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How to say “no” effectively

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There are so many reasons why for many youth screen time has crowded out activities and interactions that would benefit them—in other words, why they are experiencing excessive screen time.

One of the reasons is the inner discomfort that many parents (and teachers) feel from saying “no” to their children and teens. Saying no and being able to tolerate the myriad of emotions that result, such as guilt, self-doubt, and sadness is challenging for many people. On top of that, the child may add on their own negative emotions to the “no,” such as anger and disgust. Having to tolerate any one of these emotions, let alone several of them at one time, is a major undertaking.

Perhaps you have been wanting to set new limits, such as saying “no” to screen time in the car, “no” to screens in the bedroom at bedtime, “no” to screens at the dinner table. I will give some tips below but first these insights.

I have thought long and hard about how challenging it is to tolerate the discomfort of setting boundaries and saying no, not only from my viewpoint as a researcher and speaker on tech and parenting but also from my 25 years of practicing medicine. The hardest “no” that health providers are confronted with over and over is a person requesting opioids when the provider does not think the opioids are in the best interest of the patient.

What has frankly shocked me over the past couple of years with the discussions on the causes of the opioid crisis is that I never hear anyone (reporters, authors, policy makers, etc.) bring up the fact that a contributing cause to this crisis is the fact that health care providers often prescribe these medicines because they can’t tolerate the backlash from saying “no.” We hear reasons about how the drug companies told providers that the long-acting opioids were not addicting, about broken health systems, and others, but the human interactions in the providers’ offices are ignored.

In medical school, students learn next to nothing about addiction medicine. This amazed me since so many of the patients I was seeing in the hospital were there due to addictions (lung disease and tobacco, liver disease and alcohol, and so on). I decided to do an elective in addiction medicine and had the good fortune of having an incredible mentor, Dr. Barry Rosen. He would always tell me that, “The surgeon has her tool, a scalpel…my tool is my words.” Watching Barry lead complex dialogues, laden with intense emotions from his patients such as shame, denial, and hope, was true mastery in action.

I went on to do research and short films on doctor-patient communication, opioid requests, and recovery.  In the films I talk about one way to stay compassionate when setting boundaries is to remind oneself that it is the addiction talking (or crying or yelling), and not the person. That person at say 15, or pick any pre-addiction age, would never have thought to themselves “I would love to be a slave to heroin, wouldn’t that be great and how cool to know that I could die each time I use it.”

The real skill of a health provider is in their effective communication to be able to maintain a connection with the person so that along with a “no,” come discussions about why the “no,” collaborative decision making for alternatives and at times conversations about recovery treatment. Daily my heart hurts when I think of all the people and families dealing with an addiction of any type. If you are interested to hear about the many solutions happening around the opioid epidemic, my dear friend Ann Boiko just launched a wonderful podcast series on iTunes called Finding Fixes. I recommend listening to an episode with your teens.

Back to our topic of saying “no” to prevent excessive screen time. Here are some tips.

Prepping to say the “no”

1. Spend time writing out why you want to set this screen limit so you feel confident that it is an overall positive thing for your child—such as providing undistracted time for better sleep or for them to build in-person relationships.

2. Remind yourself that there are hundreds of studies that show parenting with love, but with boundaries, leads to the best outcomes (vs. command and control type parenting or a passive parenting style.)

3. Baby steps are key. Just pick one thing you have wanted to say “no” to and work on that single challenge. Start with the easiest one.

4. Know that you are modeling to your children, students, girl scouts, etc. the deeply important skill of “acting with integrity.” If you really believe, as I do, that having times undistracted by devices is good for youth (and all of us), then you are showing them that you are willing to act in line with your beliefs even though it means stepping into discomfort.

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Delaney Ruston, MD
Screenagers’ Filmmaker

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