Abstract
A model for group psychotherapy with terminally ill patients is proposed, one in which the group is homogeneous and open-ended. Cancer and HIV infection are used as examples of chronic, terminal illnesses, and the relevant literature on group psychotherapy with these conditions is reviewed. Treatment with both sets of patients has been characterized by considerable variation in the structure, composition, and duration of the group.
Being diagnosed with a terminal illness is traumatic and leads to denial, which may be adaptive or maladaptive depending upon its behavioral manifestations. The homogeneous, open-ended group encourages adaptive denial, which fuels hope and the will to live. The mechanism through which this occurs involves the unconscious identification with the group as an entity. This causes the emergence of a fantasy of a mother-infant dyad, within which can occur reworking of the depressive position. Scheidlinger, Turquet and Anzieu are cited to demonstrate this unconscious function of the group. Finally, clinical implications of such a model are highlighted.
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References
Anzieu, D. (1984).The group and the unconscious. London: Routledge & Kegan-Paul.
Beckett, A., & Rutan, J. S. (1990). Treating persons with ARC and AIDS in group psychotherapy.International Journal of Group Psychotherapy, 40, 19–29.
Beisser, A. R. (1979). Denial and affirmation in illness and health.American Journal of Psychiatry, 136, 1026–1030.
Bion, W. R. (1961).Experiences in groups. London: Tavistock.
Eissler, K. R. (1955).The psychiatrist and the dying patient. New York: International Universities Press.
Fawzy, F. I., Cousins, N., Fawzy, F. W., Kemeny, M. E., Elashoff, R., & Morton, D. (1990a). A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance.Archives of General Psychiatry, 47, 720–725.
Fawzy, F. I., Kemeny, M. E., Fawzy, N. W., Elashoff, R., Morton, D., Cousins, N., & Fahey, J. L. (1990b). A structured intervention for cancer patients. II. Changes over time in immunological measures.Archives of General Psychiatry, 47, 729–735.
Fawzy, R. I., Namir, S., & Wolcott, D. L. (1989). Structured group intervention model for AIDS patients.Psychiatric Medicine, 7, 35–45.
Ferlic, M., Goldman, A., & Kennedy, B. J. (1979). Group counseling in adult patients with advanced cancer.Cancer, 43, 760–766.
Franzino, M. A., Gener, J. J., & Meiman, G. L. (1976). Group discussion among the terminally ill.International Journal of Group Psychotherapy, 26, 43–48.
Freud, S. (1921). Group psychology and the analysis of the ego.Standard edition, 18, 65–143. London: Hogarth Press, 1955.
Furst, W. (1951). Homogeneous versus heterogeneous groups.International Journal of Group Psychotherapy, 1, 120–123.
Gambe, R., & Getzel, G. S. (1989). Group work with gay men with AIDS.Social Case Work, 70, 172–179.
Green, S. A. (1985).Mind and body: The psychology of physical illness. Washington, DC: American Psychiatric Press.
Grief, G. L., & Price, C. (1988). A community-based support group for HIV positive I.V. drug abusers: The HERO program.Journal of Abuse Treatment, 5, 263–266.
Huggins, J., & Cohen, W. I. (1990). A group approach for working with gay and bisexual men with AIDS. In M. Seligman & L. E. Marshak (Eds.),Group psychotherapy: Interventions with special populations (p. 55–71). Boston: Allyn & Bacon.
Jaques, E. (1968). Death and the mid-life crisis.International Journal of Psychoanalysis, 46, 502–513.
Kennedy, S., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Immunological consequences of acute and chronic stressors: Mediating role of interpersonal relationships.British Journal of Medical Psychology, 61, 77–85.
Kibel, H. D. (1989). An introduction to the work of Didier Anzieu.International Journal of Group Psychotherapy, 39, 531–537.
Levy, R. S., Tendler, C., Van DeVarter, N., &, Cleary, P. D. (1990). A group intervention model for individuals testing positive for HIV antibody.American Journal of Orthopsychiatry, 60, 452–459.
Lifton, R. J. (1973). The sense of immortality: On death and the continuity of life.American Journal of Psychoanalysis, 33, 3–15.
Newmark, D. A. (1984). Review of a support group for patients with AIDS.Topics in Clinical Nursing, 6, 38–44.
Norton, J. (1963). Treatment of a dying patient.Psychoanalytic study of the child, 18, 541–560.
Parson, E. R. (1988). The unconscious history of Vietnam in the group: An innovative multiphasic model for working through authority transferences in guilt-driven veterans.International Journal of Group Psychotherapy, 38, 275–301.
Richter, C. P. (1957). On the phenomenon of sudden death in animals and man.Psychosomatic Medicine, 19, 191–198.
Ringler, K. E., Whitman, H. H., Gustafson, J. P., & Coleman, F. W. (1981). Technical advances in leading a cancer patient group.International Journal of Group Psychotherapy, 31, 329–344.
Scheidlinger, S. (1974). On the concept of the “mother-group.”International Journal of Group Psychotherapy, 24, 417–428.
Siegel, B. S. (1986).Love, medicine and miracles. New York: Harper & Row.
Spector, I. C., & Conklin, R. (1987). AIDS group psychotherapy.International Journal of Group Psychotherapy, 37, 433–439.
Spiegel, D., & Bloom, J. R. (1983). Group therapy and hypnosis reduce metastatic breast carcinoma pain.Psychosomatic Medicine, 45, 333–339.
Spiegel, D., Bloom, J. R., Kraemer, H. C., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer.Lancet, 2, 888–891.
Spiegel, D., Bloom, J. R., & Yalom, I. (1981). Group support for patients with metastatic cancer. A randomized outcome study.Archives of General Psychiatry, 38, 527–533.
Spiegel, D., & Glafkides, M. C. (1983). Effects of group confrontation with death and dying.International Journal of Group Psychotherapy, 33, 433–447.
Spiegel, D., & Yalom, I. D. (1978). A support group for dying patients.International Journal of Group Psychotherapy, 28, 233–245.
Taylor, S. E., Falke, R. L., Shoptaw, S. J., & Lichtman, R. R. (1986). Social support, support groups, and the cancer patient.Journal of Consulting and Clinical Psychology, 54, 608–615.
Temoshok, L. (1987). Personality, coping style and cancer: Toward an integrative model.Cancer Surveys, 6, 545–567.
Tunnell, G. (1991). Complications in group psychotherapy with AIDS patients.International Journal of Group Psychotherapy, 41, 481–498.
Turquet, P. M. (1974). Leadership: the individual and the group. In G. S. Gibbard, J. J. Hartman, & R. D. Mann (Eds.),Analysis of groups (pp. 349–371). San Francisco: Jossey-Bass.
Vachon, M. L. S., & Lyall, W. A. L. (1976). Applying psychiatric techniques to patients with cancer.Hospital and Community Psychiatry, 27, 582–584.
Van der Kolk, B. A. (1987). The role of the group in the origin and resolution of the trauma response. In B. A. Van der Kolk (Ed.),Psychological trauma (pp. 153–171). Washington, DC: American Psychiatric Press.
Wortman, C. B., & Dunkel-Schetter, C. (1979). Interpersonal relationships and cancer: A theoretical analysis.Journal of Social Issues, 35, 120–155.
Yalom, I. D. (1975).The theory and practice of group psychotherapy. New York: Basic Books.
Yalom, I. D., & Greaves, C. (1977). Group therapy with the terminally ill.American Journal of Psychiatry, 134, 396–400.
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The authors thank James L. Levenson, M.D., for his critical reading of the manuscript.
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Presberg, B.A., Kibel, H.D. Confronting death: Group psychotherapy with terminally ill individuals. Group 18, 19–28 (1994). https://doi.org/10.1007/BF01459715
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DOI: https://doi.org/10.1007/BF01459715