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HEALTH & WELLNESS
Buckeyes Prove
Themselves
SPORTS D6
THE WALL STREET JOURNAL.
* * * * * *
Tuesday, January 13, 2015 | D1
Tot Therapy:
Psychiatrists
Join Up With
Pediatricians
How Well Are You Listening?
We’re Naturally Bad Listeners, Even With Loved Ones; Steps to Avoid ‘Burnout’
BY ELIZABETH BERNSTEIN
BY MELINDA BECK
PHASES OF LISTENING WELL
Many parents know the scenario:
Their child shows signs of anxiety or
depression, throws fits or has trouble
focusing. They tell the pediatrician,
who has only 15 minutes to see them,
a crowded waiting room and limited
experience with mental-health issues.
If the problem seems serious, the
parents get a list of child psychiatrists or psychologists to call. There
is a monthslong wait to see them and
many don’t take insurance.
It is little wonder that only about
1 in 5 children with diagHEALTH
nosable mental-health
JOURNAL problems gets treatment.
Now, more pediatricians are embedding mental-health professionals
into their practices, where they can
help spot problems early, provide
care fast or reassure parents that a
child’s behavior is normal.
Integrated care, as it is called, has
other advantages: Pediatricians often
see patients annually for a decade or
more and follow families closely. If
issues arise, instead of giving parents
a referral, they can do a “warm handoff,” personally introducing them to a
therapist down the hall. In some
practices, mental-health professionals
The very first step, before the conversation even begins, is to pick up on hints
and signals that the other person needs to talk.
You seem swamped.
I feel totally
swamped, too.
Actually, I have a
little time right now.
Everything OK?
Let the other person disclose the issue. Acknowledge and provide legitimacy for their experience
and feelings. If you dismiss or minimize, the conversation will probably end.
Something bad happened
this morning. I went to
that job interview, and I
really messed up.
Oh, no! What
happened?
Encourage the other person to elaborate. Ask open-ended questions. Use verbal cues to show
you want to hear the whole story. Lean forward. Make eye contact.
I prepped for four hours last
night, and I made notes of
all my recent projects. But I
just couldn’t concentrate.
I kept yawning!
I couldn’t remember
what to say. It was like
my brain was frozen. I’m
so discouraged.
There is less stigma
associated with a doctor’s
office than a mental-health
clinic, so families are more
receptive to treatment.
Oh, dear. Did
you feel like you
were getting
sick? Did you get
enough sleep?
Show you heard what the other person said by paraphrasing and using a verbal ‘checkout.’
So you stayed up late, you got
up early, and you couldn’t
concentrate—is that right?
Continue asking questions and listening so you can collaborate together on possible solutions.
Yes, I am exhausted. I’m
not sleeping well, and
I feel totally run down.
I’m getting nowhere.
Hmmm. Let’s think.
Do you feel qualified
for the jobs you are
interviewing for? Or
is there some other
kind of work you’d
rather focus on?
Scotty Reifsnyder
When Traci Ruble and her husband, Clemens Gantert, climbed
into bed one night recently, he began telling her about his day at
his software startup. He explained
that changes in a state law would
affect his business. And he told
her about a technical problem he
was having with a security certificate for the software.
After several minutes, Ms. Ruble turned to look at him. Then
she burst out laughing, picked up
the remote and turned on the TV.
“Whatever you are saying is like
speaking Greek to me,” said Ms.
Ruble, who is a marriage and family therapist.
“I can’t believe you get paid to
listen for a living,” Mr. Gantert replied, calling her on her behavior.
Why is it so hard to listen to
our loved ones?
Experts say we’re naturally just
not good at listening for a whole
range of reasons. We have a tendency to swap stories, so we interrupt. We’re uncomfortable with
emotions, so we avoid focusing
too closely on someone else’s.
We’d rather talk about ourselves,
so we rush the talker along.
And there is something relationship researchers call “listener
burnout.” We’ve all endured someone’s endless droning on and on,
often about the same old problems. When we offer quick advice
or suggest ways to fix the situation, we may be unconsciously
trying to protect ourselves from
burnout.
“Good listeners overcome their
natural inclination to fix the
other’s problems and to keep the
conversation brief,” says Graham
D. Bodie, an associate professor of
communication studies at Louisiana State University, who studies
listening.
It isn’t as easy as it sounds.
Practice “active listening,” a term
experts use to describe the way
you listen when you are an engaged presence in the conversation, fully in the moment with the
other person, not just sitting
there, half paying attention.
Think of the different ways you
can listen to music. You can put it
on in the background while you’re
doing something else. Or you can
put on your headphones, give it
your undivided attention and really notice how it affects you.
That is active listening.
To actively listen to a person,
you will need to master certain
behaviors—some verbal, some
nonverbal—that signal your interest. Researchers call these “immediacy behaviors.”
Start by putting your phone
away and turning off the TV. Sit
close to and lean toward your
loved one. Let your facial expressions reflect what he or she is
saying. Be sure to make eye contact. (Your mother was right when
she said, “Look at me when I am
Please turn to page D4
evaluate patients and devise treatment plans that pediatricians or
nurses carry out.
Currently, it often takes eight to
10 years from when symptoms are
first noticed before children get care
for mental-health issues, says Gregory Fritz, president-elect of the
American Academy of Child and Adolescent Psychiatrists, which endorses
integrated care. By combining forces
with primary-care doctors, “the potential to intervene early and make a
lifelong difference is huge,” he says.
There is less stigma associated
with a doctor’s office than a mentalhealth clinic, so families are more receptive to treatment. Medical issues
such as stomach aches, headaches,
asthma and obesity often have psychological components and vice
versa.
“Our mantra is, let’s put the head
back on the body and treat the whole
child,” says Marian Earls, a member
of the Mental Health Leadership
Work Group at the American Academy of Pediatrics, which has championed integrating medical and mentalhealth care for years.
Integrated care has been slow to
catch on. Only about one-quarter of
pediatric practices have some sort of
formal arrangement with mentalhealth professionals, Dr. Earls estimates. Coordinating insurance is a
Please turn to the next page
People gargle mouthwash thinking
it will get rid of bad breath, but that
is the minty liquid’s least effective
function.
Dentists say mouthwash and other
rinses can be beneficial to overall
oral health and an important part of
daily oral hygiene routines but aren't
essential.
Mouthwashes can be divided into
two main categories: cosmetic and
therapeutic. Cosmetic
YOUR
rinses reduce and
HEALTH
help control bad
breath and leave a
pleasant taste in the mouth, said Peter Arsenault, division head of operative dentistry at Tufts University
School of Dental Medicine.
But, “they don’t really deal with
the actual cause of bad breath—they
don’t kill the bacteria and they don’t
chemically inactivate the compounds
that cause bad breath,” said Dr. Arsenault.
Therapeutic rinses have more targeted functions and come both overthe-counter and by prescription.
They can help reduce tooth plaque or
gingivitis, inflammation of the gum
which can lead to gum disease. They
can also help neutralize the acidity of
the mouth to lessen the decay pro-
cess. They may hydrate individuals
who suffer from dry mouth, and help
soothe canker sores. Fluoride and xylitol rinses aid in cavity prevention.
Sales of mouthwash have been robust, increasing each year over the
past five years, according to data
from Euromonitor International, a
market research firm. In 2008 sales
of mouthwashes and rinses totaled
$1.4 billion and were projected to go
up to $1.5 billion in 2014.
The American Dental Association,
a professional association of dentists,
tests products and has a council on
scientific affairs which evaluates
products to determine if they are
safe and effective. Those that pass
the tests receive a seal, which can be
found on the product. Currently, 128
mouthwashes have the seal.
The ADA has found just two products that satisfy claims they eliminate bad breath and neither are
mouthwashes. They are toothpastes,
said Clifford Whall, director of the
seal of acceptance program at the
Chicago-based ADA.
Some therapeutic rinses work by
neutralizing the pH of the mouth,
said Dr. Arsenault. When the bacteria
in our mouth consume carbohydrates
and sugars, their metabolic waste is
acid. The acid draws out the minerals, resulting in an acidic mouth that
leads to tooth decay.
An important ingredient to look
for in such rinses is xylitol, a naturally occurring sugar alcohol which
certain bacteria are unable to metabolize. “It kind of results in the bacteria in your mouth choking,” said Dr.
Arsenault. Xylitol stimulates salivary
function due to its sweetness and
taste and helps restore the mouth to
a neutral level of acidity.
But some dentists, such as Judith
Jones, a professor of general dentistry at Boston University, recommend looking for alcohol-free mouthwashes because they can dry out the
mouth. A dry mouth can end up encouraging bacterial activity, resulting
in worse breath.
Alcohol is used as a preservative—to increase the shelf life of
mouthwash—and as a carrier for flavor. The alcohol itself isn't the antispectic. Rather, it dissolves essential
oils (like menthol and eucalyptol) or
active ingredients, which together
have an antiseptic effect.
The therapeutic mouthwashes
with the ADA seal currently have alcohol in them, said Dr. Whall.
“Your saliva is more than adequate to keep the mouth moist,” said
Dr. Whall. “It might be an issue for
people who have dry mouth,” as alcoPlease turn to the next page
Sales of mouthwash are rising as people seek to control breath and tooth decay.
P2JW013000-6-D00100-1--------XA
BY SUMATHI REDDY
Alamy
Rinse Well: Mouthwash Is More Than Just a Minty Taste
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