Home

The Role of Health Care Professionals

WHAT THE RESEARCH SHOWS
Ogilvie, one of the originators of the advertising industry, supposedly said that most people use research like a drunk uses a lamppost--for support rather than illumination. Health care professionals should heed these words. The research documents that divorce can, and often does, have a devastating effect on children. Unfortunately these results are being used to support demands to make it more difficult for couples to divorce, despite many credible studies that indicate that children who live in environments characterized by continual parental hostility or alienation suffer just as much as the children of divorce. Rather than use the research as a weapon in a political or ideological battle, it would be more constructive to use it to determine what's in the best interests of children.

A LONG-TERM OPPORTUNITY
Health care professionals can play a very constructive role in helping children of divorce. Children face a series of adaptations as they get older; they don't recover in the same way or in the same time period as adults. As most children are eight years of age or less at the time of the divorce, they are still seen frequently in the medical office offering health care professionals the opportunity to guide parents toward understanding their children's needs and viewpoints. Without this knowledge, the parent-child relationship suffers. Doctors and nurses can also raise salient issues with parents, and anticipate others, in order to help these children thrive despite the divorce. Health care professionals may not think so, but they do have many of the skills needed to address complex family crises. They are adept at interviewing all age groups, at carefully selecting the pertinent details from multiple different sources (parents, child, teacher), and at maintaining a long term relationship with all members of the family -- which gives them an advantage over counselors, mediators, lawyers, and social service workers.

NO ROADMAP
However, helping divorcing families is a considerable challenge. Every situation is different and every situation painful to some if not all those involved. While the pain for children caused by the death of their parents' marriage may not be quite as intense as that which occurs consequent to a bereavement, it continues indefinitely. Meanwhile if we are to encourage both parents to remain involved in parenting, it is clear that the knowledge we have gained from studying models of single parenting sheds little light on how to advise two parents to parent the same child separately. With no set guidelines to follow, the clinician faces immense pressure to both "fix" immediate problems, relieve current emotional tensions, and prevent other crises from occurring.

These are ambitious goals especially when parents are caught up in their own life adjustments. During the separation and frequently for years afterward, "intuitive parenting" doesn't function well and parental feelings of competence have generally been undermined. So support and advice is a necessity. Parents come seeking help to re-establish their role as the "good-enough parent". As a result, while wanting insights into their own and their children's behavior and emotions, parents also seek quick, practical advice.

BE PROACTIVE
While it would be optimal for health care professionals to become involved in the process as soon as parents contemplate separation/divorce, they often learn about it much later and even by accident.
The subject of divorce often arrives without warning, or out of context or "by accident, firstly because parents rarely discuss divorce directly in front of their children so they stay silent in the office, and secondly because many parents do not identify health care professionals as a primary resource they can turn to for help during the early separation phase.

To circumvent these problems, we would recommend that a question about the health of the marriage be part of every well-child visit, just as inquiries about domestic violence, drug use, sexual activity, and gun possession are now part of the standard interview.