Medical Play of Children with Illnesses and Siblings

1. Medical Play of Children with Illnesses and Siblings Laura Nabors, Kenneth Woodson, Jennifer Bartz, Rebecca Elkins, and Rebecca Sievers , University of Cincinnati, College of Education, Criminal Justice, and Human Services, School of Human Services, Children Community and Health Research Team

2. Children and Play • Play is children’s work • They express their feelings through play and repetitive play is a way to work through issues in their lives (Virginia Axline & others) • Play allows for emotional release and control of upsetting emotions - as a child work s through issues

3. Imaginal Coping • Clark proposed that play and accompanying stories about illness and recovery were a form of “imaginal coping” for children with chronic illnesses (2003, 2011). • Clark viewed “imaginal” play as being positive in nature, serving as a mechanism to assist the child in coping with medical trauma related to his or her illness (Clark, 1998).

4. Play and Our Study • Play is a mechanism for children to gain mastery and control over upsetting events in their lives • Our study: • Children with medical illnesses and their siblings have opportunities to participate in activity groups at a local Ronald McDonald House, and our team made medical play with toys a key activity to select during the group

5. Activity Groups • Children had choices to participate in other art and creative activities, but they gravitated to… • Hospital toys: doctors kits, stuffed animals &favorite toys were Playmobilfigures with hospital beds, IV, casts, wheelchair, doctors, ambulances • Thus, idea for our study…

6. Participants • Groups at RMH • 15 children with chronic illnesses • Children had cancer, GI problems, were awaiting or recovering from transplant etc. • 14 siblings • We also recruited a comparison group • Children were young, under age 10 (range 2-10 years), average age about 5-6 years

7. Methods • Groups videotaped and pictures taken of toy play (hands and toys only) using a flip cam • Children were asked open ended questions to tell a story about what was happening in their play • Grounded theory used as a method to search for themes in review of videos and notes from the groups

8. Themes Children w/Illnesses • (1) mastery play, where the child arranged/re-arranged medical toys or told stories indicating a need to control of the situation • (2) stories where a character benefited from social support • (3) stories where a character expressed fear related to needles • (4) stories related to the withdrawal of blood by evil doctors who made their patient angry or afraid.

9. Fear of Loss of Blood • “She’s going to take the blood; she puts the blood in the huge shot. So then she gets the blood and puts it in that tiny (points to IV bag), then she keeps the blood, she’s the evil doctor, she gets the blood and puts it in the puke bag.”

10. Themes: Siblings of Children w/ Illnesses – vicarious learning • (1) stories reflecting their own observations and experiences of a brother or sister’s illness • (2) wanting the attention of a distracted parent • (3) depicting medical illness as a “family affair” (4) aggression toward medical staff • (5) vicarious needle fear

11. Illness is a family affair • Story from a sibling • One girl discussed a girl who was sick who had to go far away to see a doctor. In her story, the girl picked up a figure and said she was, “…the sister. She’s kinda sick too.” The interviewer said, “She is? How is she sick?” The girl replied, “She is like, kinda sick, she has the flu. Next, all the other sisters in the family “got sick too.”

12. Getting well • Lots of wishes for getting well • “getting better” • From both children with illnesses and their siblings • Support from others was a resilience factor for “getting better” • Distraction from the medical scene and experience was a coping strategy

13. Comparison Group • No detailed stories • Did not play long with medical toys • Cartoon-like quality to stories • Wishes for getting well and recovery not evident in stories

14. Medical play was… • Opportunity to release emotions • Work through upsetting feelings and recall of traumatic situations • Child had mastery over start and stop of the event and had ways to rescue the child, supporting Clark’s idea of imaginal coping to gain mastery

15. Medical play was… • Children who came several times to groups – had scripts that they kept telling to work through their feelings • Just like adults tell stories over to work through emotional events – children may work through play scripts to “retell” and work through upsetting or traumatic events

16. Future • See what play therapy techniques further enhance child healing and make use of play therapy more effective! • Future research should focus on ways to use play techniques to help medically ill children and siblings cope with medical trauma • Remember, siblings may need support to work through vicarious observations! • Thank you very much! • References available from Laura Nabors naborsla@ucmail.uc.edu

17. Disclosure • The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:Laura Nabors and other authors • No interests to disclose