I am currently treating a 10 year old girl with leukaemia twice a week. Her exercise program consists of general strengthening, stretching, cardiovascular endurance and netball drills. Her mother attends all treatment sessions and says very little throughout the session. This stood out to me on the first session but I thought it was just because I was new person. After several more treatment sessions, the mother is still distant and it has become apparent that she doesn’t interact with her daughter at all. There is no encouragement from the mother to her daughter, nil engaging in conversation or saying anything about her.
The lack of encouragement by the mother stood out like a sore thumb. When I noticed that the pts ability to hop had improved I was very excited and encouraged the patient a lot, and reminded her that the hopping will help her get back to netball. I knew since the mother wasn’t encouraging that I had to give even more encouragement/praise. I told the mother at the end of the session how great her daughter’s improvement was and I spoke enthusiastically because I thought that maybe she wasn’t seeing the benefits of the treatment sessions. Once again, the mother had no reaction.
Although as a Physio student it is good to be engaging in conversation with the child alone, it felt odd that the mother wouldn’t say anything. Usually mothers and fathers like to talk about their child e.g. funny stories, what they did during the week that was good. Compared to all my other patients’ mothers who are encouraging, talkative to myself and the child, this child’s mother made me feel as if she was distant from her daughter. I wondered whether this mother was not coping well, or whether it was just her personality. I spoke to my supervisor regarding the girls’ mother. He told me that this family in particular has not coped as well as other families with a child with cancer.
THIS SITUATION HAS CLARIFIED THE PSYCHOLOGICAL ISSUES IN A FAMILY DEALING WITH A CHRONIC CONDITION. IN FUTURE TREATMENT SESSIONS WITH THIS PT, I WILL CONTINUE TO BE VERY ENCOURAGING TOWARDS THE CHILD AND PARENT. I ALSO UNDERSTAND THAT PARENTS WHO SEEM AS IF THEY ARE COPING AND ARE ENCOURAGING ARE STILL CONCERNED AND MANAGING THEIR EMOTIONS. THAT IS, SOME FAMILIES CAN DISGUISE THEIR CONCERNS IN FRONT OF THEIR CHILD, WHEREAS OTHERS FIND IT DIFFICULT. IT IS ALSO IMPORTANT TO KNOW WHAT FAMILY SUPPORT SERVICES ARE AVAILABLE TO OFFER TO A FAMILY.
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Aside from telling the mother how well the little girl was progressing, did you consider other ways that may have gotten the mother more involved in the treatment sessions? For instance, might her mother have any interest in Net ball and therefore can be involved in some of those drills? Or something of the like? In some cases this can be hard if the mother doesn't feel able or willing to be involved (if she isn't coping). On the other hand, a 10 year old child may very well need some support and motivation from her family, particularly once discharged so in the long run, this would be something to aim for.
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