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The Psychotherapy Curriculum

Emotional Responses to Chronic Medical Illness

Learn about the psychological and traumatic impact of being diagnosed with a chronic illness from the perspective of the patient, family, and treating professionals.

Program Description

This program is about chronic illness. This type of illness or condition will not be cured, although the patient may get better and be able to maintain himself at a high level. In this program, we’ll be discussing the impact of chronic illness on the self, the family, and the therapist, as well as how chronic illness impacts the work of therapists who are ill.

The movie, "The Doctor," is the story of a rather arrogant physician who develops cancer, becomes a patient undergoing radiation, and has to deal with being on the other side of the coin. The film is used as a backdrop to this program.

Learning Objectives

This program provides clinicians with the opportunity to:

Be able to define chronic illness and distinguish it from acute illness.

Be able to understand the stressors of chronic illness.

Understand the use of dreams as a component of individual counseling for cancer patients.

Become aware of the shattering impact of brain injury on the patient.

Learn about a model for coping with chronic illness using cognitive techniques.

Learn about group therapy for chronically ill patients.

Learn how breast cancer affects the relationship between mother and adolescent daughter.

Recognize the impact of diabetes on the family, especially management issues for the adolescent patient and parents.

Become familiar with the challenges of working with chronically ill patients and how it affects the therapist.

Become familiar with the impact the severe illness of the therapist has on his patients.


Adolescent Daughters of Mothers with Breast Cancer - Marica Spira, Ph.D., LCSW

Adolescence is the transitional period between childhood and adulthood characterized by dramatic biologic, physical, cognitive, emotional, and social changes. Hormonal changes trigger the onset of puberty and, with it, preoccupation with body image. Compared to other family members, daughters of women with breast cancer are particularly and poignantly affected. They also may be at an increased risk of emotional problems when their mothers are diagnosed with cancer. In the light of the high incidence of breast cancer and recent developments in breast cancer genetics, it's important to develop effective ways of educating and treating these possible patients of the future. Dr. Marcia Spira discusses her work with these young women.

Cognitive Coping Skills - Kenneth Sharoff, Ph.D.

Dr. Kenneth Sharoff has developed a cognitive coping skills approach. This is a prospective form of treatment. It looks forward in time and plots the steps needed to accomplish a goal. He tells us there are positive ways of coping, and of course, there are negative ways. One way or another, everyone copes. The concern of the therapist is whether their way of coping is adaptive, rational and realistic, or pathological and resulting in a backfire.

Group Therapy with the Medically Ill - James Spira, Ph.D.

Group therapy specifically designed for people with medical illness is one of the most powerful forms of intervention available to them. In fact, it's often the treatment of choice. Dr. Spira reports there are several curative factors in the group setting which contribute to patient improvement. First, there is universality, the opportunity for group members to feel they're not alone in their situation. Second, there is altruism, which gives group members a sense of purpose through lending support to others in the group. Third, there is hope, where group members can see others experience the same emotions and find meaning in life.

Impact of the Patient's Chronic illness on the Therapist - Carol Garrett, Ph.D.

Working with chronically ill patients presents many challenges to the patient and the therapist. A countertransferential risk in working with this client population is the therapist’s own fears and vulnerabilities about illness. This may arouse the need to distance from the client’s emotions in order to ease the therapist’s discomfort. Empathic failure is expected to occur during the course of treatment, as feelings of hopelessness, helplessness, and loss often interfere with the therapist’s ability to maintain their experience-near stance. Drs. Garrett and Greene-Weisman discuss their work with AIDS and terminal cancer patients, as well as its impact on them.

Impact on the Self - Mark Smaller, PhD WEBSITE

Life-threatening illness takes us to a place of fear and deep soul-searching rapidly and without warning. Dr. Mark Smaller discusses the impact of a chronic illness diagnosis through the lens of self psychology. There is no doubt the minute a person hears those dreaded words, their identities are permanently altered, as they begin their struggle for life.

Jungian Dream Work with Cancer Patients - Ann Goelitz, CSW website

In her research and clinical work, Ann Goelitz has found the use of dream work as a component of individual counseling can often jumpstart a therapeutic process and encourage clients to discuss topics which are normally difficult to talk about. Not only did the dream work help the patient come to terms with the dying process, but it also seemed to reduce his sense of isolation.

Psychosocial Factors - Gary Gilles, LCPC website

Gary Gilles, LCPC discusses the psychosocial aspects of chronic illness. New medical and technological advances don’t address the psychosocial needs of patients, family members, and caregivers, and the emotional burdens they encounter in living with and taking care of a chronically ill person.

The Impact of Brain Injury on the Self - Laurence Miller, Ph.D.

When a chronic medical situation arises from trauma, such as a brain injury, the patient has to deal with rehabilitation and whatever recovery can be achieved, as well as come to terms with a totally different world and a self. Traumatic brain injuries now account for an estimated 400,000 new hospital admissions yearly in the U.S. Head injury patients have specific difficulties with affect management and problems with identity and self-esteem. Dr. Miller views brain injury as a blow to one's integrity beyond any compromised functioning and stresses we must shore up the shattered sense of self and core identity before trying to resolve other conflictual issues.

The Impact of Diabetes on the Family - Joseph McBride, MSW, BCD

In no disease is successful management more dependent on the attitude of the patient relationship within the family. The complex nature of control, the need for frequent monitoring, the dietary restrictions, and the limitations on activity all have an impact on the life of the individual and other members of the family. Further, like other families in which there is a chronic disease, the disease may be blamed for every problem. Joseph McBride presents a systemic framing to illustrate the coping strategies necessary to deal with the diagnosis, management of the illness, and restructuring of the family system.

The Therapist Has Cancer - Marcia V. Adler, MA, LCSW, Roneen Blank, MD

Marcia Adler and Dr. Roneen Blank are friends and colleagues, who were diagnosed with breast cancer within one week of each other and formed their own support group as they each went through radiation and chemotherapy. Here, they discuss how they told their patients, how the patients reacted, and their own thought process.

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Client Testimonials

“Excellent programs. I actually learned new material for the first time in years. Thanks for this opportunity!”

... Deborah S.

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