Models of Psychotherapy

Psychotherapy can provide a time and place where patients can effectively vent feelings of fear, anger, or sadness. Common elements of the interaction include support, reassurance, empathic validation, advice, suggestion, and explanation as well as introspective exploration of dysphoric feelings such as demoralization or hopelessness (Goldberg and Green 1985). Psychotherapy is generally more easily accepted by children and their families when provided within the framework of routine ongoing medical care (see Table 28-2).

For families struggling with the burden of frequent outpatient visits and/or hospitalizations, the simple pragmatic issues such as scheduling appoint-

Table 28-1. Goals of psychotherapy with the physically ill child

1. Establishing a new social network with other youth with similar medical diagnoses

2. Facilitating the expression of emotions related to the illness and its treatment

3. Increasing understanding by education about the illness and its treatment

4. Allowing the child the opportunity to reprioritize both short- and long-term life goals

5. Identifying and communicating the needs of parents and family members

6. Facilitating communication with health care providers

7. Managing symptoms such as anticipatory anxiety, nausea, pain, refusal of treatment, or excessive sick role behavior

8. Facilitating the child's connection to his or her school and peer group

9. Facilitating discussion of issues related to fears about death and dying ments can be overwhelming. However, when the therapist is integrated into the patient's medical team, access to treatment is improved and the stigma associated with mental health care is minimized. Furthermore, therapists who work as part of a medical team have greater access to the treating physicians along with enhanced knowledge of the medical issues associated with the physical illness. There are a number of different models of psychotherapy, each with its own theoretical basis and techniques, that may be applicable in the pediatric setting.

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