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Finding a Rhythm Where There is None: Medical Family Therapy in a Pediatric Intensive Care Unit (PICU)

Posted By Alex Schmidt, Tuesday, October 28, 2014

Last year, I began working as a medical family therapy (MedFT) intern in a pediatric intensive care unit (PICU). During my master’s program, I worked as part of a collaborative treatment team in a clinic serving patients with neuromuscular disorders. I loved the steady, consistent pace of this bustling clinic and the team with whom I worked. Although many of my skills in designing behavioral health interventions transferred to this new setting in the PICU, I quickly realized there were significant differences between an outpatient adult neurology clinic and this pediatric intensive care setting.



In the PICU, there are more frequent changes of physicians and nurses as shifts rotate, no opening and closing hours, and an expansive variety of injuries and diseases being treated. In the past year, I have worked with patients and their families facing diabetes, cerebral palsy, hydrocephaly, seizure disorders, rare neuro-genetic disorders, leukemia, and accidental and non-accidental injuries including suicide attempts. This vast array of illnesses provides me the freedom to be curious and briefly research many different types of diseases. However, this has also presented a substantial challenge to my ability to accumulate a great deal of knowledge quickly. 

In the early weeks on the job, I felt like I was trying to grasp onto a rhythm when the genre and pace of the music kept changing. At the same time, I was also very aware that I was the first MedFT intern to join this multidisciplinary PICU team. This meant that a significant part of my job has included educating medical providers about how I, as a medical family therapist, can improve patients’ experiences by helping meet essential needs of their families. As a supportive team member, I also serve as an outlet for the staff to process the social, emotional, and mental stresses inherent in this type of work.  

I was trying to grasp onto a rhythm when the genre and pace of the music kept changing 

By now, it seems cliché to say that working in a medical setting requires a great deal of flexibility. What may be cliché is also powerfully true, as I have seen in my experiences. There is simply no way to predict with certainty when a patient might develop an infection, when parents’ bosses may tire of being patient and demand a return to work, or, in the most devastating of cases, when a patient might die after an unexpected complication from treatment. As a MedFT intern, I have become accustomed to receiving calls for consults during weekends, holidays, and evenings since, not surprisingly, illness does not operate on a schedule. Whether you are a patient, a parent, or a provider in the PICU, you learn to expect the unexpected. 



I receive consults from charge nurses, hospitalists, and intensivists for a variety of reasons, including: patients with a history of treatment noncompliance, families experiencing significant emotional difficulties due to a devastating diagnosis, families struggling to elicit social support from others, and families appearing hesitant to answer questions from the medical providers. Whereas physicians carry a large case load of patients and are responsible for managing a great deal of information, I have the luxury of time and the training to sit a with a family in uncertainty for as long as they need – sometimes 15-20 minutes, and sometimes upwards of an hour in crisis situations. In sessions, I typically aim to meet several goals

·         Elicit the family’s illness story beyond simply tracking physical symptoms,

·         Assess for emotional, relational, spiritual, and physical needs that can be met during the family’s hospital stay,

·         Identify any barriers to meeting these needs and creating a plan of action, and

·         Identify the family’s level of satisfaction with and comfort with making requests for more information or additional support from the treatment team. 

In alignment with family-centered care principles, I overtly state to family members that I view them as essential partners in providing the highest standards of care for the patient. I make it known that, regardless of the circumstances, I value the wisdom and concern of family members. One of the first things I often say to parents and caregivers is, “I know most people here have probably asked you about how your child is doing, but my job is being aware of how this hospital stay is affecting your entire family. How are you doing?” Usually, this is met with a tired half-smile and “I’m doing ok, now that he’s doing better,” “I feel like I’m losing my mind,” or “You know, I haven’t even stopped to think of that.”

Working in an intensive care unit also requires intensive self-care 


This simple question reinforces for families that we, as a collaborative treatment team, realize that our patients’ lives do not exist in a vacuum only large enough for medical history. Rather, we recognize the importance of our patients’ relationships. Our team extends beyond those of us with clinical experiences in hospitals and degrees after our names to include those who love the patient most and know their innermost dreams and the sounds of their heartbeats.  

I have found it helpful to remind myself that working in the intensive care unit also requires intensive self-care. This work is adventuresome and thought-provoking and invigorating, but there are also days when it is draining. There are days when my heart aches for families who are in so much pain that I break into tears as soon as I get into my car. Caring so deeply for these patients and their families encourages me to care for my own spiritual, emotional, physical, and relational health so that I can continue to give my very best and deepest caring to those with whom I work.                                 

I have found that I am a better dancer when I don’t think too much about finding the rhythm in the music. By following my instincts and trusting in my training, my dance steps become more fluid, more like me, and more in sync with the music. Over time, I have found the same to be true of working as a MedFT in the PICU. By learning to let go of a need for a static job description, unambiguous answers, and a certain structure, I believe I have found my rhythm.


Alex Schmidt is a doctoral student in Marriage and Family Therapy at Texas Tech University. She currently works as a medical family therapy intern at Covenant Women and Children’s Hospital in Lubbock, TX, and she is a Licensed Marriage and Family Therapist-Associate (TX). Her clinical interests include working with patients in intensive care settings and patients with neuromuscular disorders. Her research interests include factors influencing the comfort of therapists in working with patients facing life threatening illnesses, the collaboration experiences of medical family therapists, and families’ experiences of raising an adolescent with diabetes.


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