ABSTRACT The author presents an in-depth exploration of her work with Grace, an 11-year-old girl dying of liver failure. The experience of terminal illness in childhood is discussed with attention to the ability to cope with multiple losses (e.g., body image, body functions, important objects, a healthy future), the impact of the denial of impending death on the child and her family, the child’s use of fantasy as a means to obtain comfort and reduce feelings of loneliness, and the difficulties in the perception of self and other that result from the overwhelming stress of serious illness. Although the author was a pediatric resident at the time, the ability to work therapeutically at the patient’s bedside is illustrated, and unique aspects related to interacting with the ill body are discussed. The therapist’s ability to enter the experience of dying with the child, to understand both verbal and nonverbal forms of communication, to openly discuss loss and death and to allow the child to elaborate and address fears and fantasies regarding the child’s rapidly changing physical self in a developmentally appropriate way are illustrated. The experience of caring for a dying child is explored with a discussion of the range of affects evoked by this work and the centrality of the relationship as a way of both processing and defending against loss for both patient and therapist.

中文翻译：

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垂死儿童的治疗

摘要作者介绍了她与11岁死于肝衰竭的女孩Grace一起工作的深入探讨。在讨论儿童期末期疾病的经历时，重点关注应对多种损失（例如，身体形象，身体功能，重要物体，健康未来）的能力，拒绝即将死亡对儿童及其家庭的影响，孩子使用幻想作为获得舒适感和减少孤独感的手段，以及由于严重疾病的压倒性压力而导致的自我和其他方面的感知困难。尽管作者当时是小儿科住院医师，但仍说明了在患者床边进行治疗工作的能力，并讨论了与患病身体相互作用相关的独特方面。治疗师具有与孩子一起死亡的经验，理解口头和非言语交流形式，公开讨论损失和死亡以及允许孩子阐述和解决对孩子快速变化的身体自我的恐惧和幻想的能力。说明了在发展上适当的方式。通过讨论这项工作引起的各种影响以及这种关系的中心性，探讨照料垂死儿童的经验，这种关系是处理和预防患者和治疗师损失的一种方式。说明了如何公开讨论损失和死亡，并允许儿童详细阐述和解决对儿童快速发展的身体自我的恐惧和幻想。通过讨论这项工作引起的各种影响以及这种关系的中心性，探讨照料垂死儿童的经验，这种关系是处理和预防患者和治疗师损失的一种方式。说明了如何公开讨论损失和死亡，并允许儿童详细阐述和解决对儿童快速发展的身体自我的恐惧和幻想。通过讨论这项工作引起的各种影响以及这种关系的中心性，探讨照料垂死儿童的经验，这种关系是处理和预防患者和治疗师损失的一种方式。