Train Analogy in Child Life

Today I came across a very interesting article from the blog Pick Any Two that talks about “The Train Analogy”. You can read the article in full here. But in a nut shell, the author talks about how when we feel highly negative emotions (for example, feeling very scared, anxious, angry, or so forth) it can be likened to a train being in a tunnel. You are the train and the tunnel is the negative emotion that you are experiencing. The goal is to get out of the tunnel and into the light, but sometimes well-meaning people (and even the person having the negative emotions) can accidently stop the train from making it out of the tunnel. For instance, distracting, dismissing, ignoring, or cajoling a person is like trying to make a door out of the side of the tunnel that’s not really there. The tunnel that the person is in does not have any emergency exits, the only exit is at the end. And the only way to get to the end of the tunnel is to work through the emotions that is the tunnel.

I really liked this analogy because it helps me explain to people one of the ways child life specialists sometimes help kids cope with difficult procedures. Staff and families are often quick to distract and/or dismiss a child’s pain and frustration during procedures, hoping it will keep the child calm. While I agree that a well placed distraction can be very helpful at keeping a child from escalating, it does not work for every child or every situation. There will always be times when the child becomes so distressed that they enter the tunnel and must travel through until they come out the other end. When this happens, no amount of distraction is going to magically create the emergency exit door. The child must make it out of the tunnel before he is able to redirect to a distracting toy or game. While the child is still in the tunnel, the best thing a child life specialist or other caregiver can do is just provide support, perhaps through soothing touch, calming sounds, or just being physically nearby.

This is an important lesson for child life interns and new child life specialists to learn. Often I see students panic when a child escalates and the student begins to throw all these distracting toys at the child in an attempt to calm the child down. I always remind the students that there is nothing wrong with just providing a calm presence. It can feel like you are doing nothing, but you are in fact providing support and teaching resilience to the child while also modeling to caregivers how to handle the situation.

Does this technique take more time? It depends on if you are waiting for the child to calm down to do the procedure or if you are already in the middle of the procedure and you have to continue. In the second instance, the goal is to get the procedure done as quickly as possible with as little stress as possible. If the child is escalated in the middle of the procedure, it actually makes sense to not try and distract from or dismiss the feelings, because the child is not only having to deal with the feelings, but also the real sensations of the procedure, which is quite a lot of processing. When you throw in distracting toys or threats from caregivers, the child is even more overwhelmed, which isn’t going to get anyone anywhere. With so much sensory information the tunnel can almost seem like a big, dark, empty room where there is no sign of an exit anywhere or in what direction to being searching. By providing that calm presence, you can anchor the child back to the light at the end of the tunnel until she makes it out.

As for the former, if you have a child who is in the tunnel but you haven’t yet accomplished the procedure yet, let’s say, taking medicine, it becomes a bit of a waiting game until someone breaks. When you think of the analogy the child is in the tunnel of “I won’t take my medicine because…(insert reason here)”. As the caregiver, you know the child needs to take the medicine and you could just force it in some way, but it would be much easier if the child was willing. You want the child to come out of the tunnel in order to logically understand that the medicine is important and help you come up with a plan to make it as easy as possible. There have been many times where I have sat  quietly next to a child while he or she raged, cried, or even sat stoically, until the child finally calmed enough to talk about how we were going to accomplish our task at hand. In this instance, you must have patience… and often lots of time. But it is worth the extra effort because you are teaching the child resilience and perhaps how to regulate their emotions. And that knowledge is worth it’s weight in gold.

Do you have any stories of helping a child through the tunnel? Share them in the comments below!

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