Does Brief Psychotherapy Have Role in Cancer Care?

Trinidad, who does time-limited psychotherapy with cancer patients—anywhere from 10 to 20 sessions—said that he focuses on the here and now. He uses interpersonal therapy (IPT) to resolve interpersonal conflicts and cognitive-behavioral therapy (CBT) to correct patients' erroneous, self-defeating thoughts, he explained. For instance, he had a cancer patient who indicated no will to fight the disease or find any pleasure in the rest of his life since he viewed his illness as terminal. Trinidad helped him replace that thought with "Everyone dies, but they can still experience joy while they are here."

Nonetheless, not all of cancer patients' psychological problems can be solved with IPT or CBT, Norris emphasized. Therapists also need to be able to deal with patients' existential issues, such as their will to live, their spirituality, or their desire for assisted suicide.

So how should a clinician approach an existential issue with a cancer patient? Perhaps by acknowledging the dire situation a patient is in, he said, although there are other approaches that can be used as well. Once a psychiatrist ventures onto this fragile terrain, Norris told the assembled psychiatrists, it is sort of like Dante descending, with the patient, into the nine circles of hell. You want to help the patient dig deeper and deeper into the issue while also helping the patient tolerate his or her pain. You want the patient to ultimately "discover meaning and awe" in his or her predicament, although you do not yet know what the meaning and awe will be.

Yet not all cancer patients want to tackle existential issues, Norris cautioned. And even if they want to, it is critical that they are able to tolerate the anxiety that comes from probing life at such a profound level.

Still another challenge in doing brief psychotherapy with cancer patients, Trinidad noted, is that clinicians have to be flexible and get as much mileage out of each session as possible. For example, sometimes a clinician may have to conduct shorter sessions, other times longer ones. Sometimes patients do not live any longer than a few weeks. In fact, each session with the most seriously ill patients may be the last one.

However, no matter how few psychotherapy sessions a psychiatrist may have with a seriously ill patient, those sessions can be used to provide the patient with relief from psychological anguish and to help the patient make positive life changes, Moghimi stated.

For example, he once conducted brief psychotherapy with a 40-year-old patient with breast cancer. Although the woman was not terminally ill, the cancer and the chemotherapy she received for it had changed her mind about how she wanted to spend the rest of her life. Moghimi helped her segue into a totally new profession—one that she had always wanted to pursue. He also helped her deal with anxiety and panic attacks that, he explained, "revolved around reconciling the new path she had set out for herself with the guilt that she was doing something that her dead mother would not have approved of and with the guilt that she was using money from her mother's will to pursue it."

Another advantage of brief outpatient psychotherapy, Moghimi pointed out, is that cancer patients know that the therapy is brief, and this knowledge can motivate them to take full advantage of it.