Cancer and psychotherapy
The general aim in psychotherapy is to try and preserve the patient’s self respect. If this is achieved it will also be possible to reduce stress to a manageable level and preserve the patient’s image of Self. As a result the patient’s sense of control will improve and the anxiety level will drop.
It has been observed that it is very helpful to keep in touch with patients that live in rural areas, by phoning them.
It has also been observed that video recordings with information and guidance are much appreciated by patients.
In cancer patients psychotherapy is usually started as a crisis intervention. If the patient improves physically, the process turns into a normal psychotherapeutic intervention. Most patients tend to stop psychotherapy when they start to feel better, but return to psychotherapy if there is a relapse or crisis. This should not be interpreted as a resistance against treatment, it is a normal situation because this is in line with the contract of the treatment. The main issues the patients has, are a shortened life expectancy and the feeling that death is approaching. Although these two issues are linked, they are dealt with in a separate context. The shortened life expectancy is a subject that can be discussed. It can be dealt with as an extension of other life problems. But death is a totally dark area. If the patient has religious beliefs he should be given the opportunity to exercise his beliefs at ease. If the patient has no religious beliefs then focus should remain on the first subject and one should keep away from the subject of death except in the educational stage. At a certain point in the process the majority of patients accept death even though it is a dilemma. In fact they even desire it. Firstly the doctor himself should come to terms with the fact that in such a situation the dilemma is unsolvable and natural and has to be accepted. Then the patient’s family and the patient himself should be approached from this point of view.
Group therapy is very beneficial in cancer patients. The patients are offered systematic and sincere support, and are provided with an environment in which they can be informed, easily express their feelings and have space to breath. The groups can differ in their format. Educational groups are led by a personnel from the oncology department. Emotional outbursts are not permitted, the only function of the group is to educate. Support groups, in which emotions are dealt with, are led by a psychiatrist.
I have personally witnessed that the support groups which I organized at Cerrahpaşa Medical Faculty during the years 1997-2011 considerably improved the quality of live of my patients.