Putting the Therapeutic in Burn Camps
By Megan Bronson, RN, MSN, CS
There are differing schools of thought on what the focus of a children’s burn camp should and should not be. Some believe that burn camps should focus solely on fun and helping children to forget about their burn injuries, and should provide them with an experience that compensates them for their injury and suffering. Others build into their burn camp time and structure for clearly psychotherapeutic activities, such as process groups facilitated by mental health providers. Likely both schools of thought, the fun and the therapeutic, have something important to offer and, as is often true in life, something in between the two that blends the best of both is likely the correct answer.
Webster’s Dictionary defines the term therapeutic as “having healing qualities.” Healing is not about curing or fixing or providing compensation for injury—healing is about coming back into balance after loss and trauma. It is about reclaiming confidence and self-esteem. Many aspects of burn camps are inherently healing, such as experiencing nature, being with people who care, laughing, having fun, acquiring new skills, and sharing one’s feelings and one’s self. Being with others who have suffered a burn injury is also healing because it decreases the sense of isolation and stigmatization that many burn survivors experience; it also helps young survivors to be accepted for who they really are separate from their burn injury. Being allowed to be just a kid having a great camp experience is also in itself healing. However, another level of healing can take place at burn camp when an environment is created that supports healing and the reclaiming of personal power. Establishing such an environment is an additional challenge to burn camp organizers and requires meticulous attention to building a solid, cohesive team and setting norms that support healing.
Last summer I had the privilege of staffing the Cheley/Children’s Hospital Burn Camp near Estes Park, Colorado. I was invited by the camp’s director, Marion Doctor, to serve as one of the camp’s two psychosocial support staff. Marion is one of the leading experts on burn camps not only in this country but also internationally. She is currently the chairperson of the International Association of Burn Camps and the editor of the Psychosocial Forum for the Journal of Burn Care and Rehabilitation. She has created a prototype for burn camps that I think warrants careful consideration and examination. The effectiveness of the Cheley/Children’s Hospital Burn Camp is evidenced by the fact that it has provided 20 consecutive years of successful camping experience for burn-injured children and adolescents. What I observed in this week at the Colorado burn camp was truly amazing and I will attempt to share those observations as clearly as I can.
A COOPERATIVE EFFORT
The Cheley/Children’s Hospital Burn Camp is a cooperative, and I mean this in the truest sense of the word, effort between the Cheley Colorado Camps and the Denver Children’s Hospital. The camp is co-led by Marion Doctor, MSW, and Brooke Cheley, daughter of the director of the Cheley Camps, Don Cheley. This joint leadership of the camp is, I believe, key to its success. Located in the heart of the beautiful Rocky Mountain National Park, the Cheley Colorado Camps have been owned and operated by the Cheley family since 1921. Since then, they have been providing camping experiences for youngsters that are challenging, safe, life-changing, and self-esteem and confidence building. Not only did Brooke Cheley colead the 2003 burn camp, her brother, Jeff Cheley, was also an important part of the staff as a cabin leader. This is truly a family affair!
The Cheley staff’s expertise in providing a positive, growthful camping experience for children and teens teamed with Marion Doctor’s 26 years of experience with working with burn-injured children is an incredible combination. Participating hospital staff include registered nurses, physical and occupational therapists, and mental health counselors with burn experience. Volunteer staff include firefighters, emergency medical technicians, and people from a variety of other walks of life, in addition to burn survivors, most of whom are former campers who have gone through Counselor in Leadership Training and then have become counselors. These survivors serve as wonderful role models for the campers; the fact that they are now ready to reach out and help other young survivors is a positive indication of their own personal healing.
The experience and commitment of the entire staff to the children within a context of full cooperation between the co-leaders provided a structure and an environment for the children and staff that facilitated growth and putting forth one’s best effort for both. There was an obvious respect and trust between the camping staff and the hospital-based staff and, as with any system, I believe this was a reflection of the respect, trust, and lack of competition for power and control between Marion and Brooke.
A HEALING ENVIRONMENT
Children who have suffered a burn injury have survived a traumatic injury unlike any other. This level of trauma requires healing and recovery on all levels of the child’s being if the child is to truly heal and move forward with their life. Physical, emotional, social, spiritual, and psychological healing all need time and attention if the child is to remain developmentally on track. Much has been written about the resiliency of children after a traumatic event and, although it is true that children are resilient, they also have a great capacity for walling off and encapsulating the profound psychological and emotional impact of trauma and to appear to move on unaffected. The reality is that the effects of a traumatic event and process, such as burn injury and its treatment, continue to fester and affect the child in countless ways socially, emotionally, spiritually, and psychologically. Burn camps are a logical and powerful environment for addressing the impact of trauma.
Judith Herman, MD, a recognized expert in the field of trauma, describes a three-phase process in the healing of trauma and traumatic loss:
- Phase I—Recovering a sense of safety in the world
- Phase II—Remembering, telling one’s story, and mourning
- Phase III—Reconnecting with life
This is a helpful model for guiding burn camps in developing an environment that is conducive to healing and that supports the recovery process of children who have suffered a burn injury. What impressed me in working with the Cheley/Children’s Hospital Burn Camp was the care with which an atmosphere of emotional safety was created first within the staff and then extended to the children. The training of the staff and care taken in connecting the Cheley and the volunteer and medical staffs as a team with a singular focus was indeed impressive. The Cheley/Colorado Camps is accredited by the American Camping Association and the volunteer and burn center staff recognize and respect the Cheley staff as experts in principles of providing a well-rounded, safe yet challenging, and self-esteem-building camp experience. The Cheley staff in turn recognize and respect the expertise of the burn center and volunteer staff in working with burn-injured children. The respect the two staffs demonstrated for each other and the lack of competition for power and control provided safety for the children.
In addition to a standard of non-competition among staff, other norms that create an environment of emotional safety are the expectation that conflicts be dealt with directly and in an adult manner, an intolerance of any type of hazing (among not only campers, but also staff), respectful communication, and a willingness to listen to others’ feelings and points of view. Verbal and emotional abuse on the part of campers is dealt with directly with an aim of securing the emotional safety of the camp as well as with helping the offender to learn and grow from mistakes within reason. Clear, firm limits and fair consequences further support the emotional safety of the camp. Expectation for behavior and treatment of others is clearly spelled out in each cabin group at the beginning of camp. All of these norms sound pretty basic; however, you would be surprised at how few families or systems are able to implement them with any consistency. It is these basic expectations for behavior and communication that create an atmosphere in which members of the staff are safe with each other. When that is accomplished, children, whether in a burn camp or a family, know intuitively that they are safe to be themselves and take risks that help them to heal and grow.
“Burn camps are a logical and powerful environment for addressing the impact of trauma.”
Because a safe emotional environment is created at the camp, the process of talking about and processing feelings related to burn injury becomes a naturally occurring phenomenon—around campfires at night, at the outcamps, in the cabins during the evening hours, on hikes, and during activities in general. In order for it to be safe for campers to share their feelings, it has to paradoxically be safe not to share. There is no expectation on the part of anyone that campers discuss their feelings, yet many do quite naturally throughout the week. It is important to remember that burn-injured children have all of the typical issues, challenges, and developmental hurdles that growing up presents to all children, in addition to having issues directly related to their burn injury.
Campers are also challenged to take steps in mastering increasing levels of competence in activities, such as horseback riding, hiking, climbing, challenge courses, swimming, getting along in a group, making friends, sharing in a group, etc. In the end it is not the praise of others that builds our self-esteem, although there is plenty of that happening at this camp. What truly builds a strong internalized sense of self-esteem is accomplishing a goal and improving a skill, and accepting and meeting a challenge. Praise that bears a true relationship to an actual accomplishment of the child is a powerful self-esteem builder. Specific praise such as “You challenged yourself to go that extra step—and you did it! That’s great!” helps the child to feel his or her own sense of power and accomplishment. There is a pervasive “can do” attitude at this burn camp. All of the activities serve the healing process in that they help campers to reconnect with life and with a belief in themselves.
At the Cheley/Children’s Hospital Burn Camp, meals are served family style and campers are given the opportunity to assist in bringing food to the table and also in clearing the table at the end of meals. Everyone helps and does their part and this is an important aspect of children feeling included in any group. It is important that children who suffer burn injury not be treated as victims who deserve some sort of compensation for what they have gone through. This attitude keeps them stuck in their healing process and reinforces the idea that they are forever victims. Treating children with respect includes setting limits, expecting cooperation, and participation.
An appreciation of and respect for the natural environment is integral to the Cheley camp. This certainly needs to be a part of any meaningful camp experience as connecting to the natural environment helps us to connect with ourselves. The beauty of nature, the power of the Rocky Mountains, and the emotional safety created by a positively and singularly focused staff creates a wonderful container for the healing process of children who have burn injuries. It was a privilege to be a part of this camp and to witness the healing environment that has been created for these children.
Megan Bronson RN, MSN, CS, is a registered nurse and psychotherapist, specializing in grief, trauma, and traumatic loss. She is a frequent presenter at World Burn Congress and is on the professional advisory board of The Phoenix Society.
This story is an excerpt from The Phoenix Society’s® Burn Support News, Summer Edition 2004, Issue 2. Burn Support News is a quarterly publication that contains articles on the emotional, psychological, and social aspects of burn recovery. All Rights Reserved.