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Emotional and behavioral responses in children and adolescents with physical illness are the result of the interplay between developmental, psychological, physiological, and family factors. The psychological reaction to any physical illness or disability can be viewed as a transitional process that often begins with shock and disbelief, proceeds through feelings of sadness and anger, and ends with a youngster's successful or unsuccessful efforts at adaptation to the implications of being ill. Physiological changes associated with the disease process itself may also affect the brain, resulting in emotional and behavioral changes that further compromise the child's adjustment.

Individual psychotherapy is an important treatment option for emotional and behavioral problems in physically ill children. Treatment targets the enhancement of coping mechanisms that promote continued psychological development and adaptation to illness (see Table 28-1). Effective psychotherapy in the pediatric setting can help patients understand the meaning of and responses to their illness, improve treatment adherence, and enhance psychosocial functioning. However, there is a relative paucity of empirical evidence that supports the efficacy of any psychotherapeutic modality in children and adolescents with physical illness. This chapter reviews existing data drawn from psychotherapy intervention studies and clinical consensus. Although the focus is on individual psychotherapy, data suggest the importance of involving the parents in the child's treatment. While difficulties in family functioning have not consistently been reported, parents are vulnerable to emotional distress and communication problems that have been shown to interfere with treatment adherence (Dolgin et al. 2007; Gerhardt et al. 2003; King 2003; Noll et al. 1994, 1995). Parental psychoeducation may be helpful in improving psychosocial outcomes and alleviating parental distress (Beardslee et al. 1993; Drotar 2000; Sahler et al. 2005). Issues related to family therapy and the treatment of parents of physically ill children are covered in Chapter 29, "Family Interventions."

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