The increasing number of pediatric patients with end-stage renal disease who undergo dialysis and transplantation have necessitated the development of psychological interventions to lessen the emotional impact of these procedures. This report describes the dilemmas involved in mental health interventions and consultation in a treatment program for end-stage renal disease. Case illustrations of a young child's severe anxiety reaction to dialysis, an adolescent's depression, and a family's withdrawal document the varied patterns of adaptation to treatment for renal failure. Psychotherapeutic approaches are presented to illustrate the flexible use of a number of treatment modalities including brief crisis-oriented intervention which emphasizes the patient's cognitive mastery of procedures. The development of viable mechanisms of professional collaboration improves the quality of patient adaptation by lessening the fragmentation of care and problems of interdisciplinary communication often associated with the medical care of children and adolescents with end-stage renal failure.
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