The Struggle for Life: A Psychological Perspective of Kidney Disease and Transplantation

The Struggle for Life: A Psychological Perspective of Kidney Disease and Transplantation

The Struggle for Life: A Psychological Perspective of Kidney Disease and Transplantation

The Struggle for Life: A Psychological Perspective of Kidney Disease and Transplantation

Synopsis

With case examples and step-by-step frameworks for intervention, the authors illustrate the challenges and solutions in establishing an effective ward-based psychotherapy service for renal dialysis and transplant patients. They describe clinical patterns of presentation and how psychotherapeutic intervention was refined over time in a clinically meaningful and evidence-based manner. Each chapter is focused on specific emotional disorders among renal patients.

The authors introduce the concept of loss of an imagined past' (aspirations and ambitions) never realized, or compromised, as a result of renal disease and as a major cause of post-transplant depression. Emotional issues which have received little prior attention in the literature- including substance abuse, eating disorders, gender disorders and emotional body image- are addressed in depth. Practical advise, including that against referencing the transplanted organ as a gift, is offered.

Excerpt

The emotional and psychological manifestations in patients receiving dialysis and organ transplants have been recognized for some time. These disorders have been classified in terms of chronic depression and psychosis or conceptualized in keeping with distortion in body image, fear of rejection of the transplanted graft, and grief for the donor. in keeping with other chronic illnesses, some authors have pointed to the manner in which emotional problems may delay and adversely affect medical management and progress of the illness, resulting in graft loss and even death. However, in contrast to other chronic illnesses, little attempt has been made to provide psychosocial support for these patients either before or after transplantation. Where such intervention does exist, it has been fragmented and intermittent. Our own experience of implementing a ward-based psychotherapy service at the transplant unit in Glasgow has suggested that while renal disease shares many common characteristics with other diseases, some aspects of the clinical manifestation of emotional problems in patients with renal failure and recipients of organ transplants are also unique, multifaceted, and more complex than has been generally realized. Not only was our service designed to support these patients, but also to have a positive impact upon the transplant agenda, defined in terms of individual patient access to and adherence with the transplant process.

Our primary concern has been to gain a deeper understanding of the relationship between the emotional states recalled by patients during ther-

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