EP54: Dr. Chris Cipriano on social and emotional learning

It sounds overly simple, but hear why the question, How are you feeling? is so key in interactions like doctor-patient ones, but really, all of our relatinoships. An open-ended question like that can truly keep the door open on validating others' emotions, avoiding unintentionally suggesting that the way someone is feeling is not normative.  Dr. Chris Cipriano is an expert in social and emotional learning and gives this tip as well as several others, to help me (and maybe you!) in every day interactions. Dr. Christina Cipriano, PhD is an Assistant Professor at the Yale Child Study Center and is the Director of Research at the Yale Center for Emotional Intelligence. Dr. Cipriano is an Applied Developmental and Educational Psychologist. Her research is focused on social and emotional learning intervention and assessment, particularly as it pertains to marginalized student and teacher populations. She has published more than 70 papers, commentaries, and reports on emotions, assessment, and social and emotional learning. She is the mother of four beautiful children and has a website drchriscip.com. Find her on Twitter @drchriscip and on linkedin.

Transcript

[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I have the pleasure of speaking with Dr. Christina Cipriano. Dr. Christina Cipriano has a PhD, and she's an Assistant Professor at the Yale Child Study Center and is the Director of Research at the Yale Center for Emotional Intelligence. Dr. Cipriano is an applied developmental and educational psychologist. Her research is focused on social and emotional learning, intervention and assessment, particularly as it pertains to marginalized student and teacher populations. She has published more than 70 papers, commentaries, and reports on emotions assessment and social and emotional learning. She's the mother of four beautiful children and has a website, drchriscip.com, and I'll put a link to that in the show notes. Welcome to Chris. 

[00:00:43] Chris Cipriano: Thank you so much for having me. 

[00:00:45] Christine Ko: Thank you for being willing. First off, I wanted to ask you to share a personal anecdote about yourself.

[00:00:51] Chris Cipriano: You mentioned during my introduction that I have four children. My kiddos are 10, nine, just turned eight, and three and a half. My 10 year old has a rare disease called Phelan-McDermid Syndrome. He's one of about, estimated, just over 3000 people in the world with this diagnosis. It presents with autism, epilepsy, fine and gross motor delay and significant physical, cognitive and social regression. I raise awareness for Phelan-McDermid Syndrome. We use the hashtag #Phelanlucky, and then also for my son, it is the hashtag #SmilesforMiles. 

[00:01:27] Christine Ko: Oh, that's nice. May I ask how you got a diagnosis of something so rare? 

[00:01:32] Chris Cipriano: Oh my goodness. It was quite a journey. I've written pretty extensively about it online to help raise awareness, but a whole road of misdiagnosis along the way, which started from at eight months old, just expressing some concerns that he wasn't hitting milestones I would've expected. And being told, oh, that's what you do for a living. You're just worrying too much about it. And then he had his first seizure at 13 months old, and that sent us down a path of different specialists and -ologists and tests. Second level genetic testing, at just before he turned six years old, revealed to us the diagnosis of Phelan-McDermid Syndrome. What we're told and what the Phelan-McDermid Syndrome community has come to understand is that when many parents get the autism diagnosis, which for our son was around four and a half, because he at that point started presenting with some kind of typical, if you call it that, presentations of autism such as toe walking behaviors. Many families will stop on their journey, or care providers may stop looking any further as a result of, oh, we've got a diagnosis, we've got something that we can treat. We've got something we can put an insurance code in for and get all the services in place. But, when Miles started losing the ability to chew and swallow, to walk up the stairs, and got quiet very quickly. He was slow to start speaking in the first place and then got very quiet over just a period of weeks. Those are not characteristic of your kind of general autism diagnosis.

[00:02:57] Christine Ko: It sounds like you had to be such an advocate and learn so much yourself to try to tease things out. 

[00:03:03] Chris Cipriano: Definitely. It definitely has been and continues to still be a journey. And the family community, the Phelan-McDermid Syndrome community. We consider ourselves tiny and mighty. We share best practices of how our children respond to medications, and treatments, and things to say to doctors; things to ask for as more and more information becomes available.

[00:03:23] Christine Ko: When you mentioned things to say to doctors, can you expand upon that a little bit?

[00:03:29] Chris Cipriano: For example, if doctors look at our children and treat them as an autism diagnosis, they may start to set up behavioral or speech support plans that build on a progression of skills. Those ways do not work for children with Phelan-McDermid Syndrome. From a neurological standpoint, their brain will, to simplify it, continuously prune away things that they initially learn. So you can't base care on the presumption that something is going to sustain. Another thing that we would often share and say to doctors is there is lots of anecdotal evidence within the Phelan-McDermid Syndrome community that our children, their bodies, metabolize medication at different rates. There's a number of studies looking at this, and when doctors are quick to prescribe based on weight for height, asking or raising, have you looked at this within the Phelan-McDermid Syndrome community? Here's links to resources to further explain how this may or may not be applicable to our child.

[00:04:23] Christine Ko: I respect you for pressing on, advocating. Smiles for Miles. Go, smiles for Chris. 

[00:04:29] Chris Cipriano: Oh goodness. Thank you. I'll tell you, our son has never stopped telling you what he needs and bringing joy to the world around him with his eyes and with his smile, and his eyes kind of smile for him and show us what he needs and that he's listening. 

[00:04:44] Christine Ko: Talking about smiling and smiling with your eyes, that starts to touch on emotion and how we can connect through emotion. Can you talk about emotional intelligence and how you define it or use it?

[00:04:57] Chris Cipriano: I'll start a little bit with kind of the history on it. In 1990 psychologist Peter Salovey, now president of Yale University, and Dr. John Mayer introduced the first formal theory of emotional intelligence. It's defined as the ability to monitor one's owns feelings and emotions, discriminate among them, and use this information to guide our thinking and our actions. Now, fast forward a few decades. Presently we understand emotional intelligence as the ability to Recognize, Understand, Label, Express, and Regulate your emotions. This is actually also the acronym for RULER, which is a well known and popular universal school-based SEL program that's grounded in emotional intelligence theory. It's founded by my colleague Dr. Mark Brackett and his colleagues at the Yale Center for Emotional Intelligence.

[00:05:50] Christine Ko: SEL stands for Social and Emotional Learning. 

[00:05:52] Chris Cipriano: It's important to contextualize that emotional intelligence is one theory that sits under a broader umbrella of social and emotional learning or SEL or "SEL" [pronounced like "cell"]. SEL includes the fostering of emotional intelligence, but it also is a much wider net, and it includes behavior regulation, identity formation, and skills necessary for establishing and maintaining supportive relationships, making empathetic and equitable decisions that are hopefully in the best interest of you and the entire school community. Universal SEL programs support the development of intrapersonal skills, so your emotion skills, and interpersonal skills, your social skills, to promote physical and psychological health for all students. 

[00:06:40] Christine Ko: I think many schools these days are trying to incorporate SEL, social and emotional learning. I know that my daughter, that's my oldest child, she's 15, and from kindergarten, I remember she came home with a mood meter, and like, help me identify my emotions, Mom. I was thinking, oh, this will be easy. And then I quickly realized that I have never had this kind of training. I don't know what this is really about. 

[00:07:03] Chris Cipriano: Yeah. Oh, it's so wonderful to hear that. All 50 states have some pre-K or early education standard related to social emotional learning.

[00:07:12] Christine Ko: One of my interests in social and emotional learning is I think it would benefit doctors to be taught SEL, social and emotional learning. For those doctors who are over 30, I don't think they got social and emotional learning in school. I certainly didn't. I need to know how to connect with patients, and how to manage my emotions, how to manage their emotions, how to recognize that it might be different, and what I assume they're feeling may not really be the case at all because I'm misinterpreting their facial expression because they're from a different culture than I am, and a smile may not mean that they're pleased at all. It may just mean they're listening to me. [Exactly.] Can you address that? How social and emotional learning can be incorporated into medicine with your perspective as the mother of a child with a very rare diagnosis and an expert in social and emotional learning?

[00:08:18] Chris Cipriano: A couple of points come to mind. SEL promotes the development and maintenance of perspective taking and empathy, and I can't think of anything that's more important than doctors and medical practitioners humanizing the experience of healthcare for their patients through the ways they actively listen to their concerns, the way that they affirm their emotions and experiences, and understand their individual fears or anxieties or needs, and attend to the complexity of how disease and illness present for each of us, just like it presents in my oldest son. 

[00:08:57] Put simply, all emotions are information. And they are valid. Doctors can begin by affirming their patient's experiences of emotions as valid, and then use that information in how they care for their patient. So for example, a procedure or a visit or a test may seem routine or innocuous to a medical professional, right? But it may also bring about tremendous anxiety or fear in the patient for a whole host of individual or community reasons. Validating that patient's emotion expression and using that information to attend how the doctor proceeds to schedule the service, to perform the procedure or test, that will support the psychosocial wellbeing of the patient while also attending to their physical health needs. It's not like a one or the other. It's really an and.

[00:09:55] Christine Ko: I like that. I think that I can easily misinterpret what someone else might be feeling. Is it okay to just be like, I'm not sure what you're feeling. Do you wanna tell me? Do you wanna share?

[00:10:07] Chris Cipriano: Starting with an open question like, how are you feeling? And actually creating that as a regular routine in practice would be the first kind of step to opening up that healthy dialogue, and doctors can model that, just like we work with teachers to model that owning that our emotions are information, and we are authentic expressors of it, and we care about that, in this setting. We care about you. We care about how you're feeling. Cause I know that you do, right? I know you do. But when we say things like, you should not be feeling scared right now. It sets a precedence or gives a perspective that there is a right way or a normative way to be feeling in a given context or situation. That is something that we really wanna back away from, in both medical practice and education, when we think about emotion science, right? Because that's actually invalidating the experience of the individual. 

[00:10:56] Christine Ko: So really the key question would be, how are you feeling? 

[00:11:00] Chris Cipriano: Yes. And then if you have the relationship or you're working on building the relationship, moving into the, why might you be feeling that way? Or, what's contributing to those feelings for you? To get a little bit more specific. That's opening that window of information that you as the care provider can then take, and use, and attend to in helping to support the overall health of your patients. 

[00:11:21] Christine Ko: Yeah. One thing I find hard though, both as a doctor and as a patient, is sometimes, on the doctor's side, I feel like the patients don't wanna tell me, and it seems intrusive to be asking. And then I felt that as a patient, too, like, this doctor does not actually seem interested. Even if they're asking, how are you feeling? [ Yeah.] Or they just asked me three questions, and I can tell they're barely listening. So then I don't wanna share my deepest, darkest feeling, in the moment. 

[00:11:51] Chris Cipriano: Totally. There's a number of factors that come into play of why someone will show up in a given office or with a doctor and not want to authentically engage, right? They may have been harmed or mistreated in the past and not been taken seriously, or listened to, before they even got into the office. When I think about our son and our journey with our son.... the amount of questions and surveys and pre-visit surveys and check-ins, and all of that stuff that goes into before you actually see the doctor, is exhausting and in many cases for him, dehumanizing in his experience in the world and the way that he interacts with it. If you've had experiences like that, and then someone's asking you how you're feeling, right? You may not be so inclined to share authentically. 

[00:12:31] So what can you do to counteract those experiences, right? It's normalizing emotions as part of the process and how you're engaging. Normalizing emotions, it becomes a regular part of checking in with all patients, really making that a routine: showing that you're authentically listening and caring through how you're engaging.

[00:12:47] You mentioned the idea of, oh, they're not really listening to me. Engaging in good eye contact and positive body language, throughout, and sharing yourself, making it a co-construction of the experience of emotion, to lay that foundation, so that you're building rapport.

[00:13:01] Christine Ko: Yes. The only thing I've come up with myself is that it just takes time sometimes. And so I have to give my doctors time, and as a doctor, I have to give my patients time. And if they don't really answer a question like, how are you feeling? I can still ask it. The next time or maybe five minutes later, or, just give it another try. 

[00:13:23] Chris Cipriano: And also look for different cues, so strategies, what people are saying without their words as well. The ways in which their body is presenting, they're maybe trying to support themselves to regulate or not regulate in a given circumstance. Like asking about, your leg is shaking, how can I support you? Bringing that information up in a way that is helpful and healthy to promote dialogue. 

[00:13:45] Christine Ko: That's a really good tip. Do you have any final thoughts? 

[00:13:48] Chris Cipriano: It is incredibly important that we, as healthcare and medical practitioners and providers, as academics, as moms, that we are authentic in our expression and our regulation of emotion in all of our contexts. So when we're engaging with our patients or our students or kids or our families, they are constantly learning from us and looking to us as models. The more that we can show up and engage in that co-construction of emotion, we will all be better.

[00:14:16] Christine Ko: Thank you. I think you're amazing. 

[00:14:19] Chris Cipriano: You're so kind. Thank you so much, Christine.