LEARNING OBJECTIVES
- Be able to define chronic illness and distinquish it from acute illness.
- Be able to understand the stressors of chronic 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.
- 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 self of 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/her patients.
CURRICULUM SUMMARY
This program is about chronic illness: an illness or condition that will not be cured, although one may get better and may be able to maintain oneself at a high level. In this program, we'll be discussing the impact of chronic illness on the self, on the family, on the therapist, and how chronic illness impacts the work of therapists who themselves are ill.
Interview #1 and 2
1. Gary Gilles, LCPC "PsychoSocial Factors"
Gary Gilles, LCPC discusses the psychosocial aspects of chronic illness. New medical and technological advances do not 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.
2. Mark Smaller, PhD "Impact on the Self"
Life threatening illness takes us rapidly and without warning to a place of fear and deep soul-searching. Dr. Mark Smaller discusses the impact of the diagnosis of a chronic illness on the self, through the lens of self psychology, for there is no doubt that the minute a person hears the dreaded words, their identities are permanently altered as they begin their struggle for life.
Interviews #3 and 4
In their fight for life, many patients become very knowledgeable about the physical aspects of their disease, but they may become disconnected from their emotions and isolated from others. The stress associated with coping, combined with the withdrawal of friends and family who are uncomfortable with painful feelings and awkward about what to say or do can lead to intense feelings of loneliness.
3. Ann Goelitz, CSW "Jungian Dream Work with Cancer Patients"
In her research and clinical work, Ann Goelitz has found that the use of dream work as a component of individual counseling can often "jump start" a therapeutic process and encourage clients to discuss topics which are normally difficult to discuss. Not only did the dream work help the patient come to terms with the dying process, but it also seemed to reduce his/her sense of isolation.
4. Laurence Miller, PhD "The Impact of Brain Injury on the Self"
When a chronic medical situation arises from trauma, such as a brain injury, not only does the patient have to deal with rehabilitation and whatever recovery can be achieved, the individual must also have to come to terms with a world and a self that is totally different. Traumatic brain injuries now account for an estimated 400,000 new hospital admissions yearly in the United States. 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 the integrity of the self beyond any compromised functioning, and stresses that we must emphasize shoring up the shattered sense of self and core identity before trying to resolve other conflictual issues.
Interviews #5 and 6
If there's one thing all our speakers in this program agree on, it's that how a person or a family copes with chronic illness depends on their pre-diagnosis functioning. With the development of a chronic or terminal illness, many people suddenly find themselves unable to use the skills they had previously learned for managing life problems. Here we present two different treatment methods of work with medically ill patients: cognitive treatment and group treatment.
5. Kenneth Sharoff, PhD "Cognitive Coping Skills"
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 that there are positive ways of coping and of course, there are negative. But 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 thus will backfire.
6. James Spira, Ph.D. "Group Therapy with the Medically Ill"
Group therapy specifically designed for people with medical illness is one of the most powerful forms of intervention available to them. In fact, it is often the treatment of choice. Dr. Spira reports that there are several curative factors in the group setting that contribute to patient improvement: first, universality -- the opportunity for group members to feel that they are not alone in their situation. The second is altruism, which gives group members a sense of purpose through lending support to others in the group. The third is hope -- group members can see that others experience the same emotions and yet can find meaning in life.
Interviews #7 and 8
The diagnosis of chronic illness is a major crisis for a family. Often, it is the children who are most vulnerable.
7. Marcia Spira, Ph.D.
"Adolescent Daughters of Mothers with Breast Cancer"
Adolescence is that 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 may also be at an increased risk for 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 is important that we develop effective ways of educating and treating these possible patients of the future. Dr. Marcia Spira discusses her work with these young women.
8. Joseph McBride, MSW "The Impact of Diabetes on the Family"
In no disease is successful management more dependent on the attitude of the patient's 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 on other members of the family. Further, like other families in which there is a chronic disease, the disease may come to be blamed for every problem. James 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.
Interviews #9 and 10
Therapy is a system in which everything about the therapist and everything about the patient combine and interact in the therapy situation as both parties attempt together to make sense of and heal the patient's suffering. There is no such thing as therapeutic neutrality. We will see this beautifully in our next two interviews as our speakers discuss first, the impact of work with a severely ill patient on the therapist, and then the impact on patients when the therapist has a chronic illness.
9. Carol Garrett, Ph.D. and Michele Greene Weisman, Ph.D
"Impact of the Patient's Chronic Illness on the Therapist"
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. It is expected that empathic failure will 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, and its impact on them.
10. Marcia Adler, MA and Roneen Blank, MD "The Therapist has Cancer"
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 they examine their own thought process as they continued to work with their patients.
