Hi everyone, today I bring a super guest to have a very important conversation with me here on the blog! It's Kátia Pacheco, a clinical and hospital psychologist, a doctor in medical sciences from FMUSP, a master's in developmental psychology, and a specialist in rehabilitation. She works at IMREA HC FMUSP, has a private practice, and teaches at Nepho and IPOG.
We always talk about the importance of a multidisciplinary team in scoliosis treatment, right? Well, the psychotherapist professional can't be left out; in fact, they are extremely important to the patient and their parents. Check out everything in the interview below, and don't hesitate to comment for more questions:
Katia, welcome to this space and thank you for being here with us. To start our conversation, could you tell us about your experience in treating patients with scoliosis?
Thank you very much for the invitation. My greatest experience is in working with people with physical disabilities: individuals with amputation, brain injury from stroke or traumatic brain injury (TBI), children with cerebral palsy, spinal cord injuries, and so on. Therefore, most of the patients I have worked with who have scoliosis developed a spinal cord injury or had difficulties with mobility, making psychological support essential. There were issues related to self-image and self-esteem, as well as difficulties in coming to terms with their physical disabilities.
Specifically regarding congenital scoliosis – the type that a person is born with – what are the main challenges in addressing a child's psychological well-being in this context?
Initially, guidance is provided to the child's parents. It is essential that the topic of scoliosis does not become a taboo in the family. The more openly one can talk about the child's diagnosis, the more the child feels that there is an internal space within their parents to accept them as they are. The parents' attitude during early childhood functions as a mirror for the child and is an important foundation for the development of self-image and self-esteem. Naming the feelings that arise during the course of treatment is also crucial for helping the child better understand these emotions. Later, when the child enters school and expands their social groups, they begin to become aware of their difference and the potential impact they may have on their social and school life. At this point, the approach is more child-focused, aiming to increase the child's awareness of their diagnosis, expression of feelings that may arise, and the development of tools/strategies to address potentially prejudiced attitudes that may occur. It is essential for the family and school to be aligned in providing opportunities for the child's life without overprotection or ableism while valuing the child's potential.
Do parents also need emotional support in cases of children with scoliosis?
As I mentioned earlier, in the treatment of children with congenital scoliosis, the work often doesn't start with the child but with their parents. It is common for parents to experience feelings of guilt (even if there is no rational basis for it), insecurity about treatment decisions (whether more conservative or surgical, for example), and difficulties in facing societal prejudice. Parental guidance aims to equip these parents with the tools to address all of these issues and provide support for the emotions that arise while avoiding overly protective or, conversely, more prejudiced attitudes toward their children. A child's body image is developed based on the sensations their body absorbs from the imagined body that their parents had for them even before their birth, meaning the expectations their parents had for them and their bodies, as well as how their parents perceived their actual bodies after their birth. The possibility for an individual to be recognized and valued for their uniqueness is crucial for the development of an integrated and positive body image. It is essential that parents know how to respond to situations where their children ask about their diagnosis or encounter prejudiced comments at school, for example. All of this is discussed with these parents so that when the child grows up and becomes aware of their diagnosis, they already have a strong and supportive family foundation that aligns with their needs.
What is the importance of psychotherapy for patients with scoliosis?
Psychotherapy is important for people with scoliosis because it promotes self-awareness and enables a more realistic perception of the diagnosis. It also facilitates the development of productive strategies for better adaptation, active participation in the rehabilitation process, and social inclusion. Improving self-esteem and self-image are crucial aspects to address, and when well-developed, they bring significant benefits to a person's quality of life.
In your experience working with patients in these conditions, is it possible to notice that girls, in particular, tend to have low self-esteem?
In our society, we observe that there are increasingly rigid and unattainable aesthetic stereotypes and standards. It is very common to see, especially in girls, serious self-esteem issues. The condition of scoliosis, which often comes with a visible bodily mark, tends to exacerbate these problems. In my practice, I have already treated girls with scoliosis who had low self-esteem, and others who, on the contrary, had a good relationship with their self-image. It is very important for parents to give the necessary importance to the development of self-esteem. I always advise parents of children to avoid praise regarding final results and physical appearance, such as "Congratulations on doing so well with all the physiotherapy exercises today" or "You are beautiful!" because these do not value the process the child went through and can often give the child a false perception that if their result is not exemplary, it will not be valued. Praises express the adult's opinion about the child and can make the child dependent on external/social evaluation, reducing intrinsic motivation. Conversely, when you value the process: "You dedicated yourself to physiotherapy today and should be very proud of yourself" or "You chose your dress well. You look lovely!", you encourage the child. Encouragement develops a sense of capability, self-assessment, and autonomy. Encouragement focuses on the process and is task-centered rather than person-centered, which benefits the development of self-esteem.
And how do boys deal with all of this?
The literature shows that there are many more cases of scoliosis in girls than in boys, and this is also reflected in my experience. However, the basis of psychological treatment does not change depending on gender. Both girls and boys will need psychotherapeutic support, and their parents will need guidance and support to better handle the challenges of the condition.
What is the importance of family support in the emotional well-being of scoliosis patients?
The importance is significant because the family is the first social group to which the child belongs and interacts with. It is within the family that the child forms their initial impressions about themselves and the world. Therefore, the family relationship provides a foundation for the child that often serves as a reference for the rest of their life. This foundation can be either productive or unproductive. Even if the family has good intentions and a lot of love for the child, the fear that parents may have regarding social prejudice, as well as their own prejudices, can lead to "protective" reactions that convey the belief that parents do not believe in the child's potential, for example. It's not about pretending that the child is not different; on the contrary, it's about openly discussing the child's diagnosis and supporting them in their achievements and potential. Given the complexity of this dynamic, which is unexpected for most families, professional support is highly important.
Any final thoughts?
Even though it may seem like a long and challenging journey, psychotherapy for individuals with scoliosis and family support are crucial for a more realistic self-perception, the development of self-esteem, and the appreciation of one's potential, ultimately promoting social inclusion and a better quality of life.
Kátia, thank you very much for your participation here with us! Everyone, if you have any questions, we're here to help. Just leave them in the comments section below.
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