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Clinical commentary by Cathy Troupp, child and adolescent psychotherapist working at Great Ormond Street Hospital for Children, London
These sessions strikingly illustrate how therapeutic work with children with severe or life-threatening illnesses is so different from mainstream CAMHS work, and also how difficult this work can be.
It is one thing to address primitive anxieties, such as the fear of dying, with physically well children, and quite another to do so with children who may actually be dying, or who don't know whether they will be well again, or how long it may take. In well children, there is the background reassurance – comforting to both patient and therapist – that they aren't really dying just now. With seriously ill children, there is no such reassurance.
I think these two situations need to be seen as separate and different, with the bodily illness making all the difference. Although the fear of dying can feel very real to a well child who finds himself or herself in a psychically threatening situation of some kind, it can be jumped out of, and reality returned to, like waking up from a bad dream. But children who really are ill cannot wake up from the bad dream; hence the condition is like a ‘living nightmare’. This situation may be
so horrible as to be unimaginable to those who have not experienced it themselves, or who have not observed a loved one go through it. It is something like being slowly suffocated.
Children with severe or life-threatening illnesses know very well about their own fear of dying, but they can also learn quickly that the adults around them, their own parents, doctors and nurses, do not talk about this, and they conclude that the subject is taboo and unbearable to the adults. So they protect the adults by not saying anything, and the adults conclude that the children aren't thinking about dying and that it would be cruel to put such thoughts into their head.
This seems to be what Maya is indicating when she tells her therapist