Psychologists in hospitals help people minimise the emotional impact of their physical health problems, reports Dr Emma Piepenstock

Psychologists in hospital settings are trained to assist people understanding the relationship between psychological and physical well-being. We aim to help people to maximise their health and quality of life and minimise the emotional impact of their physical health problems. This is vital for many people with arthritis, particularly children.

The Great Ormond Street Hospital for Children in London has its own dedicated rheumatology psychology team, which is where I work. All the children I see have a rheumatological condition and are under the care of rheumatology consultants.

I use principles developed from research into human experience and behaviour to help children and their families cope with the challenges associated with their rheumatology condition and treatment while still leading fulfilling lives.

Whilst my job is extremely varied, it always centres around the unique needs of each patient. I work with:

• Individual children, using cognitive behavioural therapy, narrative therapy and/or acceptance commitment therapy;
• Parents and carers;
• Schools;
• A regular group for young people who take methotrexate. We help young people understand their medication and side effects and give them ways to cope with these. Meeting others in similar situations helps young people with arthritis feel less alone in their challenges.

We see children of all ages from when they are first diagnosed until they transition to adolescent services.

Psychologists find creative ways of getting younger children to talk about thoughts and feelings and often use stories, videos, games and drawings to engage with them. With young children our role often involves supporting parents too. As children get older we work directly with them, but parents often stay involved.

Our input is especially important when children are struggling with aspects related to their condition or treatment. This can be different for different families.

At the point of diagnosis, we help children adjust to what it means, how it makes them feel, and how to cope with treatment. Later, we may get involved when someone is struggling with a particular issue such as pain management, side effects of medication or feeling different from their school friends.

How often we see people depends on their difficulties. Sometimes people need one or two sessions as a space to express their feelings and reflect on their situation. Or perhaps there is a particular challenge, such as how to manage questions from their classmates. It could be that an individual needs more sessions (six to 10) to work through a specific issue or set of issues.

Parental input

It is vital that psychologists work with parents as they need to be able to support their children. We help parents adjust to their child’s diagnosis and manage new challenges. For example, some parents find administering medication to be a challenge that makes them feel anxious and guilty. Parents needs to cope to be able to support their child. Children usually look to parents to work out if they should be worried or not, and often cope better if their parent seems to be taking things in their stride.

Dr Emma Piepenstock is principal clinical psychologist at The Great Ormond Street Hospital for Children, London

The wider context

Teamwork is essential for teaching, research and working with individual patients.

Psychologists work closely with doctors, consultant nurse specialists, occupational therapists and physiotherapists within the rheumatology team. Weekly meetings are held to discuss psychosocial issues affecting the children we look after.

Outside the hospital, we liaise with schools, GPs and Child And Adolescent Mental Health Services (CAMHS). Our focus is on the impact of the physical health problem and its treatment on psychological well-being, but sometimes our patients have difficulties with their mental health such as anxiety and depression, and in these situations we work with CAMHS to find the best support for each individual.

COVID-19

The last two years have been a particularly difficult time to have arthritis. Many treatments suppress the immune system and it was a confusing time to be immune supressed. It continues to be challenging for some people with arthritis to get back to “normal life”. Anyone struggling should speak to their rheumatology team or GP to make sure they have the most up to date information and to see what support is available.

Advice

Look after your health and follow your treatment plan, medication regime and take regular exercise. Take stock of the other elements of your life. Invest in them so that your health problems are just one slice of a busy and fulfilling life. If it feels like health problems are taking over, which can happen from time to time, get some help. Ask if there is a psychologist in your hospital or speak to your GP about a referral to a local psychology service.

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