Crucial Conversations QA

How to Discuss Childhood Immunization with Reluctant Parents

Dear David,

With the recent rise of children getting measles and the increasing number of people who refuse to have their children vaccinated, I have become very curious about the decisions that parents are making about their children. I work in healthcare and support vaccinating children, and I know that people who refuse to vaccinate their children can put together an informed case to support their point of view. I think their case is flawed and I can identify specific flaws in their case, which makes it difficult for me to hold a conversation with them.

Do you have some suggestions about how to hold conversations with parents opposed to vaccinating their children when I really do believe that they are taking a huge and unnecessary risk with their child and, as a result, other children?

Concerned Healthcare Professional

Dear Concerned,

Thanks for a great question. It’s not just vaccines that cause communication breakdowns. We see breakdowns across our culture, which makes your question especially relevant. I’ll outline some tips below that should help.

You Can’t Win an Argument. It’s a paradox that it becomes harder, instead of easier, to convince someone when you are supremely confident in your own point of view. It has to do with Dale Carnegie’s insight, “You can’t win an argument.” Here is how a conversation can turn into an argument:

  • I ask the parent why they don’t want to vaccinate their child.
  • The parent shares all the reasons they have against vaccination.
  • I attack their reasons and try to add reasons for vaccination.
  • They attack mine and defend theirs.
  • I attack theirs and defend mine.
  • Rinse and repeat.
  • They win, because it’s their child.
  • In trying to win an argument I’ve fallen into what’s called the Persuasion Trap. I have become the champion for my cause and pushed the parent into being champion for the opposite cause. The result is an argumentative cycle I can’t win.

    Motivational Interviewing. Motivational Interviewing is an approach that is designed to avoid the Persuasion Trap. Instead of taking sides, it helps the parent explore and resolve the ambivalence they probably feel about vaccinating their child. And it recognizes the reality that it’s the parent who will make the final judgment. The goal is to engage the parent’s own intrinsic motivation. Below are a few principles you can use:

    Ask for Permission. When the parent says they are unwilling to have their child vaccinated, don’t launch into an argument. Instead, ask permission to discuss it further. This puts the parent into the decision-making role.

    Explore their Ambivalence. Most unwilling parents have doubts. Make it safe for them to voice their concerns. This establishes your role as helper, rather than opponent. Below are how these first two elements might sound in a conversation:

    YOU: Your child is due for her measles immunization today, but I heard you declined it from the nurse. Would it be okay if we discussed it?

    PARENT: Um, okay.

    YOU: Many of my patients are concerned about the safety of vaccines and whether their child is more likely to get sick from the shot than the actual disease. Others have questions about how bad it would be if their child got the measles. Would it be like a common cold, or could it affect their heart? Could their child die? Still other parents want to spare their child the pain of one more shot. These are all valid concerns. What do you see as the pros and cons of having your child vaccinated?

    I like to draw a line down the middle of a piece of paper and write the pros on the left and cons on the right side of the line. This helps the parent turn their vague feelings and fears into a finite number of specific concerns—concerns that can be addressed.

    Paraphrase to Ensure Understanding. Summarize each concern. This makes sure you understand it and also demonstrates that you are listening. “So, correct me if I’m wrong, but you are worried the vaccine will make your child’s arm sore and that she might feel sick for a week. You’ve also heard that measles used to be considered a relatively minor childhood disease. So, you have questions about how serious a problem it is. Is that right?”

    Address Each Concern with Facts. But first, ask for permission (again), “Would you mind if I provided you with more information about the measles, so you’ll have all the facts before you decide about the vaccine?” Then provide clarifying information in a nonjudgmental way.

    Consider the Messenger. Ask yourself whether you are the right person to provide the facts. If you are a nurse, a physician, or another healthcare provider, consider yourself credible. Your profession puts you among the most trusted people in our society. If that’s you, then you might make your presentation more personal, “I’ve had all of my children vaccinated. My son, Elijah, hates shots, but none of my children had any kind of bad reaction. I feel very good about my decision.”

    If you don’t think the person sees you as a credible messenger, then use information that comes from a more credible source. Provide a handout from the American Academy of Pediatrics or a pamphlet from your local public health agency.

    Consider Multiple Influences. You asked how to have a conversation with an unwilling parent. These conversations are important, but they’re only one aspect of a comprehensive influence strategy. If it was your job to improve vaccination rates in your region, country, or hemisphere, you would want to employ a combination of strategies at the Personal, Social, and Structural levels. These would include conversations, but also involve community leaders within schools, churches, and sports teams. They would also include changes to laws, incentives, and perhaps the way the vaccines are delivered. I hope this is helpful. Try a few of these approaches and let us know how they work.


Crucial Conversations QA

How to Talk With Your New Spouse About Your Stepchildren

Dear Joseph,

I recently got married and moved into my husband’s house. My husband has three children: two sons, 23 and 19, who don’t live with us, and a daughter who lives with us part time. I love them all very much and am happy to be part of this family.

But there is one thing I’m struggling with. The boys drop by unannounced pretty often. In the midst of working full time and trying to combine two households, I find myself very stressed with these surprise visits. I want them to feel welcome, but I also need some down time. This is the house they grew up in, so they’re used to coming and going. I’d like to get a heads-up when they are thinking of stopping by.

I don’t have kids of my own, so I’m feeling lost on what reasonable boundaries would look like and how to approach them without creating resentment or hurt feelings. My husband and I have discussed this at length and he thinks this kind of request will drive them away. How can I have my quiet and family, too?

Stuck Stepmom

Dear Stuck Stepmom,

Congratulations on your marriage. It’s to your credit that you are being thoughtful about boundaries and agreements before issues become divisive. The fact that you freely express love for your stepchildren shows there is enough goodwill to find a way forward.

The crucial conversation is not with the stepsons, but with your husband. He married someone with different needs and norms than his. You married someone with a different reality than yours. There is so much I don’t know about your situation that would lead to different potential outcomes. For example, is your husband being influenced by:

  • The boys’ mother competing for their time and attention?
  • Guilt about things that affected the kids in the previous marriage?
  • A desire to increase his connection because the boys are heading in risky directions?
  • A hope the boys will mentor and connect with their younger sister?

Since I’m flying blind in these nuances, I’ll focus my advice on the decision-making principles, not the outcome.

  1. Declare your commitment to Mutual Purpose. Let your husband know that you will not be satisfied with any solution that doesn’t satisfy him. At the same time, let him know your needs are important to you and you will expect the solution to accommodate you as well. Be firm on both parts. Tell him you want to understand all of his needs and concerns first. You’ll share yours only when he says he believes you “get it.” However, let him know up front that it’s likely you’re both going to have to give a little in order to find a workable solution.
  2. Listen intently to his needs and concerns. Listen. Ask questions. Get curious. Don’t move on until he feels deeply understood, and until you can appreciate the legitimacy of his needs. Ask questions to get beyond the positions he advocates to the needs and concerns behind them (like the four examples above).
  3. Be honest about your needs. As you share your needs, be careful to differentiate between enduring needs and adjustment needs. Enduring needs are those that are so embedded in your personality that they are unlikely to change. Adjustment needs are those that will relax over time as you get used to a new “normal.”
  4. The result will likely be a compromise. This means that neither of you may be fully satisfied with the details but will derive satisfaction from the fact that you are sacrificing for your mate. Love is about sacrifice. If you can’t derive happiness from occasionally surrendering your interests in the service of the other, then it’s a transaction not a marriage. Be creative in looking for solutions. For example, if your frustration is that the boys leave messes, you may be able to agree to their spontaneous drop-ins, but only if they (or your husband) are held accountable for restoring the house to your standards.

The most important thing is that you spend the time needed to arrive at a shared solution soon. Don’t let this fester or the present feelings of goodwill will start to evaporate.


Power of Habit QA Logo

How to Adapt to New Technologies at Work

Dear Emily,

My organization has just rolled out a new collaborative software tool and my manager let us know we are expected to use it. I’m excited about the new tool, as several people on my team have used it at previous organizations and swear by it. Yet, I still don’t use it. When I need to connect with someone, I send a quick email or—and this will make me seem old—I pick up the phone and call them. This has worked for me for years. I want to adapt to this new way of working, and I know I need to if I am going to stay relevant in today’s workplace. The problem is not my willingness to change; the problem is I keep defaulting to old habits. What should I do?

Old Dog Wanting to Learn New Tricks

Dear Seasoned, Mature, and Experienced Dog,

I hear you. I know what it’s like to get stuck in that space between wanting to change and actually changing. Everyone has been there at one point or another. We are wired to build habits. Our brains efficiently automate routine behaviors. And our habits serve us well . . . until they don’t.

It sounds like collaborating through email and phone over the last several years has served you well. But now you are faced with a change in your environment. Your old habits are holding on in the face of that change. You are in what we refer to as “the lag”—the delay between wanting to change and actually making a change. Living in the lag results in regret, frustration, anxiety, and unhappiness on a personal level, and diminished performance, engagement, and efficiency on an organizational level. The key to reducing that lag is to understand how habits work so you can change them.

Most of us think of a habit as a behavior. But that is just one part of the habit. A habit is actually a three-step process that begins with a cue (the trigger), that triggers a routine (the behavior, or what we tend to refer to as the habit), that results in a reward (the reason your brain remembers and repeats the routine). Without the cue and the reward, you don’t have a habit.

Right now, you have a habit that probably looks like this:

  • Cue—you need some information from someone
  • Routine—you email the person
  • Reward—you feel a sense of satisfaction for completing a task on your to-do list

This habit has worked well and now you want to change it. And change is the right word. Because as much as we might want to, you can never break a habit, you can only replace it. This is the Golden Rule of Habit Change.

So, you already have your new routine—communicate with coworkers using the new collaborative software. Assuming you know how to use the software, the routine is not the problem. You are likely getting tripped up by either the cue or the reward. Ask yourself, “Am I forgetting the new routine?” If so, this indicates a cue problem. Or, “Do I remember to do the new routine and choose not to?” This would indicate a reward problem.

If you tend to open your email and send a message before you even think about using the new software, reconfigure your cues to make the new routine more likely and the old less likely. You might try the following:

  • Keep the collaborative software open on your primary desktop and minimize or close your email program.
  • Put a sticky note or other reminder on your monitor to prompt you to use the new software.
  • Set an alarm on your phone that prompts you to connect with someone using the new software.
  • Allow all notifications from the collaborative software but silence all notifications from email.

If, on the other hand, you remember to use the new software but decide that it’s easier or better to use email, you may have a reward problem. You are remembering to do the new routine but choosing not to because you aren’t sufficiently motivated. So, add some rewards:

  • Track the number of messages you send each day with the new software and make it a game—give yourself a target to hit each day and reward yourself when you do.
  • Eat an M&M each time you send a message in the new software.
  • Take a 10-minute break after sending your tenth message of the day with the new software.

The reward can be anything that will motivate you, but make sure it’s immediate and obvious. This is where most people fall short. They consider the cue and the routine, but they fail to implement a reward. They assume that the outcome (my manager and coworkers will be happy I am using the new tool, and I’ll be more relevant and effective) will be sufficiently motivating. But while the promise of positive outcomes can spark a desire to change, it rarely sustains us—outcomes are only realized as long-term consequences. When building a new habit or replacing an existing one, you will need to implement an immediate and obvious reward.

So, implement cues and rewards to reinforce the routine. If you falter, experiment with different cues and rewards until it’s clear you remember and want to do the routine. This should get you out of the lag and onto using the new software.

Good luck!