The Role of Play in the Psychotherapy of a Child Suffering from Cancer

Abstract

This article describes clinical work with a child suffering from cancer carried out in a Department of Pediatric Hematology and Oncology.The use of play and drawing was an important part of the work with the child. In order to conduct a more detailed analysis of the psychotherapeutic process in a hospital context, we shall focus on the description of several distinctive aspects of the work which, in contrast to child psychotherapy, emphasize more the containment provided by the therapeutic relationship, and less the interpretive comments directly related to the child.

KEYWORDS:

• psychoanalytic psychotherapy
• pediatric oncology
• role of play
• containment

Acknowledgments

The authors would like to thank Prof. Anna Maria Galdo, Dr. Paola Zagari, Gennaro Moccia, the Rotary Club and, above all, the Fondazione Banco Napoli for their assistance for children which they have supported through donations and funding. We would like to express our profound gratitude to the Head of the Department of Paediatric Haematology and Oncology at the “Federico II” university teaching hospital, Dr. Amedeo Fiorillo, and to Dr. Roberta Migliorati, for their willingness to share their work with us.

Notes

1. The real name of the child has been changed to ensure the patient's privacy.

2. Like Emanuel and colleagues (1990), we use the term “session” to refer to all the interviews or forms of interaction with Gabriele and his parents, since, as the authors suggest, brief forms of interaction can sometimes be more intense and significant.

3. The bambola dormigliona (the sleepy doll) is a doll from the psychotherapist's toy box whose name Gabriele chose because its eyes would close when it was lying down. It was immediately clear that the doll represented the child's anxieties about death.

4. The precise diagnosis, which was only made after various tests, was a rhabdoid tumor of the occipital foramen.

5. This means that the progress of the tumoral mass had been blocked and had been reduced, but that it was still in a state of quiescence; the father of another child who had therapy with us explained to us the concept of quiescence of the tumor, following remission, using an extremely vivid image: “It's like a volcano. You just have to hope that it won't explode, because in that case there's nothing more you can do.”

6. The aim of this article is to show the development of the therapeutic relationship with the child; the references to the relationship with the parents are therefore very limited. Indeed, this theme too deserves more detailed analysis and discussion.

7. The extracts from the session are part of the protocols written by the psychotherapist (R. De Falco) who followed Gabriele and were discussed in the supervision group led by the project's director (S. M. G. Adamo).

8. Over the years, an attempt has been made to work together with the medical team on the problem of the distribution of children between the rooms, trying to ensure that they were matched according to age and, in particular, according to the same phase of the treatment.

9. It was the standard practice of the medical team in the pediatric hematology and oncology ward to guarantee treatment to young patients until death, in cases where the parents did not feel they could take the child home. In this case, the children, as would happen shortly afterward with Silvia, were moved into a room of their own with their parents (in this phase, the father is also allowed to sleep in the room) in order to ensure them some privacy and to protect the other patients.