Medical Traumatic Stress

Trauma researchers and practitioners, within the last few years, are more widely acknowledging the concept of medical traumatic stress, defined as the development of PTSD symptoms in relation to life-threatening illness, injury, or medical procedures, treatment, or intervention. Most of the work has been done with children, with focus on very serious medical procedures and illnesses, such as organ transplants and cancer. This is in part because of their life-threatening potential. The remainder of this section will focus on pediatric or child medical traumatic stress (M-PTSD).

Some risk factors for developing M-PTSD include perception of threat to life and the intensity of a particular treatment or intervention. The more invasive and dangerous a procedure is, the more potential there is for M-PTSD. Burn injury has been associated with an increased risk of M-PTSD (Stoddard, Norman, Murphy, & Beardslee, 1989), in part because of the often horrendous pain involved. Laurence Miller talks about the concept of traumatic pain, for instance. Pollin (1995) and Koocher and Pollin (1995) discuss the use of the medical crisis counseling model in addressing the emotional complications in children and families secondary to traumatic injury or illness. They suggest focusing on eight critical issues that arise for children and families for intervention: loss of control, loss of self-image, dependency, stigma, abandonment, fear of expressing anger, isolation, and fear of death.

Bronfman, Biron, Campis, and Koocher (1998) focus on event-related traumatic injury treatment. Initially, the focus should be on helping the child (and families) review what happened and tell the story. It is important to facilitate a recounting of what led up to injury and afterward. These authors warn to be careful not to communicate to the child not to talk about it and to be sensitive to the child's ability to tolerate arousal and emotion. Be careful not to push too hard, but also be supportive enough to push just enough. The next step in treatment involves helping the child explore his or her physical sensations and perceptions of the event (what did they see, hear, smell, etc.). This can help elicit a more complete and vivid recounting and assist in deeper processing and integration of oftentimes fragmented percepts. Next, therapist and child should engage in exploration of his or her trauma related beliefs. Bronfman and colleagues suggest the clinician "support the children's efforts to make sense of what happened to them, including their frequent attempts to formulate a plan that would have, or could in the future, prevent such an event from recurring" (p. 4).

The fourth step involves the use of drawing and play therapy as methods to help organize a child's experience, which can be less threatening than talking. The fifth step is to explain the medical interventions in sufficient detail and to reassure the child about his or her ability to cope with any procedure, reinforcing that the purpose of any procedure is to help and not to punish, a belief that some children may hold. Provide clear and accurate information in a develop-mentally appropriate language and format. Finally, Bronfman and colleagues (1998) suggest the clinician assist parents in managing their own affect related to the event and subsequent injury as some parents may neglect themselves and focus exclusively on the child. This can be detrimental as parents may lose sight of their own well-being and serve as poor models for courage, self-care, and confidence. It is important to help parents avoid overwhelming the children with their own fears.

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