Insight Oriented Psychotherapy

In contrast, insight-oriented psychotherapy aims to help patients acknowledge and put into perspective painful feelings of loss or conflict that are brought up in the context of their illness (Green 2000). Patients are helped to become more aware of previously unrecognized or repressed emotions. Insight-oriented psychotherapy depends to a significant degree on the patient's ability to tolerate increased symptoms of anxiety that commonly emerge in the therapeutic process. Insight-oriented therapy is generally believed to have limited applicability in the inpatient pediatric setting for several reasons: 1) acutely ill patients have a diminished capacity for self-expression or self-examination as a result of physiological effects that occur during acute illness exacerbations; 2) patients may be emotionally overwhelmed by their illness such that they cannot tolerate the additional anxiety that is generated using an insight-oriented psychotherapy; 3) the brief time available to intervene in a pediatric setting does not readily lend itself to this more reflective and time-consuming treatment modality; and 4) children may not have the cognitive capacity required to participate as a result of developmental or physiological factors or because of emotional regression that commonly accompanies an acute physical illness. Nevertheless, Szigethy et al. (2002) demonstrated the potential usefulness of this approach in children with somatoform disorders.

Table 28-2. General issues across psychotherapies for physically ill children

Issue

Consideration

Setting

Inpatient

Limitations with privacy and risk of interruptions requiring flexibility on the part of the therapist

Outpatient

Couple timing and location of appointments with medical visit to decrease time burden and feelings of stigma

Duration

Session often of shorter duration and increased frequency

Dependent on child's illness severity, physical symptoms, and level of consciousness

Consistency

Dependent on degree of psychological impairment, although outpatient follow-up during acute illness phase is recommended Therapist flexibility required in terms of timing and location of appointments Consistent availability of the therapist in times of increased stress or uncertainty (e.g., disease flares, surgery) Importance of integration of mental health services with the medical treatment and communication with the pediatric team

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