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Section 20
Group Psychotherapy

Question 20 | Test | Table of Contents

Group Interventions for Cancer Patients
The desire to improve the psychological and emotional quality of life of people with cancer illness has been gaining momentum over the last few decades as medical advances have enabled people to live far longer than in the past. Rather than focus on general therapeutic change, as many group interventions with medically healthy individuals do, group interventions for cancer patients tend to focus specifically on issues arising from dealing with their illness, including education, coping, and support. Despite this apparent limitation, however, they cover a broad range of pragmatic and/or existential issues, including educational forums, lessons in symptom management, cognitive-behavioral psychoeducational groups, supportive-expressive existential groups, as well as various combinations thereof. Cunningham and Edmonds recommend choosing from a hierarchy of options ranging from those requiring the least active participation (i.e., the receiving of factual information) to the most (spiritual/existential), based on the particular needs of the individual. Empirical research on existential groups has tended to focus on patients with a diagnosis of breast cancer, leaving other populations potentially underrepresented in the research on these interventions.

Ali and Khalil, found that a teaching session focused on concrete issues involved in surgical procedure (including a visit from someone who had previously undergone the procedure) was enough to help patients with bladder cancer cope with surgery. Sessions were less than one hour in length, and resulted in decreased anxiety up to the third postoperative day. Johnson, in his "I Can Cope" group sessions, extended the range of education to include such broader issues as coping with daily health concerns, communication, self-esteem, and living with limitations set by one's illness. Patients undergoing this intervention also reported decreased anxiety after the intervention, as compared with matched controls.

Many psychoeducational groups were modeled after the Omega Project, with its behavioral emphasis on teaching coping skills, including the use of illustrated problem cards to guide discussions. These interventions usually comprise approximately six sessions of one and one-half to two hours duration. They emphasize education, stress management, problem-solving, and support. The active coping style fostered by such groups has been found to be more beneficial to cancer patients than a passive or avoidant one. Participants in psychoeducational groups also have reported decreased psychological distress and better quality of life compared with controls.

Cain et al. compared individual and group methods of thematic counseling, and found no differences in their effectiveness for cancer patients, but found significantly improved coping for both groups compared with controls. Yalom, however, suggested that groups offer benefits not available in individual settings. These include a sense of universality among otherwise isolated people who may feel shunned because of their illness, a feeling of helping oneself by helping others, hopefulness fostered by seeing how others have coped successfully with difficult issues, and a general sense of belonging to a larger group. He developed a program of existential supportive-expressive group psychotherapy for women with metastatic breast cancer, which was also adapted by Spiegel and his colleagues. Groups had an unstructured open format, and generally met once weekly for one year, or, in some instances, two years. Special sessions were also included to teach relaxation and autohypnosis for pain. In addition to helping women deal with the disfiguring aspects of their illness, the authors' stated objective was to focus on living in the context of dying, and to foster patients' authentic processing of their situations.

Similar to the findings of the psychoeducational group research, Spiegel and his colleagues found that when the intervention ended, patients who had participated exhibited less distress in the form of tension, fatigue, and confusion, as well as less pain when compared with no-treatment control groups. While follow-up psychological measures were not taken, Spiegel found ten years later that group members also lived significantly longer than control subjects. This latter finding, however, has been the subject of some debate.

Kissane and colleagues combined aspects of Spiegel's model with a cognitive intervention for women in the earlier stages of breast cancer. Groups of six to eight patients met over a six-month period. Topics for discussion included grief work, coping skills, mastery, cognitive reframing, and the reordering of priorities. The authors suggest that their therapy is better suited for patients with early disease, for whom cure or survival is a realistic possibility, while groups with greater emphasis on existential issues and less on cognitive processes might be better suited to people with late-stage cancer. Edelman and colleagues applied a more purely cognitive model of group psychotherapy, with a focus on reframing irrational beliefs. However, they found this difficult, as many of the fears of cancer patients were not irrational but realistic, especially at later stages of disease.

Despite the relationship of a sense of meaningfulness to psychological well-being, meaning is not usually a focus of outcome research on cancer-patient psychotherapy groups. Rather, most of the outcome research tends to focus on symptom-based measures, particularly anxiety and depression, as well as measures of general mood states, such as the Profile of Mood States. There has been some criticism that empirical research has been hampered by too narrow a focus on the possible negative psychological sequelae of cancer without a concomitant discussion of the potential for positive psychological states as well.  Indeed, in at least one study in which no differences between group members and control subjects were found on paper-and-pencil tests, clinical differences were observed by therapists. The authors suggest the possibility that these measures simply are not sensitive enough to the range of possible positive group outcomes.

LogoTherapy and Cancer
While there has been some attempt to specifically incorporate Frankl's existentialist system of logotherapy into a group context with both ill and well participants, this work generally has not been extended to cancer patients. Zuehlke and Watkins, however, adapted individual logotherapy to patients with terminal illness, meeting for six individual sessions over a two-week period. Their aim was to shift attention from dying onto areas of life that provided meaning. They did this in part by fostering a sense of temporal integrity between past, present, and future. Sessions spanned the time continuum, with earlier sessions focusing on the past, middle sessions on the present, and later sessions emphasizing the future. Patients who participated experienced a stronger feeling of purposefulness and meaningfulness than controls, as measured by the Purpose in Life Test.

Update
Online Group Psychodynamic
Psychotherapy-The Effectiveness
and Role of Attachment- The Results
of A Short Study

Wajda, Z., Kapinos-Gorczyca, A., Lizińczyk, S., Sitnik-Warchulska, K., & Izydorczyk, B. (2022). Online group psychodynamic psychotherapy-The effectiveness and role of attachment-The results of a short study. Frontiers in psychiatry, 13, 798991.

QUESTION 20
What four benefits did Yalom suggest group psychotherapy offers that is not available in individual settings? To select and enter your answer go to Test.

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