Psychotherapy with an adolescent boy who refused medical treatment

Abstract

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.

Keywords:

• adolescence
• paediatric hospital
• refusal of treatment
• skin
• body
• child psychotherapy

Acknowledgements

We would like to thank Paola Zagari, who has generously supported the project for children and adolescents with physical illnesses. We are also grateful to Dr Giulio De Marco for the medical information concerning the case and for the fruitful collaboration.

Notes

1. To preserve confidentiality, the patient's name has been changed and hospital details omitted.

2. These are holes made for the flow of gastric juices and the faeces. The proximal neostomy joined the first part of the intestine to the abdominal wall and thus enabled the discharge of gastric juices and material that was swallowed. The distal neostomy joined the remaining part of the intestine to the anus.

3. W. de Cristofaro was the psychotherapist who worked with the patient. S. Adamo supervised the case and was Head of the Child and Adolescent Mental Health Unit.