Group Therapy in the Rehabilitation of the Severe Chronic Asthmatic Child

Abstract

At Blythedale Children's Hospital, a residential treatment center for chronic discases, we have utilized group therapy in the rehabilitation of the severe asthmatic child. Group therapy as one of the vehicles for management and treatment of asthma has proven valuable in the understanding and in the muhidisciplinary approach to this chronic illness. The physician's role is one of coordinating the multi-disciplinary approach. Besides the general medical management, he needs to utilize all the modalities available for these children. The severely chronic asthmatics have a long road ahead of them in learning about, adapting to, and accepting their coniplex illness. Usually they arc completely dependent individuals in terms of the physical management of their illness and their emotional dependence at home. They have to learn to cope with asthma at every level-medical, social, and psychological. The pat'ients must learn to become increasingly independent and t.o gain control of their asthma in terms of completely managing themselves. A transference of total dependence from the family and medical personnel to themselvcs is necessary. They must develop and achieve confidence in themselves and obtain t,hat sense of control which will make them independent. In the course of this emancipation, they must learn to use and understand their medications. Complete knowledge of drugs, their actions, their side-effects, thcir doFages, and their indications, are all part of the education of the asthmatic. The patients should be oriented so that they become more self-reliant. This can be done by repeated review and discussion of the therapies and the medications. Also, patients need to develop a sensitivity t.0 all problems of asthma. Free and frequent discussions on a one-to-one basis are necessary. The physician must be completely aware of assuming and fulfilling this role. Triggering factors should be discussed and understood. Good orient,ation and proper medical guidance improve the patients' ability to make those judgments which will hclp control wheezing. As stated above, the goal in the education of our asthmatic children is to provide thein with a maximal feeling of control over their own care and a greater sense of independence in terms of handling their physical crises. By providing our asthmatic patients with a better understanding of their illness, both in t'erms of potential asthmatic triggering factors as m7ell as self-administered symptom-relieving medication, we attempt to minimize their anxiety, their utt'er sense of helplessness, and their sense of complete dependence on others.