I just came across a type of therapy that is quite popular, but also controversial, in Germany: the Gelsenkirchen Method (“Gelsenkirchner Behandlungsmethode”). This method was established by Prof. Dr. med. E. A. Stemmann and is based on the idea that the atopic disease (eczema or asthma or allergic rhinitis) is triggered by emotional pain that hit the patient unexpectedly and is re-enforced and sustained by particular circumstances. One hypothesis is that the sudden separation of the child from the parent is experienced as a traumatic event and is followed by a separation anxiety, which causes constant stress for the child and thus disturbs the immune system. In genetically predisposed children this can lead to atopy. Some of the psychological reasons sound a bit esoteric to me, but some approaches seem to perfectly make sense. I will try to outline some aspects of this method, according to what I have learned so far.
The Gelsenkirchen method focuses on the elimination of all disturbing factors through psychotherapy and diet. The idea behind this is that the immune system is over-reactive and with eliminating all potential allergens and stress factors the disturbed immune system can come back into its normal range, where it can handle aggressors much easier. The diet seems to be the usual allergen-avoidance diet – I just ordered a book about it and am waiting for it to arrive. The psychotherapy focuses on teaching the child to be able to relax, and to create by himself situations where he can relax (e.g. playing alone). The therapy starts with a three-week stay of mother (or primary guardian) and child at the hospital in Gelsenkirchen, Germany. During this time the parent is coached in seminars how to deal with the disease, dietary aspects and in autogenic training. And the child has to learn to be away from the parent for short periods of time without the support of another attachment figure. This separation of parent and child seems to be the hardest part of the therapy, according to some parents. The child is brought to a nice play room where he has to stay for a couple of hours without the parent or another attachment person. Many children scream or cry or scratch themselves bloody, without anyone interfering. After about two weeks child a parent have learned to deal with this separation and in the last week new behavioral patterns are solidified. The parents are equipped with dietary plans, instructions how to establish a healthy daily routine and letters for grandparents and other guardians outlining the new rules. Local support groups and follow-up visits to the hospital help with the continuation of the therapy.
One important step is that the child learns to spend time alone. During the time alone the child can concentrate on one thing, and the occupation and the deep immersion into an activity is one way to provide the necessary relaxation for the child to deal with stressful situations. Also, the therapy aims at relaxing the whole family about eczema. I can definitely say from my own experience that J.’s eczema have a firm grip on many aspects of our family life which creates stress for all of us. It is one goal of the therapy to help the families to deal with eczema in a non-stressful way. One way is to simply not mention anything related to eczema in front of the child, not to react to any scratching, and to avoid any special treatment (non-medical) the child might enjoy because of eczema. Further, there should be clear daily routines where everyone has his place and is comfortable.
Is this method something for us? In general I think it is worth a try. Many aspects of the therapy seem very reasonable and since I am convinced that stress plays an important role in eczema, many of the taught tools to deal with stress could come very handy. The biggest hurdle for me is to commit to the three weeks of hospital stay which are hard work and I don’t know if I can support the quite forceful behavioral training. But again, I just started to learn about this method. For now we will try to put into praxis the idea about play time alone and dealing with stress.
To summarize, the main aims of the therapy are:
- the diet should consist of whole foods, this means it should be low in acidity and as natural as possible
- the main allergens should be avoided
- there has to be a daily relaxation training
- education should be loving but consistent
- the adult learns through intensive coaching how to change behavioral patterns to break through the vicious circle that sustains the disease
The methods used are a combination of conventional medicine and psychotherapy and contain:
- autogenic training, separation training
- stress immunization training, sleep training, dietary training
- behavioral therapy in groups, family therapy, play therapy, psychoanalysis
- elimination of factors that support the disease and positive reinforcement of healthy behavioral patterns, stress infused change of behavior (e.g. flodding)
- allergy tests (prick test, IgE), diet low in allergens and acidity
- movement therapy
- antibiotics in case of bacterial super-infection, aciclovir in case of eczema herpetikatum
- medication if needed during acute flare up
Here are the links where I found the information (unfortunately all in German):
- Kinder- und Jugendklinik Gelsenkirchen: this is the hospital where the children are treated together with one parent.
- Bundesverband Allergie- und Umweltkrankes Kind (AUK): This organization focuses on the Gelsenkirchen Method and is the umbrella for many local support groups.
- SWR2 Leben – Neurodermitis bei Kindern: this is a radio show featuring interviews with parents of a child with eczema and with a doctor from the clinic in Gelsenkirchen. The show can be downloaded as mp3 or as transcript.