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Many young patients with serious organic disease or chronic physical illness develop a remarkable capacity to cope with their illness, especially when one considers that each has his or her own life experiences and developmental struggles, apart from the ongoing trauma of the illness. Anna Freud (1952) alerts one to the fact that unconscious fears and fantasies are aroused by the experience of illness and its treatment and that children react excessively to pain when latent unconscious fantasies are dominant.
The medical and nursing team on the ward where I worked dealt skilfully with the children when their ability to cope lapsed. Many young patients, who had been known to the paediatric team for many years, were encouraged by the staff to spend short periods on the ward when the symptoms of their condition appeared to be exacerbated during periods of stress or crisis. Only in unusual circumstances were child psychotherapists asked to intervene. A good relationship between the paediatric and child psychiatry team was a necessary condition for successful intervention.
Three vignettes will be presented. They demonstrate the challenging task confronting a child psychotherapist when regressive or self-destructive behaviour is unremitting and becomes an interference with medical treatment and the healing process.
The aim of the interventions was to restore the capacity of the patient to cope and thereby to facilitate the role of the nurses as primary caretakers.
Peter, aged 19, had been a patient on the paediatric ward for the previous three years. He had generalised histiocytosis and was admitted regularly for treatment. He suffered with recurrent back and leg pains and had Harrington rods inserted to relieve his back pain. The disease shifted to various organs and he required major lung surgery. He remained under the care of the hospital surgeons and physicians.
Peter was very knowledgeable about his illness, dealing with this entirely on hi