Hi Larsy, thanks for taking the time to reply to my questions.
Larsy writes:"What the parent sees as 'fact' is actually hir theory about what needs to happen- what is going on with child, ways to deal with it, what the options are. "
I fail to see the significance of this point? TCS is a theory. A theory is simply an unproven idea. But, the better the facts it is based on, the better the theory. Symptoms are facts, a diagnosis is a theory until tests confirm it. However, the better you (or a doctor) are at understanding the facts of your sick child's condition, the better your theory will be, and in turn, the diagnosis can be made faster and the treatment started sooner, all because of a sound theory.
Larsy wrote: "But it would not be help for that problem. If the child is afraid of being hurt, a parent can talk to the doctor and other sources and find out what the options are for pain relief. "
For practical purposes, I had hoped we would not overly dissect the clinical aspect of the family in this example. But, to clarify, I maintain that asking about pain relief etc. is little more than gathering info to better inform the child. It does not reflect interference on behalf of the parents preference in the situation. Expressions of personal preferences or feelings about the situation are more than just fact gathering IMO.
"However, if the child begins to cry and say they will not go for reasons xyz, then IMO anything you say at this point to allay the concerns, and make the doctor visit seem more attractive, and elicite a willingness to go...that is just coercion, IMO, and nothing more."
"Find solutions to the problem xyz."
If that is possible, I certainly would. But if the fear is "This will hurt" that might be unavoidable (even with the latest skin numbing cream, shots still hurt, unfortunately). The solution may be a compromise, and it is perfectly understandable that a child may be unwilling to make a compromise that involves pain.
"One reason is because I think it is unrealistic to confuse a willingness to go with an absence of reluctance. "
Larsy responds: That would be a faulty theory.
Why is that a faulty theory? Have you never experiences the feeling of being willing to do something you still harbored doubts about?? I have heard many people describe such feelings, so I felt this was a possible condition the child may experience. Why do you disagree?
larsy writes "If it is truly a common preference, the child prefers going and solving the problem, than not doing so. Child might still be scared, but determined to confront the fear and do what child feels must be done to help with hir problem. A parent can support their child in this. "
Hmmm. I realize you will not agree, but you are essentially describing the state I feel TCS defines as coercion, which involves the feeling of coping with two opposing forces etc. I realize you feel it is not coercion for a parent to share a personal preference to the child about the situation they are in. I often feel TCS ignores the fact that such statements are more than just objective observations when they happen in real life. It would be mighty hard for a sick 4 year old to not feel quite a lot of pressure from mommy worriedly noticing his symptoms and suggesting he go to the doctor.
larsy writes:"If the child is having a problem that is bothering hir, and the parent and child have entered into a process of finding solutions for that problem, they might have consulted more than one doctor and done research on the problem and talked to many other people with that problem and discovered lots of good information that can help them figure out if, indeed, the problem must have intrusive and painful treatment to be solved, or if there are alternatives, or if the treatment can wait for awhile until the child comes to terms with it, what measures can be taken to control pain, can child listen to music on headphones to help distract hirself, or the child might decide s/he would rather live with the problem than the solution. "
I feel this is all good advice and would hope the parent would follow it. Unless the condition poses a health risk, I agree the child could just live with it. However, especially with a young child, I hope you are not saying to simply let a child die from untreated diabetes because it occasionally takes coercion from the parent to take the daily shots?
TCS parents here have made it pretty clear they agree to save their child from death even when it involves coercion. I assume this extends to getting treatment for a critically ill child, regardless of whether the child agrees. Does it?
"If the child gives any indication that s/he is still in a state of coercion over the doctor visit, and wishes to put it off, barring a life-threatening situation, I would back off and continue to help child to find solutions that we are both happy with. I would let the child know the consequences of cancelling a doctor's appt- if we had to pay for it anyhow, we might not be able to get another for a long time- in a non-accusatory way. I would let hir know my feelings about the matter, whatever they are, but I would also acknowledge that it is hir body and it is hir decision as to who touches it and what is done to it."
I agree that it is always better for the child to consent. However, I disagree that without consent treatment is automatically wrong. I believe it is psychologically unrealistic to expect a child to always "consent" to something they know will really hurt. With a baby, I think it is unrealistic to expect them not to cry in protest if they experience pain. IMO it can help the child to be told "If we don't do this, you are probably going to die, and I can't let that happen to you". This can be a relief for a child, who may not fully understand death, or illness, and can only relate to the pain part of the treatment. Once a child knows a thing must be done, whether or not they like it, it can actually lessen their resistance to what is being done, which in turn makes it less traumatic. I realize this flies in the face of TCS theory, however, in my experience it can work this way so long as the parent is honest and loving and ever present in helping the child cope.
*sighing* Larsy I think we have wandered far from what I was asking
With all of this, what I do not understand, is how TCS distinguishes the influence of "sharing preferences" from coercion. I feel that the qualities that define coercion according to TCS shift every time I try to hold them to a real life example. If a child doesn't want to do something, and we keep addressing their fears, creating incentives, sharing our desire that they choose to do it, and they come around to saying "okay I will do it"...especially when the resist was out of fear, it is just *SO* unlikely, in real life, that a real child would have 100% set aside fear and become totally excited about doing the feared thing.
To me, this child was coerced, the parental effort to change their mind was coercion, and I am hearing nothing that proves it isn't. Someone said in another post, something to the effect of "The fact that non tcs parents feel that this process is coercive indicates non trusting relations in the family...". I am just looking at TCS definitions and noticing that they define things as coercive, yet TCS parents say they don't, and I'm racking my brain trying to get an illustration as to why one thing isn't coercive and one thing is etc.