First Person: Cori Liptak, PhD
Christopher Bartorelli, 11, beats Liptak 3 to 1 at a game that employs cognitive memory and function.
"The minute a family hears the diagnosis 'Your child has cancer. Your child has a brain tumor,' their lives are irrevocably changed. An enormous emotional roller coaster begins that takes on different meaning depending on where people are in the process: diagnosis, treatment, or post-treatment.
When a child is diagnosed, the family goes through different phases. They wonder, 'How am I ever going to get through this?' They do, however, learn to manage. In pediatrics, all families are assigned to a psychosocial clinician right from the start to help them adjust to the new routine. Here, we recognize that the psychosocial care is critical to support a family in addition to the medical care.
Some people don't understand what we do because we do so many different things. We might be playing the card game Uno with a patient or helping him or her with a doll and medical kit. Play therapy is a proven research-based technique. There's therapeutic value in it, and it provides opportunities to learn about the patient, his or her behavior, and approach to social situations. Playing also gives children a little bit of control and encourages them to just be kids. It's reassuring because they think, 'If I can play, I'm okay.'
For example, I work with a 10-year-old girl who comes for weekly chemotherapy treatments. The possibility for mood and anxiety struggles is always present because of the demands of the treatment, and the weekly play therapy sessions can be very helpful during the course of a lengthy treatment day. She loves art and decided that we needed to make a portfolio of all the projects that we work on. This has provided a means to document her treatment journey and a vehicle to express her feelings about illness. For instance, we wrote a story about a sick centipede, and it was a beautiful way for her to express her struggles, needs, and worries. When she is done with her treatment and walks out of Dana-Farber with her portfolio, she has something that will serve as a reminder of the work that she has done, the relationships formed, and how she can cope when things get difficult.
Behavioral interventions also play a role in helping children master their situation medically. Sometimes they aren't sedated for difficult procedures, and they need to sit still, and we help them to get through it. We can do work ahead of time to help them prepare so they understand what their job is throughout the course of the procedure. They might say, 'Cori, I'm going to sit like a statue right now.'Anytime you get to witness a child using something you taught and be successful as a result, that's rewarding. For instance, when I use medical play with a child and see him stop giving the puppet lots of shots, and instead hear him say, 'We're now going to put on your magic cream. It's numbing and you're not going to feel a thing. Don't be scared!' I'm watching him evolve in his ability to cope, and that transfers over into his real-life experience.
There are other behavioral interventions that go beyond what happens in the clinic. For example, a child who had been sleeping in his own bed before he got sick may all of a sudden want to sleep in his parents' bed. We help him work through that while encouraging families to continue to set limits. Upholding family rules and expectations is important; it encourages the child and family to have a regular routine – because that's what's going to be most helpful for him and the family.
