If you’ve worked in pediatric therapy for any length of time, you’ve probably experienced conversations you wanted to avoid, perhaps ones you actually did avoid.
Maybe…it’s talking with a caregiver about a reduction in therapy frequency?
Maybe…it’s discussing inconsistent attendance or a home program implementation?
Maybe…it’s giving difficult feedback to a colleague or assistant?
Maybe…you’re a practice owner who has to address productivity, documentation, workplace culture, or performance concerns with a valued employee?
These conversations are uncomfortable. They’re emotional. The stakes feel high. And because we care about the people involved, it’s tempting to delay them…or to avoid them altogether.
Unfortunately, avoiding difficult conversations rarely makes them easier. More often, it causes misunderstandings to grow, assumptions to take root, and relationships to weaken.
Ironically, the conversations we dread most are often the ones that strengthen relationships the most when handled well.
Read on to learn more in this article by Jennifer Lawson, OTR, MS, Director of Educational Instruction & Design for Knowledge Is Now.
Why Challenging Conversations Feel So Hard
Why Challenging Conversations Feel So HardPersonally, my favorite framework for challenging conversations is from Crucial Conversations (Grenny et al., 2021). The authors define a crucial conversation as one where:
- Stakes are high
- Opinions vary
- Emotions are strong
Sound familiar?
In pediatric therapy, we navigate these conversations every day because our work is deeply personal. Families trust us with their children. Therapists invest their hearts in helping children succeed. Leaders strive to support both exceptional patient care and sustainable organizations.
Everyone cares. And when people care, conversations matter.
We Don’t See Reality. We See Our Story.
We Don’t See Reality. We See Our Story.One of the most valuable lessons from Crucial Conversations (Grenny et al., 2021) is that we rarely react to facts alone. Because we are human (yep, it’s as simple as that, because it is how we are wired), we react to the story we’ve created about those facts.
A therapist thinks: “The parent doesn’t care because they never follow through.”
A parent thinks: “The therapist doesn’t understand how overwhelmed our family is.”
A supervisor thinks: “My employee isn’t committed.”
The employee thinks: “Nothing I do is ever good enough.”
Each person has created a story that feels true. But stories are not always facts.
One of the simplest ways to improve communication is to become curious before becoming certain.
Instead of asking, “Why are they doing this?”
Ask, “What might I not understand yet?”
Curiosity changes conversations.
Strategies from Crucial Conversations
Let’s look at some of the strategies from Crucial Conversations (Grenny et al., 2021) to help you get curious and to stay curious.
Start with What You Really Want
When emotions rise, it’s easy to focus on winning the conversation.
Instead, ask yourself:
- “What do I want for this child?”
- “What do I want for this family?”
- “What do I want for this therapist?”
- “What do I want for our relationship?”
- “What do I want for our organization?”
Those answers become your compass. When your purpose is helping, rather than proving you’re right, people can usually feel the difference.
Make It Safe
People don’t become defensive because they dislike feedback. They become defensive when they don’t feel psychologically safe.
Safety doesn’t mean lowering expectations. It means communicating that the relationship matters just as much as the issue you’re discussing. Simple statements can change the tone dramatically:
- “I want us to solve this together.”
- “I care about your perspective.”
- “My goal isn’t to criticize, it is to better understand what’s happening.”
- “I know this isn’t an easy conversation, and I appreciate your willingness to have it.”
When people feel respected, they’re far more willing to engage honestly.
Replace Assumptions with Questions
Therapists are expert problem solvers. Sometimes we solve the problem before we’ve fully understood it.
Instead of making assumptions, consider asking reflective questions:
For caregivers:
- “What has this week been like for your family?”
- “What has been working?”
- “What barriers are getting in the way?”
For team members:
- “How are you experiencing this situation?”
- “What support would be most helpful?”
- “What do you think is contributing to this challenge?”
- “Tell me what led you to that decision.”
Questions invite partnership. Advice often ends it.
Leaders Set the Tone
For practice owners and supervisors, communication isn’t just an individual skill. It is organizational culture. Teams notice whether difficult conversations are avoided or addressed. They notice whether feedback is offered respectfully. They notice whether leaders listen as much as they speak.
Organizations with healthy communication aren’t those without conflict. They’re the ones that address conflict early, respectfully, and consistently. Every conversation either builds trust or slowly erodes it.
For Therapists: Courage Over Comfort
Many therapists worry that difficult conversations will damage relationships with families. In reality, respectful honesty often strengthens trust.
Families don’t expect perfection. They expect authenticity. They appreciate clinicians who communicate clearly, listen deeply, acknowledge uncertainty, and genuinely partner with them.
Sometimes the kindest thing we can do is have the conversation we’ve been avoiding.
Three Questions Before Your Next Difficult Conversation
Before walking into your next challenging discussion, pause and ask yourself:
- What story am I telling myself?
- What might I be missing?
- What outcome do I hope we create together?
Those three questions can shift a conversation from confrontation to collaboration.
The Bottom Line
Communication is one of the most powerful clinical skills we have. It influences therapeutic relationships, team culture, caregiver confidence, staff retention, and ultimately the outcomes we achieve for children.
Difficult conversations will never become easy. But they can become more compassionate, more collaborative, and more productive. When we pause, stay curious, and lead with respect, even the hardest conversations can become opportunities to build stronger relationships.
And in pediatric therapy, relationships are where meaningful change begins.
Interested in additional resources?
Check out:
Reference
Grenny, J., Patterson, K., McMillan, R., Switzler, A., Gregory, E., & Maxfield, D. (2021). Crucial conversations: Tools for talking when stakes are high (3rd ed.). McGraw Hill.
