22 - Psychotherapy in chronic physical disorders

Summary

Introduction

During the past few years, the number of children requiring treatment for a chronic paediatric illness has continually increased. Prevelance rates of 5–12% have been reported (Roghmann, 1981). Chronic physical illness may last for years, or go on for a whole lifetime and influence or dictate the daily life of affected children and their parents to varying degrees. Usually, there is no curative treatment, but ongoing observation and management may be required (Ryan et al., 1998).

The clinical picture may be stable, relapsing or remitting, or progressive and may be complicated by life-threatening acute episodes (McMahon et al., 1998). Frequently life expectancy is reduced, and some chronic physical disorders are associated with pain (McGrath and Goodman, 1998; Allen and Mathews, 1998). Sequelae may include physical disability or handicap, and in some cases progressive mental handicap. Acute psychological crises are a common feature of these disorders.

Compared to children and adolescents with psychiatric disorders, those with a physical illness have entirely different characteristics and needs. About twothirds have no psychopathological findings prior to the onset of their illness. A psychologist or child and adolescent psychiatrist is usually consulted in order to help the patient maintain as much quality of life as is possible with the illness. Treatment is aimed at giving support, facilitating self-help and imparting crisis intervention (Wehmeier, 2000).

Parents and patients are free to decide whether they wish to see a therapist in addition to the physicians treating their physical illness. This may be proposed at the onset of inpatient treatment or perhaps during an outpatient appointment.