Table 1.

Description of Enhancing Connections Intervention Sessions & Rationale

Session 1: Anchoring yourself to help your child: This session helps the diagnosed mother define the child’s experience with the cancer as distinct from the mother’s and add to the mother’s cognitive- behavioral methods to manage their own cancer-related emotions to prevent emotionally flooding the child. The session positions the parent to be a more attentive listener to the child as well as add to the parent’s self-care skills. Rationale: Diagnosed mothers are able to be more attentive to their child if they are able to emotionally control their own affect. An overly emotive parent is unable to fully attend to the child’s words, maintain healthy interpersonal boundaries, or be emotionally accessible to the child. Overly charged interactions between the mother and child can emotionally flood the child, risking further disconnection with the ill parent.

Session 2: Adding to your listening skills: This session assists the ill mother develop skills to deeply listen and attend to the child’s thoughts and feelings, complementing the parent’s tendency to be a teacher or problem-solver, not an attentive listener, of the child’s thoughts, concerns or worries. Rationale: Diagnosed mothers typically function like biology teachers, offering their child biomedical facts about the cancer using highly charged information that is not developmentally appropriate. By focusing on the child’s view of the cancer, the ill mother is more informed and able to strategically support the child in ways that articulate with the child’s views and concerns.

Session 3: Building on your listening skills: This session builds on Session 2 and adds to the mother’s abilities to elicit and assist the child elaborate the child’s concerns or feelings, even a reticent child. It is one thing to interact with a talkative child (Session 2); it is a distinct skill to help a child talk who is not forth coming. Rationale: Ill mothers need communication and parenting skills that enable them to initiate difficult cancer-related conversations and to interact with an upset child or one who is not forthcoming.

Session 4: Being a detective of your child’s coping: This session helps the ill mother interpret and respond to the child’s ways of coping with the cancer in non-judgmental ways. It includes helping the parent relinquish negative assumptions about the child’s coping behavior related to the mother’s cancer. By giving away negative assumptions, the session enables the diagnosed parent to positively interpret, not negatively evaluate, their child’s behavior. The session also offers the ill parent ways to elicit their child’s report of what the parent can do to support the child’s coping with the child’s cancer-related pressures. Rationale: Listening and drawing out the child’s concerns is one thing (Sessions 2 & 3); carrying out behavior that the child finds supportive is a different skill. All skills are important to reduce the child’s cancer-related distress.

Session 5: Celebrating your success: This session focuses on gains the ill mother attributes to her participation in prior sessions in parenting their child about the cancer. Both self-monitoring and self- reflection are key elements to enhance the parent’s self-efficacy in parenting their child. This session structures specific self-reflective exercises to help the parent internalize their accomplishments into a new self-view as an efficacious parent and assists the ill parent to identify available resources to be used after program completion to maintain the program gains. Rationale: This final session helps the mother internalize a new view of the self as a skilled and confident parent, anchoring the parent’s new identity as an efficacious of the parent, not just a parent with new skills.