Managing Cancer and Living Meaningfully

This text outlines the empirical research, theoretical underpinnings, and clinical application of a novel supportive-expressive psychotherapy for patients with metastatic cancer and their caregivers. Managing Cancer and Living Meaningfully, known by its acronym of CALM, provides a framework for therapists with diverse backgrounds and training to help patients and their caregivers to address the practical and profound challenges of advanced cancer and to live their lives as meaningfully as possible. CALM provides reflective space for them to consider treatment decisions and communication with their health care providers, disruptions in identity, attachment security and the sense of meaning in their life, and to address fears, hopes, and concerns related to the end of life. Particular attention is paid in CALM to the regulation of affect, to the renegotiation of attachment relationships and to helping patients and their caregivers to sustain “double awareness” of the possibilities for living, while also managing their disease and planning for the end of life. Such an approach not only helps to prevent depression and death anxiety, but also helps to reclaim the loss of the imaginative possibilities for living in the context of all-consuming cancer care. The universal dimensions of advanced cancer and the semi-structured nature of CALM permit it to be delivered in the language and cultural idiom of cancer treatment settings in virtually all parts of the world. This text provides the most comprehensive and up-to-date description of the evidence base for CALM, its theoretical foundations and a manualized guide to its clinical application, filled with rich clinical illustrations.

Therapeutic Alliance in COVID-19 Era Remote Psychotherapy Delivered to Physically Ill Patients With Disturbed Body Image

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a disturbed body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines.

Sarcoidosis: Psychotherapy and Long-Term Outcome—A Case Report

Sarcoidosis is a systemic, inflammatory disease of unknown aetiology, influenced by stressful life events and associated with a high incidence of alexithymic personality traits, and of depressive symptoms. The medical literature on sarcoidosis has called for a psychotherapeutic intervention to modify the perceived state of disease, the influence of stressful events and the depressive condition. Few studies have described cases treated with psychotherapy, and no information is available on its long-term outcome. We present the case of a patient with chronic sarcoidosis and periodical reacutizations with constantly pathological ESR. Twenty-four years after the diagnosis, a dynamic supportive-expressive psychotherapy for psychosomatic alexithymic patients was added to the medical therapy. At the beginning and at the end of the psychotherapy, and for the long-term outcome evaluations, Kellner’s symptom questionnaire (SQ) was used to investigate psychological distress. The SQ scores, initially pathological, were normal at the end of the psychotherapy and for the following three years. Psychotherapy, without antidepressive drugs, resolved the depression. The depressive symptoms disappeared, along with the normalization and stabilization of the ESR. After three years, the outcome was positive. This is the first study describing a successful psychotherapy and its long-term outcome on a patient with sarcoidosis.