Use of Fantasy for Conflict Resolution in the Pediatric Hemodialysis Patient

Abstract

Assessment of the emotional status and characteristics of children is frought with considerable difficulty primarily because of the fact that we have only limited access to their private worlds. This seems certainly to be the case with children in end-stage renal disease. Our major avenue for assessing such psychological material is through verbal interchange, as we would have with adults. Level of cognitive development in children often times all but precludes obtaining such information through verbal interview. Additionally, research data¹ indicates fear, a condition frequently noted in children on hemodialysis, generates massive inhibition which attenuates the experience of fear and may obliterate it. As a result, often times information regarding the psychological status of children is obtained from those close to them, i.e., parents, teachers, etc., as well as observation of the children’s behavior. Even these methods, however, do not allow us access to the private world of the child which would provide a more direct knowledge of their perception and relation with the world.