Abordarea psihoterapeutică a pacienților cu cancer aflați în îngrijirea paliativă: studiu de caz.
Psychotherapy Approach in Palliative Treatment of Cancer Patients: A Case-Study

Summary/Abstract: The Palliative Care for terminal patients shows many debates and ethical dilemma both in public field and for specialists. If in the medical domain the questions arise around treatment procedures and duration, in psychology we consider the need of a model of intervention who might be useful for terminal patients. In addition, we try to understand if we find and prevent a number of risk factors in the onset and development of lethal medical conditions like cancer. Psychosomatic approaches including Alexander’s papers and Dahlke’s work state that as long as the person is not aware about his internal psychological conflicts, they will express themselves through the body. In our study we discuss the case of a female patient suffering from cervical and skin cancer. The anamnestic interview shows an enmeshed relationship with his parents, without personal boundaries and underdeveloped autonomy. The relationship with her husband involved both physically and emotionally abuse, yet seem characterized by dependency, followed by emotionally reaction like isolation and rejection of the others. In her life history she talks about her brother’s death from leukemia. Related to this, the patient says she lacked the resources to cope with this event and the bereavement period. The interview analyses her cognitive model about the illness, the situational and emotional context involved in the onset of the disease. She identifies a number of stressful events (using Holmes and Rahe List of Stressful Events), with diverse degrees of intensity (evaluated with the CIDI inventory, K11-45). The patient shows fatigue, a minimal level of activity, struggling with her suffocation when she talks about her emotions, and symptoms of anxiety and panic attacks. Another important issue is experience of pain which is very hard to be controlled by medication, while the patient describes her pain like the proof that she is still alive. Furthermore, the psychological intervention was focused to emotionally secure the patient in order to be aware of and to express her feelings and emotions. These elements suggest a relationship between the stressful life events, the primary model learned in relationship with the original family and cancer. This demands a holistic approach, including the patient personality, the conception about life, the living standards, the internal psychological conflicts, the coping model. In fact, the approach of psychological and social factors is common for psychosomatic medicine and sometimes for traditional medical approach.

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