Depression in a Medical Hospital: Stuffed Animal Play
A therapist described the following intervention with a school age boy hospitalized for medical reasons:
“…JR was struggling with depression and panic attacks that were negatively affecting his recovery. While initially unwilling to talk to me, he did slowly begin to talk with me when asked about the stuffed animal monkey (named Monty) he clutched beside him, which he had obtained during a family vacation at the Colorado Zoo.
Monty quickly became an important therapeutic tool in 2 ways. First, we used Monty as an intermediary to ‘voice’ the concerns/worries the boy had about his recovery. He soon created a metaphor of monkeys/animals he had seen caged in the zoo to his own physical containment in the hospital.
Second, I created a relaxation protocol for JR using Monty as a ‘tour guide’ of the Colorado Zoo (his favorite place). We allowed Monty to open the door of his cage to visit with the other animals and see the other parts of the zoo via monorail. We taped this protocol so he could keep the tape and listen to it whenever he liked. Later, his mother shared that he had asked if he and Monty could ride the monorail again!”
God Works Through Medicine, Too
A 17 year old woman with severe depression was referred to me for a psychopharmacology (medication) consultation. Her mother was clearly quite ambivalent about the possibility of using medications for her daughter. Her mother was a very religious woman who feels that she was able to turn her life around (stopped using drugs) through finding God. She told me that she’d been praying for God to just make her daughter better and talking with her church leaders. When I told her “God also works through many forms of medicine.” she was visibly relieved and ready to hear more specifics about medication. She consented to the use of an antidepressant for her daughter.
Staff Psychiatrist at Boston Children’s Hospital
Tackling Nightmares & Trips to the Parent’s Bed
Susie, 8 years old, and I designed the following project to address her fears that led her to run repeatedly to her parent’s room:
We created a set of two sided flashcards–on one side she drew specific fears and on the other her thoughts about things that help her to feel less scared. For example:
One side BURGLARS (she drew some scary looking masked ones) and other the side (partly written by her and dictated by her) WE HAVE A BURGLAR ALARM and THERE IS ALWAYS A GROWN UP IN THE HOUSE.
One side MONSTERS (again, she drew some scary ones) and on the other side MONSTERS AREN’T REAL, REMEMBER I THINK MONSTERS ARE FUNNY IN THE DAY, and MOST MONSTERS ARE BORN AFRAID OF PEOPLE
…And so forth for a set of 8 cards.
We designed a special carrying envelope for the cards. Her mother added a special card telling Susie how much she loved her and how brave she could be. Susie was very excited about the cards, which she was to keep with her at night and refer to when she got scared.
The results were quite dramatic–almost immediately Susie began staying in her room though the night.
Stuart Goldman, MD, Senior Associate in Psychiatry, Child and Adolescent Psychiatrist responded to the following question:
Are there situations where families complain about their child, but struggle with making needed changes?
“From time to time, I work with a family who on one hand complains bitterly about a symptom in their child, yet on the other hand seem unable to join with me on their child’s behalf or even seem to work against change in their child. I sometimes use humor to try to underline or diffuse this conflict. I sometimes use the following story from the movie ‘Annie Hall.’
A man walks into a psychiatrist’s office and says ‘Doctor, doctor you have got to help me, my brother thinks that he is a chicken.’
‘That could be very serious,’ says the doctor, ‘Bring him right in, I may have to put him in the hospital.’
‘I can’t,’ says the man.
‘Why not?’ asks the doctor.
‘Because I need the eggs.’ he replies.
After telling the story I wonder ‘if you (the family or patient) need the eggs on this one?’ Often it gets them to wonder in a non-defensive way, breaking what had been a stalled treatment. While sometimes comforting, it is also difficult to hear another person articulate and agree with your description of your child’s symptoms.”
Addressing needle phobias
Joseph Gonzalez Heydrich, MD Senior Associate in Psychiatry, Child and Adolescent Psychiatrist responded to the following question:
How do you deal with children who require blood tests, but are scared or phobic of needles?
Peter is a 13 year old boy with a history of temper outbursts, learning disabilities, and refusing to go to school. I suggested that we start him on Tegretol because of the severity of his temper (i.e. he would break furniture) and the swings in this mood. This medication requires regular blood tests. His parents agreed but did not know what to do to get him the necessary blood tests. Peter was very scared of needles. They said that prior to previously needed blood tests they had gone through days of terrible tantrums followed by trips to the hospital or clinic where he would run away or need physical restraint to draw his blood.
I suggested the following via e mail:
…Give Peter the choice of who is to do it, his pediatrician or here at the hospital or whoever is close. If he chooses the hospital then call the laboratory and arrange to come in the day before for Peter to watch other kids coping with it. Promise him no needles on that visit. The second visit is the one where he gets his blood drawn. If his pediatrician is going to do it then you can ask him if he can pre-treat Peter’s arm with Emla or something like it; it’s a topical anesthetic cream. It won’t block all the pain, but it may make Peter feel better in that everything is being done. If none of this works then I would suggest making an appointment with our medical coping program…
The father subsequently reported that Peter had his blood drawn without incident. The father was very proud of the way he had accomplished this. He had arranged for the Emla cream and went searching for a local phlebotomist (blood drawer). When he visited a local laboratory, the blood drawer was someone with whom he immediately felt comfortable. When he got Peter to go with him to the lab, he also arranged for the same blood drawer to come sit for a moment in the waiting room with Peter. The blood drawer told Peter how she was going to put the Emla on first and how she would use a little needle to draw his blood. Peter went back to the lab area and had the blood drawn with some visible anxiety, but in good control of himself.
Blood drawing is now accomplished easily. Peter’s temper tantrums and mood swings have improved on his new medication. Best of all the parents and Peter have gone on to tackle his school refusal.