what the problem is. And that doesn't mean we won't talk about parenting during the feedback session, because even the best parents get stuck in 'dances' with their kids that aren't working and leave everyone feeling stuck. And kids don't come with instruction manuals, so what works for great other kids might not work for yours. Part of what we're going to try to answer is 'What does work for this child?' But I promise my answer to your questions is not going to be 'You're just a terrible parent,' because I already know you aren't."