The psychological studio of Maria Kiseleva offers its clients various programs and techniques that will help overcome crises that arise in life. Maria Kiseleva is a leading specialist of the center, candidate of psychological sciences, author of scientific papers on psychology. She works with patients suffering from particularly severe forms of somatic diseases, requiring the utmost attention and care. It provides comprehensive support to people with oncological, cardiological and endocrine diseases. Helps recover patients who have had a stroke and severe injuries. The center employs only certified specialists who have been trained according to the international standard, with vast experience, able to find a way out of almost any life situation. Meetings with a psychologist are held in an atmosphere of strict confidentiality, conducive to confidential communication. Here we will try to find the root cause of the problem. The center practices an individual approach to absolutely every patient, regardless of age and social position. The center regularly hosts psychological trainings, therapeutic sessions, group and family therapy, coaching studios work.

If you look outwardly at a man, then Dmitry Kiselev is small in stature with large bald patches and a little unsightly. The wife of Dmitry Kiselev is no longer the first woman for him, but the seventh. By education, Maria is a psychologist and the difference with her husband is 22 years. Previously, before Kiselyov, she was in a very good marriage, and Dmitry, one might say, took her away from this prosperous union. Many do not understand how this was possible, however, according to the man, no special tricks were required for this.

The personal life of Kiselev and his wife was covered last year in the program of Boris Korchevnikov, Maria and Dmitry spoke sincerely in “The Fate of a Man” and talked a lot about their personal lives. They met on the beach of Koktebel and for many years they just talked, meeting periodically. The divorce was swift, Masha was completely sure that Kiselev was her destiny and for this broke off the previous relationship. She already had a child in her first marriage, as did Dmitry, and they had two common children.

Dmitry Kiselev's wife Maria - photo

Kiselev Dmitry Konstantinovich is a very successful person, a well-known TV presenter and journalist, today he is the head of a well-known news agency. Dmitry Kiselev and his wife are very happy, their work makes life only united, despite their age. The man does not hide previous marriages, they were very bright and you can find any details about them on the Internet.

The first was considered the dumbest thing that happened in youth during medical school, it ended after a year of living together. Having moved to St. Petersburg, Dmitry Kiselev studied at the university and married Natalia, and two years later was Tatyana. Almost all marriages lasted no more than two years. This suggests that Dmitry's biography is rich and interesting. The current wife of Kiselev moved to the Moscow region, where the host of the news program lived, today they live in this Scandinavian house.

Maria Kiseleva has been running her program on the radio, at the Vesti FM station for several years, while she tells everything except her personal life, without affecting her husband and children, because their relationship is built on complete mutual understanding and I don’t want to put something up for discussion. The eldest son completed 11 classes, and successfully enters higher education educational institution. Maria is not only a psychologist, her first education was economics, the woman studied abroad and for the most part devoted herself to the family business, but after her marriage to Kiselev, psychology simply dragged her out. The family loves to travel, everyone goes in for sports, and Dmitry's wife prefers to do culinary business to please the household.

Recent article by Maria Kiseleva

More recently, when there was talk of pension reform, an article by Dmitry Kiselyov's wife appeared. It has already caused a real hurricane in in social networks, where she talked about the benefits for the Russians and the increase in age. This article was not appreciated, but seemed strange, her arguments that it is necessary to have many children turned out to be completely underestimated.

Dmitry Kiselev's wife says that pensioners who criticize the state behave like children who constantly blame their parents for the lack of attention and love. She says that citizens are dependents and live dreaming of a pension, when you can do nothing and live for your own pleasure. The woman talks about raising the retirement age as a project where a person is responsible for himself until the end of his days.

The author gives various arguments, where he explains the benefits for Russians in raising the retirement age. It concerns only those young people who are now in their prime and there is absolutely no need to panic, but there is an opportunity to hurry up and find their place in life, and most importantly, take care of their health.

The need for love and emotional closeness is one of the basic human needs. Arising from the moment of birth, receiving initial satisfaction in the communication of the baby with the mother, who merge into one in the first months of life, it grows into a desire to have friends, fall in love, create a family.

It is the family that becomes the safe place where the human need for emotional intimacy is most fully satisfied. Numerous studies confirm that married people feel happier than those who are single (single), divorced, and, most importantly, save more high level satisfaction with life even in difficult crisis periods of life. The family brings the greatest satisfaction of the need for belonging to a group, leaving community belonging, friendship or communication with colleagues far behind. The help and emotional support received from a spouse is much higher than that received from blood relatives and colleagues.

A neurological study by Jim Coan at the University of Virginia found that happy family relationships reduce a person's response to stress and literally "calm" the brain. At the same time, the reaction of the brain is different for those who consider themselves a married couple, and those who position themselves as just living together.

The study involved spouses and couples living together, and the duration and satisfaction of the relationship was the same in both groups. In the experiment, one of the pair was subjected to a safe electric shock to the ankle area, while the magnetic resonance imaging scanner recorded the brain's reaction to what was happening. When the shock occurred alone, the subject felt significant pain, and the activity of the area of ​​the brain responsible for the body's response to stress (the hypothalamus) was extremely strong. When a stranger held the subject's hand at the time of the electric shock, the reaction of the brain and subjective sensations were somewhat smoothed out. Meanwhile, when the spouse held the subject's hand during the experiment, the reaction of the brain and the sensation of pain were sharply reduced in those who called their relationship a family and considered them satisfactory. This effect did not occur in couples who simply lived together. Thus, the brain clearly discerned the degree of intimacy, trust and emotional security in a relationship, and the touch of a loved one relieved stress.

Unfortunately, it is trust and emotional closeness that are becoming scarce in the modern world. Many young people strive for pseudo-freedom, independence, trying, it seems, to hide behind this inability to love, to give warmth, to postpone the satisfaction of selfish needs. For them, family and children become an unbearable mental burden. The inner emptiness is filled with material consumption, social networking, promiscuity, alcohol, and drugs.

There are also slippery pseudo-scientific articles about the benefits of single life. A person finds himself in a trap of loneliness and illusions, from which he himself cannot escape. He looks at the family as something complicated and unattainable, and is in a hurry to devalue it, as in the famous fable about the Fox and the grapes. He destroys himself, denying his spiritual needs for emotional intimacy, experiences constant stress ... And there is no one to take his hand.

The book is devoted to a very difficult problem - the provision of psychological assistance to children with serious chronic diseases and their families. She talks about the deep psychological experiences of children caused by the disease, about how age affects the perception of the disease and how the disease can affect the development of children, about the process of adaptation to a difficult life situation - the “work of grief”, which is experienced by the parents of a sick child. Its main goal is to help parents and all family members adapt to the situation of the child’s illness, teach them to support him during treatment, to provide for his needs in the best possible way, while not forgetting about himself, and in the event of the inevitable loss of a child, to find the strength to endure grief. and live on.

If the child is sick. Psychological assistance to seriously ill children and their families

In accordance with Art. 1299 and 1301 of the Civil Code of the Russian Federation, when the restrictions established by technical means of copyright protection are eliminated, the right holder has the right to demand damages or compensation from the violator.

© Genesis Publishing House, 2015.

***

Kiseleva Maria Georgievna - clinical psychologist, candidate of psychological sciences (medical psychology), psychoanalytic psychotherapist, Researcher Scientific Center for Cardiovascular Surgery. A. N. Bakulev and the Federal Institute for the Development of Education, permanent expert of the weekly radio program Altera Pars (Vesti FM).

She has extensive experience in effective psychological assistance to seriously ill children of different ages and their parents, both in hospitals and in private practice.

The author is convinced that the psychological state of the child and the attitude of parents to his illness play important role in the struggle for recovery, and the effectiveness of treatment increases significantly when the efforts of a doctor, psychologist, parents and the child himself are combined.

“If children get sick, it’s unfair, scary, bitter, painful… Conception, birth, development, growing up, maturity, aging, death is the natural cycle of human existence. However, it happens that a serious, life-threatening illness finds its victim at the very beginning of life and falls not on an old man, but on a child or an unborn baby ... "

The main goal of the book is to help parents and all family members adapt to the situation of a child’s illness, teach them to support him during treatment, to provide for his needs in the best possible way, while not forgetting about himself, and in the event of the inevitable loss of a child, to find the strength to endure grief. and live on. Separately, recommendations are given to psychologists and doctors on organizing support for families with sick children.

Introduction

If children get sick, it is unfair, scary, bitter, painful... Conception, birth, development, growing up, maturity, aging, illness, death is a natural cycle of human existence. However, it happens that a serious, life-threatening illness finds its victim at the very beginning of life and falls not on the old man, but on the child or the unborn baby. And, perhaps, this is one of the most difficult situations in the life of a family.

Losing parents brings a person closer to death. Between him and eternity there is no layer of the older generation. Now he's next in line to oblivion. This natural course of life is difficult to accept, but most, having experienced the loss of their parents, come to humility. In the end, we are all part of the cycle in nature, and this order is true for everyone. Help to cope with the fear of death and protective illusions fed by a person: the justice of the world, their own immortality and omnipotence, which allow you to plan for the future without thinking every minute about the inevitable end of life.

When it comes to a child's life-threatening illness, all illusions collapse. The idea that a child could die before growing up, that an illness would prevent him from living a full life, is almost unbearable. It seems unfair and overly cruel. The child is the guarantor of the continuation of the life of the parents after death. Moms and dads associate their dreams and hopes with him, joy and happiness reign in the family. And suddenly disaster strikes... The world turns upside down. The pillars are crumbling. It can't be! For what?! Parents are often left alone with trouble. Feelings of guilt and helplessness can be overwhelming. The manifestations of grief can last a lifetime.

In the children's oncology or cardiac surgery department, the grief that has gripped the parents of sick children is presented in such a concentrated form that it seems that you can touch it with your hands. Each chamber is unique story experiences. Each family is a unique fighter against the fallen disaster. A child's illness is grief that develops according to certain patterns. But, despite the commonality of the stages of grief, the shades of the parent's personality shine through in everything. Each parent, except for the general loss of the “healthy image of the child”, “the justice of the world”, “his own image good parent”, “happy future”, “irrecoverable past”, is also experiencing the loss of something very deeply and purely personal.

In order to gain the ability to support parents in this difficult situation, the psychologist needs to do a huge deep inner work. It can be painful and barely bearable. Working with incurable children, I sometimes cried, looked for the guilty, hated this unfair world. Fear for their own children went through the roof. Only as a result of long internal processing, supervision and personal psychotherapy, I was able to recognize and accept that the psychologist is not omnipotent. He cannot change the laws of nature, he cannot conquer death. A psychologist will not cure children of cancer and will not correct heart disease, will not make parents of seriously ill children happy. All that he can do is to be with his parents when they are bitter and hurt, give them moments of closeness and support when needed, help them accept what cannot be changed, and do what is in their power.

This book is intended for a wide range readers. It will be useful to clinical psychologists working with seriously ill children, including those at the terminal stage of the disease, and their parents. She talks about the deep psychological experiences of children caused by illness, about the peculiarities of grief experienced by parents of children with various chronic diseases, it provides recommendations on organizing psychological support such families.

She will help her parents. The child's illness changed their lives forever, but this does not mean that joy and happiness will no longer return to their home. Favorable psychological adaptation to a child's illness contributes to the normalization of relations in the family, makes it possible to continue a full, rich life.

In addition, this book is an appeal to doctors. The heaviest burden of responsibility for the life and health of young patients falls on their shoulders. Every day they instill hope in parents, save the most precious thing they have - the life of their child. They arouse our admiration and seem to possess divine power inaccessible to us. At the same time, it is overlooked that doctors are people: they get tired, worry, and need support. Understanding the psychological component of the disease can help them accept their own weaknesses, understand what is happening in the soul of a sick little man, and establish more effective contact with their parents.

I hope that the book will also arouse interest among those who are not indifferent to the grief of their neighbor, for whom mercy is an important component of life. Perhaps it will give reason for reflection and an impetus for organizing comprehensive assistance to families in a difficult situation.

I understand that the book will not answer all the questions related to such a complex topic. However, you will learn about the process of adapting to a difficult life situation - the "work of grief" that the parents of a sick child experience, about age features psychological development of children, how age affects the perception of the disease and how the disease can affect the development of children. You will receive recommendations on how to reduce the pathological impact of the disease on the psychological state of the child. This book is a transfer of the experience of psychologists gained in the course of work in the field of pediatric oncology and cardiology, the experience of families who have coped with the disaster.

Its goal is to help parents and all family members adapt to the situation of a child’s illness, maintain a high quality of life during treatment, teach how to best meet the needs of a sick child, while not forgetting their desires, and in the event of the inevitable loss of a child, find strength in oneself. survive grief and move on.

Chapter 1 If the child is seriously ill: what happens to the parents

disillusionment

Your child has… cancer, a congenital heart disease, an incurable disease… The ground is slipping from under your feet, tinnitus… and the next moment your mind refuses to believe it.

“The pediatrician listened to my Vanyusha’s heart and said that she heard noises ... noises indicating a serious heart defect. We just came in for our monthly checkup and all of a sudden she says this. At first I freaked out, and then I thought: “She’s a pediatrician, she can’t make such a diagnosis.” I just couldn't believe it..."

Larisa, Vanya's mother (1 month)

“Vitya caught a cold and could not recover, they had already drunk a course of antibiotics, but still did not recover. They did another blood test. My husband and I were summoned by the head physician of the polyclinic and informed in a casual tone that Vitya had leukemia. We didn’t understand what it was, she tiredly explained that it was cancer ... and immediately “reassured”: “It’s okay, give birth to yourself another ...” Everything swam before my eyes, my ears were noisy, I still remember the confused look of my husband ... ".

Marina, Vitya's mother (4 years old)

“I’m already 40. I couldn’t get pregnant for a long time and did IVF several times. Finally everything went well. I was very sensitive to pregnancy, did everything according to the rules, went for examinations, because this is a long-awaited child. And now the birth, finally I will see my baby, now I will hear her voice, but the child does not scream, she turned blue, she was taken to intensive care, and then they said that the child had a serious heart defect. It was impossible to believe it, and even more difficult to be alone with it.

Ksenia, Polina's mother (10 days)

Every family with a chronically ill child has a story in their luggage, after which life will never be the same again. A story that destroys our understanding of the justice of the world and undermines faith in goodness. Human life is an unsafe and unpredictable process. A lot depends on us, but not everything. Awareness of one's own vulnerability is painful and unpleasant. A person defends himself from it with three basic illusions: his own immortality, the justice of the world, his own infallibility. When the life of one's own child is threatened, all three illusions collapse.

What kind of own immortality can we talk about if your child, who has just begun to live, is seriously ill and his life is in danger. Does a parent have the right to outlive their own child? Desire and fear own death often strangle their parents with their obsession.

“What do I need this for? It should not be! What a cruel, unjust world in which children get sick and die?!” Every mother of a seriously ill child asks these questions. The collapse of the illusion of one's own infallibility and omnipotence is mixed with despair. Parents are bogged down in saving and destructive guilt. “If I am to blame for what happened, then I can fix it,” they hope. Guilt helps to avoid even more terrible feelings - helplessness and shame. Parents are humiliated and crushed by the fact that they failed to protect their child, that this happened to them. They seem to be weak and worthless.

For psychologists

"For what?" - one of the most difficult questions faced by a psychologist in working with parents of chronically ill children. It is necessary to convey to the parents that no one is to blame and there was no way to prevent what was happening. This is one of the main goals of the work.

"It's not fair!" - Another phrase that confuses. In this case, the psychologist can simply confirm: “Yes, this is really unfair!” - and help the parent accept the fact that the child is sick and it is impossible to change this. At the same time, it must be emphasized that there is a zone of reality in which the parent is not powerless and can control the situation. It is in his power to follow the recommendations of doctors, take care of the child, other family members, and himself. It is important to reassure the parent and try to convince him that, despite the illness, one can feel the joy of life in new conditions.

The destruction of illusions is always associated with a flurry of emotions. The psychologist must be ready to endure not just anger and anger, but a storm of rage at himself, at others, at the disease, at the whole world. Other reactions may be deep depression and despair, with which the psychologist must have the strength to come into contact, but at the same time not drown with his parents.

"What can you do to help me?" - this question often takes the psychologist by surprise, especially if he himself is not always sure of his usefulness and necessity. The psychologist's self-doubt, his deep desire to heal the child, the illusion of omnipotence can make the work of psychological support impossible or useless. It is very important to answer this question honestly for yourself and the client: “I can’t cure your child, give you money, get the right medicine ... All I can do is be with you during this difficult period, share your heartache ...”

The work of grief: the stages of living grief

There is no doubt that a child's life-threatening illness is a great grief for parents. With the conception of a child, parents unconsciously build their own idea of ​​the future, which necessarily includes this child - healthy. Grief is a response to loss. significant object, part of an identity or expected future.

When a child falls ill in a family, all family members experience multiple loss:

Loss of health of the child;

Loss of the “image of a healthy child”;

Loss of hopes associated with the child;

Loss of the “image of a good parent”;

Loss of formed parental identity;

Loss of control over everyday events;

Loss of self-respect;

Loss of opportunity to live a “normal life”;

Loss of ability to plan for the future;

Loss of basic life illusions.

In order to cope with the resulting losses, the so-called work of grief is launched, aimed at overcoming the mental pain associated with the loss and adapting to the current situation.

Grief is a reaction to loss that develops according to special laws. The process of mourning is universal, unchanging and does not depend on what a person has lost. At the same time, the nature of mourning depends both on the significance of the loss for a person and on his personal characteristics.

One of the most common patterns that psychologists rely on in their work with grief is the stages identified by Elisabeth Kübler-Ross and described by her in the book On Death and Dying ( Kübler-Ross, 2001). Based on a large practical experience working with cancer patients, she identified the main stages of coping with the most difficult loss to bear - the loss of one's own life. However, these stages are characteristic of experiencing any kind of loss.

stage of denial

So, the experience of any loss goes through certain stages. And the first of these is the stage of denial, or isolation. "Not! It can not be!" - the first reaction to the news of the loss. If we talk about a child’s illness, then at such moments people hope for a diagnostic error, a doctor’s unprofessionalism, etc. The inability to accept the fact of a loss either forces parents to make numerous fussy attempts to refute what is happening, or paralyzes, drives into complete inaction and isolation. Denial acts as a buffer against unexpected shock and is a healthy attempt to cope with what is happening. While there is a struggle at the level of consciousness, processes are emerging somewhere inside, aimed at accepting reality. This usually takes from several hours to several days. It has been noticed that the more treacherously the news of a complex diagnosis invaded a person's life, the longer this stage lasts. This fact must be taken into account when informing parents about an incurable or serious illness of a child.

Denial can sometimes be expressed by euphoria, an unreasonable increase in mood. Often this happens after a painfully long ignorance, for example, during the final diagnosis, the announcement of the prognosis of the course of the disease. Uncertainty is even less bearable than the most terrible news, so the appearance of certainty, even unfavorable, is often perceived by the parent as a relief.

Often the denial is expressed openly; a person with surprise says that the doctors made a mistake, they attribute some kind of diagnosis, but this cannot be. In extreme cases, a delay in the denial stage leads to irreparable consequences:

“I gave birth to Mark without a husband, my mother persuaded me to have an abortion, but I wanted this child. When he was born, neither I nor the doctors noticed anything suspicious. But at a planned examination at 1 month, we were given a referral to a cardiologist, as the pediatrician heard a heart murmur. I could not believe it, I was tired that everything was against my child: his father, and my mother, and, as it seemed to me, this doctor. I am a fatalist and decided: come what may. I did not go to the consultation, and we lived with Mark for several cloudless weeks ...

... On that terrible day, Mark began to choke and turn blue, I got scared, called an ambulance, but they could not save him. Until now, I have a referral to the cardiology center, I can’t explain to myself why I didn’t go to the appointment ... ”

Tatyana, mother of Mark (who died at 1.5 months of congenital heart disease)

Sometimes “denial” is a more subtle process, when the parent does not seem to argue with the fact of the child’s illness, but does nothing, secretly hoping that everything will still change, or simply avoids thinking about it, delays conducting research that would help to accurately establish diagnosis delays treatment. Actually, getting stuck at this stage is dangerous because precious time is wasted.

“We have a ventricular septal defect, the hole is small there, they said that it was necessary to operate, but I decided to wait, it would suddenly overgrow ...”

Irina, Olya's mother (5 months)

“Sasha is already 8 months old, but he does not hold his head, there is a suspicion of cerebral palsy. We do massages, go swimming. So I can’t get to the MRI, it’s a pity for him. And then what will change if we find out that something is wrong: anyway, massage, swimming ... "

Nastya, Sasha's mother (8 months)

For psychologists

The task of the psychologist at this stage is to help the client find mental strength and recognize the fact of a serious illness of the child. This is a delicate process, since a rude notice only strengthens the protection. It has been noticed that denial is more often included in parents when talking with psychologists and doctors, for whom denial is also a familiar way of psychological protection. Therefore, the psychologist must first of all be internally open to a complex conversation. It is important to carefully evaluate your own reactions to communication with the client, since the psychologist's feelings are always read by the parents and can be both beneficial and harmful.

It is necessary to respect the right of parents sometimes to “hide” behind denial. The process of awareness is often not like insight, when the bitter truth suddenly dawns on the parent. Usually the perception of the problem goes in a spiral. First, some part of reality is recognized, then a retreat into fantasy is possible, then a return to reality, and so on until the fact of the disease is fully realized. It is necessary to respect the desire of a person to deny the fact of a terrible event as long as possible. Before reporting a serious illness, the needs, strengths and weaknesses parent, find explicit and hidden signs, helping to determine whether he wants and can realize the reality in this moment. It is very important to be close to the parent and help him through this hard way guiding towards the target.

The need for denial may also arise from time to time at any subsequent stage when the psyche needs some respite in contact with reality. A sensitive psychologist can allow this to the client and will not break the defense by pointing out obvious contradictions.

The criterion for exiting the stage of denial is the client's clear awareness of what is happening, as can be seen from his words and actions.

For doctors

A conversation with the parents of a small patient, during which the diagnosis is reported, is one of the most difficult for a doctor. It would be appropriate to have this conversation with both parents, or in the presence of a close relative or friend who can provide moral support to the parent. It is necessary to have enough time and give only the information that is already precisely confirmed and necessary at the initial stage of treatment.

After a period of shock and stupor, parents may begin to deny what is happening, which will manifest itself either in refusing treatment, or in a desire to see other doctors or do more research. It is important to understand that this is a normal reaction in such a difficult situation. It is necessary to give them time to get used to the idea of ​​a serious illness of the child.

It is advisable to immediately offer a further plan of examinations and treatment when reporting the diagnosis, so that the parents are not left alone with a terrible disease. It is important to give them back a sense of control over the situation, to help maintain hope for an improvement in their health. You need to be prepared that parents may have questions, and try to answer them, no matter how stupid they may seem to you.

Parents

To admit that a child is seriously ill, that a terrible disease threatens his life, sometimes seems almost impossible. Day after day, you want to fall asleep and wake up without thinking about the disease, return to the past, where this terrible news did not exist yet. Sometimes you will seem to fall out of reality and behave as if the child’s illness did not exist, and this is normal. The psyche needs such respite in order to adapt to the complex reality. No matter how hard it is, you should listen to the opinion of the doctor, conduct the necessary research. It is very important to find a doctor you trust, as you will have to fight together for the life and health of your child. Prepare in advance for a conversation with a doctor, write down the questions you are interested in - this will save precious medical time, and you will not be confused during the conversation.

Some will want to hear the opinion of another doctor (get the so-called second opinion) in order to make sure that the diagnosis is correct and the prescribed treatment is correct, which is a natural need to get the most complete and verified information. However, do not get carried away and run from one doctor to another. If two doctors say the same thing, then the rest will most likely confirm this. However, if your mother's heart is restless, look for a doctor you can trust. The result of treatment largely depends on your trust.

It may seem to you that the doctor gives you limited information about the disease, and then there will be a natural desire to fill in its lack and turn to the Internet. In this case, it is important to remember the following rules for handling information obtained there:

1. The Internet provides only general information. It would be wrong to transfer everything you read to your situation. Each case of the disease is individual. Only your doctor knows the exact medical information about your child.

2. If you come across information on the Internet that contradicts or supplements what the attending physician told you, it would be right to discuss this with him and not take any action without his knowledge.

3. Use only professional medical websites or websites of specialized charitable foundations.

4. Discussing your problem on the forum, be critical of the advice of its participants: they may be mistaken.

5. Take only as much information from the Internet as you can "digest" at this stage. Too much information will only make it harder to make a decision.

If you feel that you cannot cope with the situation on your own, be sure to seek professional psychological help. Remember: your psychological state is transmitted to your child.

Stage of anger

Along with awareness come anger and rage, irritation, envy, guilt. These feelings predominate in the next stage, the stage of anger. Questions arise: “Why me? What is this for me?! Where's the justice?!"

The stage of anger is much more difficult for others than the stage of denial. The indignation of parents spreads in all directions and splashes out at times unexpectedly.

Understanding the deep state of a person in this situation facilitates contact and work with him. It may seem to a parent that the whole world has turned away from him, the illusion of justice has been destroyed, no one cares about the troubles and problems of a single person who is forced to confront cruel reality alone and fight for the life of his child. He seems to himself weak in an unequal struggle, there is a feeling that if you do not declare yourself, then everyone will forget about him, trample on him. And then the parent begins to do everything possible to attract attention: raises his voice, scandals, demands, complains. And at the same time, he often rejects the outstretched helping hand, as it is difficult to admit his weakness and dependence. Such an internal contradiction tears him from the inside, makes him suffer greatly.

“We have been lying here for five days, no one is doing anything. Everyone walks back and forth and says nothing. I do not understand how a psychologist can help me. I'm not going to talk to you..."

Irina, Nikita's mother (5 months)

For psychologists

At this stage, the psychologist needs to be as sensitive as possible to the client's need for attention and respect. Excessive sentimentality can only increase anger, as the client wants to feel his power and the right to control his life. On the other hand, he desperately needs warmth and care. The virtuosic combination of respect for the independence of the parent and care for him brings him relief.

Keeping a therapeutic position and not getting involved in a scandal will help the knowledge that the cause of anger is not in a psychologist: do not take the reaction of parents at your own expense. This can be done only when the psychologist himself has already comprehended his own fears and destructive desires, realized his defense mechanisms that may interfere with his work.

Most often, more difficult to bear feelings are hidden behind anger: helplessness, fear, shame, envy. Another reason for anger may be unjustified expectations of parents. Nevertheless, it is not necessary to tell the parent about these repressed emotions and their causes: he is not ready to receive this information. However, it is absolutely necessary to study with him the causes of anger, asking questions like: “What is it that made you so angry? Are you angry with me for not being able to help you the way you would like? What could help you? Does it annoy you that the child cries all the time and you can’t help him in any way? Does it infuriate you that doctors cannot cure the baby (explain what is wrong with him, alleviate his condition, etc.)? How is that even possible?” etc. It is important to decompose anger into its constituent parts: “You are angry because you are unable to calm the child and you feel like a helpless, imperfect mother, you are ashamed in front of your roommates, you are afraid of criticism from doctors”, etc. Identifying the causes of anger and discussing in this vein can greatly alleviate a person's condition.

There is a great temptation to ignore clients who are going through the anger stage, as they often ask to be left alone and do not make contact. However, it is they who suffer the most from loneliness, not only because it is difficult to communicate with them, but also because it is difficult for them to accept the help they so need. While respecting their right to refuse communication, it is still worth visiting their parents and agreeing to their conditions for maintaining contact. It is important to refrain from judging their behavior, to allow them to express irritation and anger, and simply to respect their right to be themselves. This is the only way for the client to experience acceptance of his condition and himself.

For doctors

Any doctor knows the eternally dissatisfied scandalous parents scribbling complaints and attacking medical staff. The reason for this behavior can be enduring traits personality, and the fact that parents are experiencing a stage of anger. It is very important for physicians to remember the patterns of grief. In any case, it is important to understand that fear and helplessness are always hidden behind anger. The reason for the parents' anger is not in the doctors, although it looks like it. In this way, they try to take control of the situation and increase their sense of self-worth. Disputes and showdowns give vent to accumulated emotions, relieve internal tension. Try to find out exactly what this or that parent is dissatisfied with, specifically and in detail. Give a direct and exhaustive answer to the claim. You can ask to write a complaint in writing, which will help the parent to see the situation from the outside and reduce the intensity of passions. Never talk to your parents in a raised voice. If you're being attacked, interrupt the conversation by saying, "Sorry, I think we'd better continue the conversation when you're calm!"

Parents

You can catch yourself thinking that everything annoys you: doctors, relatives, roommates and even - the worst thing - your sick child. You are angry, angry at everyone, you want to express your claims to everyone, demand justice. This most likely means that you are in the "angry stage".

You are angry with the doctors because they are inattentive, treat badly, and cannot help. Behind this is often the expectation that doctors, like gods, can do anything, you just have to try, that you are the only one and all attention should be paid to you. The reality is that both you and your doctor are people with their own weaknesses, with their own characteristics. Some of the doctors are more attentive and talkative, some are not. Statistics show that this does not affect the professionalism of the doctor and the outcome of treatment. If it is important for you to communicate, talk, contact your roommates or friends. You also need to remember that any doctor wants to do his job as best as possible, he has no intention of harming your child or you.

You get angry at family and friends. It seems to you that they abandoned you, left you alone in the hospital with your misfortune. If you are in the hospital for a long time of treatment, it may seem to you that the rest of the world is bathed in pleasure and only you are cut off from all joys. Remember your everyday life, there were many worries, many difficulties, many misunderstandings. Outside the walls of the hospital, nothing has changed, there is also a struggle going on. Your loved ones think about you, try to provide for your life, often take on unusual functions for maintaining the house. They also miss you very much, they are also insanely hard. You can support each other, get closer. However, if you can no longer be in the hospital, ask your loved ones to fill in for you. The change will benefit everyone.

You get angry at the roommates for talking nonsense, for not putting things in the right way, for not being able to calm the child, for not being perfect. And it's true, your neighbors are not perfect, however, just like you. It's just as hard for them as it is for you. If you do not like or do not want to communicate with them, you can politely say so. If noise bothers you, use earplugs or headphones with your favorite music. As a last resort, ask the medical staff to move you to another room.

You are angry with your child because he does not obey, cries, does not eat, is sick. This feeling is the hardest to face and acknowledge. But sometimes your irritation is so great that you can somehow act rudely with the baby, and then you are greatly tormented by guilt. It is important to understand that there is no mother in the world who at some point would not be angry with her child, and sometimes would not even hate him. No matter how much we love children, sometimes the restrictions that they impose on us cannot but make us angry. That is, we are really angry just at these restrictions, at the fact that the child has his own desires and needs that are different from ours. Often we get angry because we want to fully satisfy all these needs, but this never works out. The desire to be the perfect mother of the perfect child is unrealistic. You shouldn't strive for it. Then there will be less disappointment and anger.

It is important to remember that feelings of anger, anger and irritation in such a difficult situation are quite natural and even inevitable, but they can be managed.

Experiencing feelings of guilt

It happens that a parent directs anger at himself. Then you can talk about guilt. An infinite number of times a person asks himself why this grief fell on him, what he did wrong. At the same time, rational and irrational explanations are found for what is happening, for the fact that the burden of guilt lies on the person himself. He reproaches himself for what he has done and not done, torments himself with self-accusations and hopes to correct his misdeeds. However, this hard to bear guilt is often easier to accept than harsh reality, which largely does not depend on the person. It seems to the grieving that if there is his fault in what is happening, then he will be able to make amends for it, and then the situation will change.

“This is a long-awaited child, I did everything right, but, apparently, I still made a mistake in something or something ...”

Larisa, mother of Vitya (3 months)

“I re-read all the books about heart disease, I can’t understand how this could happen to me, what did I do wrong ... This is the third child, before that everything was fine, so what did I do wrong this time?”

Sofia, Xenia's mother (4 months)

“And why did we just go to Turkey that summer, probably, this sun provoked leukemia in my Sasha ...”

Valya, Sasha's mother (4 years old)

For psychologists

It is important to distinguish between rational guilt and irrational guilt. In the first case, there is indeed a causal relationship between a person's act and a subsequent event.

“I was warned that I needed to be vaccinated against rubella, but I thought it would pass. When I got sick during pregnancy, I also hoped that everything would work out. And now the child has a heart defect. Now my daughter will suffer all her life, and it’s all because of me, I don’t know how to live with it ... "

Natalia, Vika's mother (5 months)

Rational guilt is painful, but it allows us to learn from experience. In a conversation with a client, we support the idea that he did not do this or that act on purpose, that he did not have a conscious intention to harm the child. In this case, we can say that although the mother behaved imprudently, she could not foresee that she would get rubella, this is a matter of chance (we cannot control everything), she had no intention to harm the child. But now she will know how important it is to follow the recommendations of doctors.

An irrational sense of guilt arises as a parent's attempt to explain something that science cannot yet explain. Parents are looking for the causes of the disease in their actions, which, from a logical point of view, could not influence this disease in any way.

“My husband's family says that the woman is responsible for the health of the child. So it's because of me that Akhmed has a heart defect. Although I did everything right, did not get sick, took care of myself, was at all examinations ... "

Gulnara, mother of Ahmed (3 months)

It is necessary to get rid of the irrational feeling of guilt, as it takes a lot of mental strength and at the same time does not give a new life experience. The psychologist needs to ask what the parent really did or didn’t do, how it can be connected with the child’s illness, and logically connect, build these answers, leading to the idea that the person’s fault in this case is not. It is important to discuss the topic of limited human capabilities, his ability to foresee and influence the future. If one cannot get rid of guilt during the conversation, on a rational level, then one can change the focus by asking what a person can do to atone for guilt. Harmless rituals and actions (lighting a candle in a church, writing a letter of apology, etc.) can go a long way in helping to alleviate a person's condition.

“I know why such a punishment was sent to me. I didn't like kids before, and a couple of years ago, you know, I wished bad on a rowdy boy on a plane. He screamed, made noise ... In general, I said, well, I thought badly about him ... And now I have a sick child myself, I think this is a lesson for me: not to wish bad on others ... I think to go to church and repent for that sin, I hope this will help…”

Veronika, Petya's mother (3 years old)

For doctors

Unfortunately, the words of doctors are often a factor provoking guilt. Carelessly dropped: “Mommy, well, where were you looking!”, “What were you thinking about!”, “Why did you turn so late!” etc. - can contribute to the development of strong feelings of guilt in parents who already feel guilty. Thus, it is advisable for the doctor to avoid condemning remarks addressed to the parents of sick children. Moreover, such words will not help the case. Parents suffering from pathological guilt are anxious and irritable, which complicates the normal interaction of both the parent with the child and the parent with the doctor.

Parents

Feeling guilty about the fact that the child is sick is very typical for all parents. You are trying for the hundredth time to figure out what you did wrong. Maybe you even think: you know exactly what. You torture yourself, hate and wish yourself "punishment from heaven." But will this attitude help your child? Definitely not. There are no perfect, ideal people in the world who do not make mistakes. As a rule, something goes wrong against our will and our desire. It's hard to accept, but that's the way the world works. You will never be able to return to the time when, as you think, the fatal mistake was made. But in the present, you are doing a lot for your child. If you are a believer, ask God for forgiveness and let go of your guilt.

Do not blame yourself for the fact that you can not get rid of guilt. Feelings do not fit the words "must - should not." It’s better to figure out what this feeling gives you: maybe the strength to fight, or maybe the feeling that a lot depends on you in this world. In any case, you are entitled to any feelings, but it is always important to understand what they are about and be able to discuss them with a loved one.

Deal stage

Anger and guilt bring us to the next stage, the deal or trade. The person is trying to "negotiate" with an unbearable loss about bonuses for himself. This type of protection comes from childhood experience when there is a relationship between good behavior and reward. In the face of adversity, a person hopes for the fulfillment of desire for special services: “If I behave well (take treatment, refuse joy, etc.), then I will get what I want (recovery, happiness) for this.” At this stage, it is important not to overlook the underlying guilt that often results from such bargaining.

The transaction can be constructive and non-constructive. In the first case, the parent reassures himself that when correct execution doctor's prescriptions, observance of the rules for him or the child will become easier and recovery will certainly come.

“I calm myself with only one thought that I brought the child to best center, I got all the medicines, so everything will be fine ... "

Zoya, mother of Nina (7 months)

In a non-constructive transaction, the client may imagine that additional hardships or some irrational actions or beliefs can have a beneficial effect on what is happening. Magical thinking is often found at this stage, as thoughts, desires, and rituals are endowed magic power the ability to solve or exacerbate a problem. Parents, for example, may be afraid to talk about the success of treatment, thank doctors, once again praise the child, believing that they can “jinx” the child in this way, as if their thoughts could cause real physical harm.

“I can’t plan anything, I’m afraid that if I think that the treatment was successful, then I’ll “smooth out” my baby. So I live today ... "

Olga, Petya's mother (2 months)

“No, you can’t rejoice in any case, otherwise you will relax - and that’s it, something bad will happen ...”

Ira, Nastya's mother (8 years old)

“I was told that I need to conduct my own purification, then the karma will brighten and the child will go to correct…”

Kira, Misha's mother (2 years old)

The stage of the transaction is the time of turning to sorcerers and healers, the time of faith in miraculous healing, into the evil eye and damage, the time of cleaning karma and turning to magical rituals.

For psychologists

In the stage of constructive bargaining, the psychologist can maintain such "collusion with himself" because it leads to adaptive behavior. At the same time, it is important to remember that, despite the seeming adaptability of a constructive deal, it does not bring permanent relief, since it does not lead a person to a full acceptance of the irreversibility of the disease situation. It may seem to the parent that if he fulfills all the recommendations, it is possible complete healing, while he forgets that serious diseases have a chronic course with periods of remission and relapse, not always dependent on our will. Each new relapse will be accompanied by a re-experience of grief, as the deal will "fail" in its magical work.

In the case of an unconstructive transaction, the psychologist may intervene to bring the terms of the transaction closer to adaptive behavior. However, it must be remembered that, like any irrational construction, such a deal is protective. If you try to quickly destroy it, without offering alternative protection, you can harm the process of adaptation of parents to the child's illness.

Parents

Our own feelings of guilt and anger at doctors for not being able to completely heal a child often push us towards magic. When it comes to the health and life of a child, it seems that any means are good, as long as there is a result. This is very understandable, because you want to use all the chances. Unfortunately, some unscrupulous specialists skillfully profit from the desperation of people. Before turning to healers and magicians for help, evaluate the possible damage. Never give up traditional medical care! To date, this is the only scientifically proven method of treatment. If you can't resist trying non-traditional therapies, use them as an adjunct and be sure to let your doctor know about any treatments you've done.

For doctors

Doctors may have different attitudes towards non-traditional treatments and magical rites. No matter how you feel about it, it is important to understand that parents turn to magic out of desperation, wanting to reduce the feeling of guilt that torments them, to use all the chances of influencing the disease. Respect your parents' choice, but firmly insist on continuing the treatment you have prescribed.

stage of depression

At some point, a person can no longer deny his grief, it becomes obvious that the deal does not work, and then the stage of depression comes. By this time, the physical and emotional forces of a person are exhausted, in addition, social and material resources are often exhausted. Depression can be caused by losses both from the past and from the future, and it is important to distinguish this.

The first type of depression, reactive, is associated with the experience of real losses that have already occurred. This may be the loss of attractiveness of the child, financial resources, friends. At this stage, you may feel guilty about not being able to save something. It is important to work it out and, if possible, cheer up the parent.

“I look at her breasts and want to cry, so I cry slowly. How can I imagine that this scar from the operation will remain there for the rest of my life ... Her breast will never be smooth as before.

Polina, mother of Vasilisa (2 months)

Second, more complex type Depression E. Kübler-Ross called preparatory. At this stage, a person is preparing for the real future that awaits him. This is the time when you have to come to terms with the fact that something will not happen in the future, something very important: the child will never be completely healthy, he will have to be limited in physical activity or communication, you will need to take medicine all your life, the child will not be able to have children. This is a difficult, painful process. Often clients are silent a lot, immersed in themselves, but at the same time they need someone who would simply share this silence with them.

“I don’t know what to say, my heart is sad, but there are no tears and no words, there is nothing ... no strength, no desires. I want it all to end, but it will never end...

Valya, Sasha's mother (4 years old)

For psychologists

When depression is a means of preparing for imminent loss, approval and encouragement will not do much good. It is not necessary at such moments to persuade a person not to be sad, not to think about the bad, thereby depriving him of the right to go through the bitter path to accepting reality. Preparatory grief requires almost no words, rather it is a feeling that is important to share with another. For a psychologist, this can be a difficult job, as his own fears and anxieties push him to actively intervene. It's important to share own wish to do something so as not to see the print of grief on the face of a person, and the need for this person in silence and grief.

At this stage, art therapy methods work well. You can ask the parent to portray what he cannot describe in words, what he is sad about, what worries him.

Parents

Depression can be felt as complete devastation, lack of strength, interests, desires. You don't care what you look like, what's going on around you. My heart is sad and I want to cry. At the same time, it is difficult to communicate, I want to retire, hide from everyone. You may be surprised that your desire to fight has disappeared; anger may be replaced by whining irritability. Despite the complexity of this period, it must be passed in order to reach a new personal level. Depression is always associated with personal restructuring and growth. It is important to understand that this period will end, the day will come when you will feel a surge of strength and feel like a new, more mature person.

However, if the period of depression lasts more than 6 months and/or you have suicidal thoughts, you should seek professional psychological help.

For doctors

Depressed parents usually do not cause much irritation to doctors, as they are not hostile and quiet. Although often doctors have to explain the same thing to them several times. If you notice that the parent cannot adequately care for the child, is distracted, forgets to give the child medicine, you should definitely talk to him and find out if he needs rest or professional psychological help.

Acceptance stage

If the stage of depression is successfully passed, then the person moves to the final stage - the stage of acceptance or humility. This stage should not be considered a stage of joy. He is almost unconscious, as if the pain is gone, the fight is over. There is another life ahead, it will never be the same again. The stage of acceptance differs from the previous stage in its appeasement and the ability of a person to build future life based on existing reality.

It is important to note that in a situation of a child's chronic illness, it is almost impossible to reach the stage of humility completely - it is always a series of new and new processes of mourning that are triggered by various stages of the disease.

Thus, the process of experiencing grief consists of the stages of denial, anger, deal, depression, acceptance. These stages are often intertwined and may overlap. However, only living through all these stages leads to the acceptance of loss and the ability to effectively build a new life.

The work of grief: the main tasks of living in grief

Along with the idea that mourning consists of a series of alternating stages, there is a classification by J. William Warden, based on the allocation of psychological tasks that need to be solved by a person experiencing a loss ( Vorden, 2001). He offered a variant of describing the grief reaction in terms of tasks that must be completed. He believed that although the forms of the flow of grief and their manifestations are very individual, the immutability of the content of the process makes it possible to single out the universal steps that the mourner must take to return to efficient life. If a person does not go through all the steps, then the grief will not receive an adequate resolution, which threatens to cause deferred problems that will persist for years. This classification is especially convenient to use when working with a family in which a child is seriously ill. Determining the task that each family member is currently working on is easier than determining what stage of mourning they are in. An analysis of the correlation of tasks that family members solve forms the basis of working with a family in grief.

So, the family in general and each of its members individually must solve four problems.

Recognition of the fact of loss

The first task of living with grief is to recognize the fact of loss. To solve it, it is important to understand what each member of the family has lost with the child's illness. The most frequent may be the actual physical loss of a child's health; loss of the "internal image of the child's health", loss of the usual way of life, the image of a good parent. At the same time, each member of the family can invest their own personal meaning in these losses. At first, after a loss, there is often a feeling that nothing terrible has happened. Often this reaction occurs in fathers who are less involved in the treatment process, especially if the mother and child are in the hospital. It can be more difficult for fathers to accept the fact of a child’s illness and the associated limitations that arise in the life of the whole family.

The task of recognizing the fact of loss intersects with the “denial” stage of grief described above. The fact of loss, or its significance, or irreversibility can be denied.

The denial of the fact of loss can vary from a strict refusal to perceive reality (while the person continues to live as if nothing had happened) to lighter forms (the person lives his former life only in his mental reality, that is, automatically follows the instructions of doctors, but in depth soul hopes that the child is healthy and what is happening is a ridiculous mistake). At the same time, he can make plans for the future without taking into account the fact of the child's illness. The parent, as it were, lives in two realities: before the discovery of the disease and after.

“Until now, it seems to me that all this is not happening to me. This is the first time that life has laid such a pig on me. I am healthy, young and my husband too, how did it happen that Milena has a defect. This hospital is terrible, I try to do everything, but it seems to me that this is a dream, a nightmare. I dream of getting out of here as soon as possible and living a normal life: meeting my girlfriends, traveling ... "

Zhenya, Milena's mother (1 month)

The denial of the significance of the loss is often expressed in the devaluation of the problem or in the desire not to think about it.

“I don’t know how to convey to my husband that the child is seriously ill. He gets angry all the time and says that it is only I who think he is sick, which means that this is my problem ... "

Nastya, Grisha's mother (8 months)

The denial of the irreversibility of the loss can be expressed in the hope that everything can be repeated, the lost can be replaced, you just have to want.

“I still hope that everything can be changed, medicine is developing so much, so I don’t want to believe doctors that I will have to sit on pills all my life ... and then, you can always give birth to another child ...”

Elizaveta, Olya's mother (7 years old)

The first task at the family level involves informing all family members about what happened and acknowledging what happened to each of them. When information about terrible disease hiding from other children and the elderly, a situation of communication breakdown arises, and family members are forced to act as if nothing has happened, which causes great tension for everyone.

For psychologists

Ask parents about the moment when they learned about the disease, about who and how told them about it, how they felt then. Repeated pronunciation of the details of a traumatic situation, which undoubtedly includes the situation of announcing the diagnosis, reduces its emotional charge and leads to an awareness of what happened.

It will be useful to find out what kind of prognosis doctors give and how parents feel about this, what they know about treatment, about what restrictions the disease can impose on family life.

It is necessary to find out to whom the parent told about the child's illness: do other children, work colleagues know how others relate to what is happening, is there any support.

Parents

It is not easy to recognize and realize the seriousness of the situation of a child’s illness, it is even more difficult to talk about it. Often there are questions about how to tell other children in the family about the illness, whether it is necessary to say at work that the child is sick.

It happens that difficulties in discussing the situation begin with communication between parents. The illness of a child is a serious shock for both mom and dad. This is a joint test that can either strengthen family relationships or destroy them. Even in an established couple, tension can arise due to different styles of experiencing this difficult situation. It happens that a woman needs a constant discussion of what is happening and seeks consolation from her husband, while he withdraws, withdraws into himself and tries not to discuss painful topics. It may seem to a wife that her husband doesn’t care about what is happening at all, which is absolutely wrong: it’s just sometimes more difficult for a man to admit the fact of a child’s illness, as this causes an acute sense of helplessness, which is especially hateful for men.

Here is how parents (Dorothy and Doc) react to the death of a four-year-old in Fannie Flagg's book Standing Under the Rainbow:

“It is impossible to come to terms with the death of a loved one, but there is nothing worse than losing a child.<…>After some time, Doc returned to work, but Dorothy could not do anything - she sat in her son's room and looked at the crib. She didn't eat<…>and could not sleep without pills. Although the doctors repeated that nothing could be done, she did not believe. Again and again she asked herself the same questions. A hundred "whys" and "what ifs" - and not a single intelligible answer. And Doc couldn't help. Even vice versa. She resented how quickly he recovered, as if nothing had happened. He didn't even want to talk about it. It was worth a hint - just left the room. She was young and did not know that people deal with grief in different ways. Doc - also still young - was wrong in trying to pull himself together and be strong for his wife. She didn't know that he would often drive out of town by car and just sit in the car and cry.

The wound from the loss of the child did not heal and will not heal completely. But after a little over a year, they were both able to return to everyday life.”

Try to pay attention and respect to the needs of each family member during this difficult time for you. To include your spouse in the process of coping with your child's illness, visit the doctor together, make treatment decisions together, discuss your fears and concerns, and delegate treatment-related tasks to your spouse.

If there are other children older than a year in the family, it is important to tell them about what is happening. Children aged from of the year before three you can simply say that the brother (sister) needs treatment, he hurts so-and-so, and therefore mom needs to stay with him in the hospital while the doctor treats him. Be sure to assure the baby left at home of your love. Children aged from four before twelve can tell you more about what's going on. Using the example of books about the structure of the human body, you can tell that the heart of a brother (sister) does not work like that (blood cells, kidneys do not work that way), and doctors need to fix this. It is very important to explain that all people get sick and no one is to blame for the illness of their loved one.

Many people doubt whether it is necessary to tell at work about a child's illness. As in any other business, honesty is the best policy. Your employer needs to know if you will be able to perform your duties to the full extent, how long you will be on parental leave. If it is difficult for you to start a conversation, take a medical report from the doctor about the child's condition in advance and rely on it in a conversation with your superiors. If you are counting on privacy, it would be right to say so directly. It will not be superfluous to find out what guarantees and benefits the labor legislation provides you with and obtain them.

For doctors

For effective treatment of the child, the active participation of both parents is necessary. Try to involve them in the treatment and decision making about it. Explain the stages of treatment in simple, accessible language so that parents have a clear understanding of what happens at each stage of treatment. If you doubt that the parents understand what is happening correctly, ask them to tell in their own words about the child's illness, treatment options and its consequences.

Experiencing the grief of loss

The second task is to deal with the grief of loss. The parent needs to go through all the difficult feelings that arise in connection with the child’s illness: anger, guilt, sadness, fear, despair, shame, helplessness, etc. Solving this problem, the parent can lose contact both with external reality, shutting himself off from people, and and from the inside, plunging into apathy, ceasing to experience any feelings.

Living feelings in the family turns into a change in communications. Family members experience the incident differently. A change in the emotional background requires a change in stereotypes of behavior. Different ways of expressing feelings different speed Changes in emotions create many difficulties. It happens that family members begin to quarrel, demanding certain forms of behavior from each other, or, on the contrary, they believe that everything is allowed in grief. Sometimes the whole family decides to "hold on" - strict discipline is introduced, there is no place for feelings.

“I cry all the time, I feel so sorry for our baby, and it infuriates my husband, he goes to friends and drinks with them all night ...”

Zoya, Ksenia's mother (6 years old)

“It’s impossible to discuss treatment with my husband, he starts to get angry, blame the doctors and me ...”

Irina, Petya's mother (4 months)

For psychologists

When describing the stages of mourning, we have already touched on such feelings as anger, guilt, helplessness. Therefore, here we will dwell on the discussion of feelings of shame, envy and fear.

A child's illness is often perceived by a woman as her own "badness", a defect in femininity, the inability to be a good mother, which reduces self-esteem. The parent experiences a strong sense of shame, which is most often suppressed, but brings a lot of suffering and affects all human behavior. Alongside shame, envy can lurk, which is not easy to admit and almost impossible to talk about. Therefore, often on the surface we see not just anger, but narcissistic rage.

“I stopped talking to my friends. Their question is: “What have you learned so far?” gives me a burning hatred for them ... "

Ekaterina, Kolya's mother (8 months)

“I don’t tell anyone that I’m going to have a heart operation, my friends won’t understand me, they’ll think that I’m a weakling ...”

Shame and envy require a very delicate discussion. You should not name these feelings to your parents, it is better to ask them to describe what they feel, how they experience what is happening. It is important to give narcissistic nourishment, to praise for the much that has already been done in terms of combating the disease, to learn about other life achievements. It can be noted that the disease is not something to be ashamed of, it does not characterize them as a person. Illness is a grief that could have fallen to anyone, but it fell to their lot that they adequately cope in such a difficult situation.

It is important to find out what kind of reaction from the environment parents are most afraid of. Often they answer that they will laugh at them, point fingers. Then it is important to find out how real it is, how it characterizes those people, what relation it has to the parents themselves.

Fear is a natural reaction in a situation of threat to health and life. Parents share fear more openly, and it is important for a psychologist to clearly understand what exactly this or that person is afraid of. Parents may be afraid that the child will be in pain, that he will be lonely in intensive care, that it will be difficult for him to endure postoperative restrictions, etc. Each fear must be analyzed separately, thereby unraveling the tangle of undifferentiated fear. It can be difficult to touch the deepest and most acute fear - the fear of death.

“I’m so afraid… what will happen if… what if she… I don’t know, it’s hard to say, I can’t lose her…”

Natalia, mother of Veronica (4 months)

Parents sometimes find it unbearable to even say the word "death" and therefore they try to avoid talking about this topic. If the psychologist sees that the parent is afraid that the child may die, but does not dare to say it out loud, you can openly ask: “Are you afraid of losing him?” Or more gently: "Are you afraid that the treatment will not be successful?" The reaction of a parent can be violent, and this is quite understandable: the most terrible topic is touched upon, a topic that there is no one to discuss with. The psychologist may be the only person able to talk about the most disturbing. If a parent is crying, do not immediately comfort him, tears usually bring relief. Take a break, let the parent get in touch with an important topic for him. Calm, empathic silence is the best support at the moment. If it is appropriate and necessary, you can take the crying person by the hand, pat on the back... Words of acceptance: "It's really very scary and hard... It's natural to cry in such a situation..." will make the parent feel that you are there and ready to share the pain with him. When the parent is able to return to the conversation, they can discuss the likelihood of an adverse outcome, the reasons for such fear, look for resources, understand what needs to be done to minimize the risks of endangering the child's life. You should categorically not say “Calm down, shame on you!” or “Everything will be fine! Do not Cry!". No one - not you, not the doctor - knows what the outcome of the treatment will be. You can only talk about probabilities, not guarantees. You can return the parent to the present, noting that at the moment the child is alive and in no danger, and agree to solve problems as they arise. Concentration on what is happening here and now is very helpful in situations of anxiety and panic.

If the crying becomes uncontrollable, don't be afraid to shake the parent by the shoulders, ask them to look into your eyes and breathe deeply. Bring him a glass of water or try washing with cold water. Stay calm and don't blame yourself for what happened. With tears, the parent gets rid of the tension that tormented him. Any crying will end sooner or later. Be sure to discuss such a violent reaction. Before you leave, make sure the parent is able to continue caring for the child.

During this period, it is important to find an acceptable way that allows all family members to respond to their feelings in the form they want. Therefore, if one of the child’s relatives closes up and prefers not to discuss their feelings, you should not climb into his soul. The situation of acute grief is not the best time for personal development training.

Parents

The situation of a serious illness of a child cannot but cause a storm of emotions. Helplessness, anger, fear, despair - whatever feelings you experience, they are all a normal reaction in such a difficult situation. Of course, it would be easier for doctors and loved ones if you remained calm and acted rationally, based on the arguments of reason. But this is not always possible, moreover, without adequate living, emotions will not happen. full acceptance what is happening.

Feelings arise without our conscious participation, however, we can consciously work with them. In order to reduce the emotional tension on your own, you must first of all determine and name what you feel, determine the cause of these experiences and understand what can help reduce the severity of the tormenting feeling. Any feeling is easier to bear if it can be shared with someone. Determine with whom you could discuss topics that concern you.

Anger and anxiety can be reduced by exercise or painting. Draw your anger and tear it up, beat your pillow with your fists, or scream (where no one can hear you) - all this will give relief to your feelings.

Cry if you feel like crying, otherwise tears can take you by surprise, for example, when talking with a doctor. Tears are a natural reaction of the body to help reduce stress. Many people are afraid to cry in front of children, which is basically right, since your uncontrollable tears can scare children. However, if you can’t hold back your tears looking at your baby, you should kindly explain to him: “I am crying because I love you very much and worry about your health. Everyone can cry when they are sad or hard, even adults. I will do everything for you to recover ... ”This will teach the child to accept his own and other people's feelings.

If tears come at the wrong moment, focus on breathing: it should be even, rhythmic, exhalation is twice as long as inhalation. Look around and call yourself everything you see: “I see ..., I see ...”

Feelings of helplessness can be reduced by being clear about which areas of your life are within your control. You cannot influence something, for example, the course of a disease, but you can choose a doctor, a hospital, provide good care for the child, to engage in its development, etc. Listen to yourself and your desires: what do you want to dress and dress the child in, what do you want to eat, what books to read, what music to listen to. The child's illness is not your choice, but you can create a more pleasant atmosphere around the treatment. Small but very important joys will help brighten up this difficult period.

In a period of despair, fantasizing can be life-saving. Imagine yourself in a safe cozy place with your loved ones, remember the happiest moments of your life, dream about the future. Remember: nothing can last forever, and a person has the ability to find happiness in any situation.

For doctors

Excessively emotional parents cannot but irritate doctors: they take too much precious time, energy, and most importantly, they expose repressed feelings in the doctors themselves. Providing psychological support to parents is not the task of a doctor. If you see that your parents are not coping psychologically, they are constantly crying or angry, it is better to calmly tell them: “I understand that it is very difficult for you, your emotions are quite natural. You may need to seek professional psychological help. Unfortunately, I cannot help you with this, I am a doctor of a different specialty ... Let's return to our conversation when you are calmer ... "

Organization of family life taking into account the disease

The third task that must be solved by each family member is the organization of family life, taking into account the illness or loss of a child. A serious illness of a child leads to the loss of the usual way of life: life changes, the distribution of roles and responsibilities. Treatment and care of the child cause the need to organize life in a new way.

Each member of the family performs some household functions: for example, the husband earns money, the wife does housework, the child goes to school and walks the dog. There is a certain stereotype of a “happy family” that goes to the sea in the summer, celebrates the New Year with a plentiful feast, goes in for sports on weekends, etc. A child’s illness does not fit into this stereotype, it breaks the usual functions of family members. It takes time and inner work to deal with these changes.

“We planned a vacation in Turkey, but now Vanya is not allowed in the sun. He says: “Mom, can I only go outside at night now?” (laughs). But I understand that, of course, we are not talking about a complete ban on the sun, but we definitely won’t go to the sea.”

Tanya, Vanya's mother (4 years old)

“It blows my mind: who will be with him in the hospital? I work, I can't quit my job, what will I live on then? And he needs to be looked after. My husband and I are divorced, my mother died. Here I am pulling him alone, and now this disease. I just don't know what to do!"

Vera, Stepa's mother (10 years old)

When a child is seriously ill, the care of healthy siblings is especially hard hit. Fathers, in addition to the usual functions, are also forced to take care of the child, which was performed by the mother, which greatly overloads them.

“I’m very worried about the elder, he’s practically abandoned there alone, dad works, and my son is only eight years old ... I call every five minutes, and he always asks me when we will return ...”

Oksana, Vladik's mother (3 years old)

“I don’t know what to do with my second daughter, she’s only three, every time I call her, she cries ... Mom asks not to call home anymore, but how then ...”

Lyudmila, mother of Ira (5 months)

In addition to everyday functions, each family member also has psychological ones. So, a husband can be the organizing, stabilizing beginning of a family, a wife can maintain an emotional climate, one child can unite, give meaning family life, the second is to be a "scapegoat". If there is no redistribution of roles in the family, then it cannot function normally and either breaks up or begins to need to create artificial problems that would promote unity and ensure its integrity. This often happens with a serious illness or death of children. So, based on the above example, if a “meaningful” child falls ill, then his illness can be artificially aggravated, thereby increasing the unifying function of the child, but in the event of his death, the family loses the unifying center, and there is a risk that one of the family members will fall ill or bring other problems into the house around which the family will unite. This is often a transitional period during which the family substitutes someone or something for the place of loss. This temporary replacement gives time to develop new interaction stereotypes.

“We pulled Yura for 18 long years. We were immediately told that he was not a tenant, but we tried. Doctors say that it is a miracle that he lived so long and fully. He left, and a void arose, we do not know how to live on. During this time, we have missed the youngest, the teachers complain. Now I have to pull it out."

Natasha, Yura's mother (18 years old)

For psychologists

The parent may not realize that the child's illness has changed a lot in different areas of family life. This needs to be clarified. It is important to help parents imagine how everyday life, rest, holidays, etc. will look like, together to find ways to enjoy life, despite the child’s illness, but taking it into account.

It is necessary to find out what psychological functions the sick child performed in the family, what future was drawn for him, and make the necessary adjustments.

It is important to convey to the mind of the parent that life has changed and family roles will have to be reconsidered. Despite all the inconvenience, this is not a disaster, and most families can handle it. It is useful to have contact details of charitable foundations, social services, where parents could apply for help.

Parents

A child's illness always breaks into life unexpectedly, changing the usual course of life. Periods of intensive treatment are especially difficult. Additional, often new, responsibilities fall on the shoulders of parents. Undoubtedly, this is a difficult period, but we can cope with it if we act together and not fight each other. Make a to-do list and assign responsibilities to family members. Let everyone choose for himself what is most pleasing to him. So, a father can be in a hospital with a child, while doing great care and interacting with doctors, and a mother can earn money. Do not cling to stereotypes of behavior: everyone has their own way.

In a situation where no one can be with the baby in the hospital, arrange with medical staff or roommates to supervise your child. Do not be tormented by guilt if you do something not perfectly, it is impossible and no one succeeds.

When you're overwhelmed by an overwhelming number of cases, it's helpful to classify them into four groups. The first will include urgent and important matters that you will deal with first of all. Then there will be urgent, but not important, then important, but not urgent. Cases from the last group - unimportant, non-urgent - can be postponed until better times. Do not forget to classify as urgent and important matters everything about your physical and state of mind. You must be in excellent shape to provide quality care to your child. The aviation rule “Put the oxygen mask on yourself first, then on the child” should be your slogan. Do not hesitate to entrust assistants with all matters that do not require your direct participation.

For doctors

The illness of a child knocks the family out of the usual rhythm. From the outside, it may seem that family members act chaotically, they hardly take responsibility for what is happening, they cannot provide adequate care for the child, which negatively affects the treatment process. It is important to understand that the family needs time to rebuild the internal structure, to decide who will be the main participant in the treatment process.

Get to know all family members of the sick child and choose the one that you think is adequate for reporting medical information. It is advisable to describe in detail the conditions of stay in the hospital, the stages where special participation of relatives is required, the scheme of financial costs, the possibilities of obtaining assistance from medical personnel to care for the child.

Information about treatment, complications, the course of the disease is better to give complete, but not loaded with details. Everything that you do not tell about the child's illness, the inflamed consciousness of the parents will draw on its own, therefore it is better to answer all the questions of the parents, reducing the work of their imagination to a minimum.

There are cases when doctors offer parents to independently choose from two types of treatment, thus relieving themselves of responsibility for the result of treatment. It would be correct to voice your idea of ​​the preferred type of treatment in a well-reasoned manner, and then ask the parents' opinion. For all their interest, parents do not have enough knowledge to make medical decisions.

Building a new attitude to the illness (loss) of a child

The last fourth task is to build a new attitude towards the illness (loss) of the child, the possibility of building later life. The solution to this problem does not imply either oblivion or the absence of emotions, but only their restructuring.

Many parents misunderstand this task and therefore need psychological help to solve it. It seems to many that the weakening of the emotional attitude to the problem of a sick child means betrayal. Others are afraid of repeating the pain of loss and refuse to have new children. It happens that the close environment disapproves of the fact that the parent returns to a full life.

Thus, the completion of this task is blocked by the prohibition of new love, fixation on the past, or avoidance of the possible re-experiencing of the loss.

The fulfillment of the fourth task means that the family acquires a new equilibrium position, in which all family members become functional, and a sign of this will be further following the stages of the life cycle and the ability to change in the event of the appearance of new family members.

“You know, I didn’t doubt at all when they told us that the child had Down syndrome and a serious heart defect. Many refuse such children, but my husband and I did not even want to hear about it. This is our child, since it is given to us, we can handle it. The defect has already been operated on, now we are recovering. Polina is very active and sociable, probably because we are constantly working with her. When we get back home, grandmothers, dad are already bored, so she will have someone to talk to, and I will sleep off ... Let's get her on her feet a little, - we communicate with other parents on the forum, - and there are kindergartens for such children, and mugs. And then we’ll think about it, maybe we’ll start a second one, and Polina won’t be bored ... "

Veronika, Polina's mother (6 months)

If the work of grief is blocked at this stage, the family is incapable of further changes, the separation of children, the appearance of new children, the entry into a new marriage, and it disables weak family members.

For psychologists

An unresolved sense of guilt can become a barrier to parents solving this final task. Parents may consider themselves unworthy of joy and pleasure, devote all their time and energy to caring for the child.

It often happens that a child's illness becomes the main meaning-forming factor in the life of parents, the only beginning that unites the family.

In both cases, unfavorable conditions are created for the development of a sick child due to his excessive disability. reverse side overprotection of the child becomes repressed hatred for him, which can manifest itself in a variety of forms: sometimes in open outbursts of anger, sometimes in insisting on additional painful examinations, depriving the child of simple childhood joys for security reasons.

End of introductory segment.

Maria Kiseleva, Clinical psychologist, child psychologist, psychodramatist

Play plays an important role in the lives of children. Thanks to the game, the child develops and learns new things, learns to manipulate objects and masters new roles.

Everything happens gradually, the children do not immediately begin to pretend to cook soup and play mom and dad. Let us dwell on each age period in order to understand what kind of game is characteristic of a child in different ages and what is its importance for development.

zero to two

From birth to two years old, children actively learn about the world and objects in this world, it is important for them to understand what kind of object it is and how it works. Therefore, in this period, an object game and games develop in which the child gets acquainted with the world of things and the world of nature.

The child learns the names of objects and what they do: “this is a car, this is how we roll it”, “this is a stone, we can throw it, we can hold it in our hand, or we can put it in a bucket”. The game of peek-a-boo, and then hide and seek, gives the baby the knowledge that the mother can disappear for a while and then appear.

“Magpie-crow” and “patties” teach bodily interaction: here are the fingers, here are the palms, fingers can be bent, and clap your hands. It seems to us, adults, that these are such simple and uncomplicated games, and it is very exciting and interesting for kids to learn to clap and enjoy what happens.

No less fun to invent yourself similar games for kids, as described, for example, in the story of a caring grandmother - "".

From two to three

From two to three years old, it is important for a child to be like a parent, so he begins to copy the actions of adults, chat with a spoon in a saucepan, as if cooking soup, “steer” a car like a dad, roll a stroller, put purchases in a shopping cart.

This is called imaginative play, that is, play that copies the actions of other people, usually adults. Here it is important to let the child prove himself, so that he puts the purchase in the cart, “cooks” the soup in the pan. And even if he is not real, but this gives the baby great knowledge and confidence that he is like a mother, he can also.

Three to four

From three to four years, the child learns to manipulate objects, this game stage is called "object-manipulative" or director's play. The child lays out toys, preferably small ones, next to him and plays, voicing them. Cars can collide, drive, and even talk. “Substitute” objects appear: the child can take the cubes and imagine that they are cars, and play like cars.

four to five

From the age of four to five, figurative play develops, the child begins to imagine himself as some kind of character: a fox, a kitten or a knight.

Five to six

From five to six years, figurative play develops into a role-playing game, the child not only imagines that he is a fox, but also begins to behave like a fox, says that he will eat the food that foxes eat, live in a mink, and mom He has not just a mother, but a fox mother.

A knight can have a horse in the form of a mop stick, homemade armor and a sword, he can famously ride his horse, defeat dragons and save the mother princess. Various family traditions, for example, playing home theater, can help a child master the repertoire of role-playing games.

six to seven

At the age of six or seven, children learn to play by the rules, these are both various board games and role-playing games in a large children's company, where there are certain internal rules.

Not all children succeed at once, it is difficult for many, they are upset and angry that they did not win, that they were not the first. Games with parents according to the rules can help with this, as in the stories "" or "". Parents can gently introduce the rules, first succumb to the child, gradually teaching that there are rules and they must be followed.

Difficult games

But the realities of our modern life are such that parents often complain: the child does not want to play, constantly asks to play with him, and he does not know how. Parents in confusion ask: what to do, is it worth playing with him?

To answer this question, let's remember our childhood, how we played and learned to play. Our stories will help us with this. Here, for example, is the story "" about a tradition that has been going on since the 70s - parents arranged for children various games and quests, they came up with impromptu performances from home-made dolls. Children like it very much, and they quickly adopt this skill and continue to play on their own, and as adults they teach their children.

You can also remember our "yard" childhood, when the guys walked a lot in the yard and came home only to eat and sleep. And these companies of different ages, where everyone is together: both kids and adult children, and everyone is busy in the game.