透過藝術與遊戲療癒住院病童的醫療創傷

Healing Through Art and Play for Hospitalized Children With Medical Trauma

兒童在面臨重大疾病和醫療介入時，通常會經歷日常生活及身心內、外在極大的改變。此外，治療過程常需要接受各種侵入性檢查和醫療處置，除了導致疼痛不適外，也容易引發巨大的不安與恐懼。特別是需要長期住院治療的病童，很常感受到孤離、悲傷和無助，也可能對未知（包括死亡）的失控感到焦慮，因為這些負面想像、甚至覺得恐怖和無望。兒科住院病童很難透過口語來表達內心複雜混亂的經驗，孩子除了吼叫與哭泣外，如何協助他們找到表達、調節和轉化情緒的方法，才能安穩地渡過療程是很重要的。兒童住院情境心理介入的文獻回顧指出，藝術治療（art psychotherapy）中的創作與遊戲歷程，可以提供兒童情緒有非語言表達與宣洩的管道，能促進其情緒的穩定與安適感，也協助兒童在面對重大醫療介入時，能更有勇氣和心理準備去因應，並減輕源於疾病或醫療介入的疼痛和焦慮，進而促進兒科病童的身心療癒。本文將透過文獻整理與臨床案例來介紹藝術治療如何應用在住院兒童的身心照顧、降低兒科醫療創傷壓力（pediatric medical traumatic stress）反應、減緩可能醫療創傷（medical trauma）的效應並預防其衍生成慢性的創傷後壓力症候群。如何有效緩解孩子在面對醫療介入時的各種焦慮與創傷壓力反應症狀，除了在藝術治療中覺察兒童的情緒、並透過創作與遊戲來轉化，也需要家庭與醫療團隊，一同參與了解兒童的身心狀態，成為完整的支持系統，在醫療疾病的歷程可以有適切地安撫與照顧方式，以建構創傷知情的環境，減輕兒童醫療創傷的發生。

Children suffering from critical illness often face significant life changes during hospitalization that can impact their external and internal worlds dramatically. Moreover, invasive treatments and medical procedures may cause physical pain and severe psychological distress. Furthermore, children with long-term hospitalization are often preoccupied with feelings of isolation, anxiety, helplessness, and hopelessness. Because children often have difficulty expressing their experiences and may resort to screaming and crying, it is necessary to help them express and transform their disturbing emotions. The literature supports the efficacy of art psychotherapy (AT) in helping children cope with suffering illness and distressing medical treatment procedures. The process of creation and play in AT helps pediatric patients express emotions non-verbally and experience catharsis in gentle and safe ways. AT can promote a sense of security in these patients by building up courage, mental stability, and the readiness necessary to face upcoming medical treatments and procedures. How AT may be used to care for pediatric patients’bodies and minds during hospitalization is presented in this article using a review of the literature and clinical case presentation, with a particular focus on how AT can effectively reduce anxiety and medical trauma responses (i.e., pediatric medical traumatic stress). In addition, the participation of the family and the medical team in the AT process is important in better understanding and appreciating the physical and mental states of pediatric patients and in realizing and transforming the emotions these patients express through this process. Family and medical team members can form a support system and offer appropriate comfort and care to children during their medical treatment, creating a trauma-informed treatment environment and reducing the risk of patient medical trauma.