When and Why Should Mental Health Professionals Offer Traditional Psychodynamic Therapy to Cancer Patients?

Abstract

Given the recent studies promoting time-limited manualized therapies in the oncology setting, clinicians may be reluctant to offer traditional psychodynamic therapy to cancer patients. However, there are no studies directly comparing psychodynamic therapy and other therapy modalities in this patient population and no data suggesting harm from psychodynamic approaches. Therefore, it is inappropriate to draw the conclusion that psychodynamic therapy is inferior to manualized therapy from existing evidence. Manualized treatment, such as cognitive behavioral therapy, is generally short term and therefore may reduce the practitioner's own anxiety stemming from exposure to patients facing grave disability and death. However, manualized treatment is not fully effective in specific clinical scenarios. We present a case reflecting these limitations and advocate for a flexible treatment approach incorporating elements of psychodynamic therapy. IntroductionThe field of psycho-oncology has moved away from psychodynamic psychotherapy toward discrete methods of measuring psychological distress and monitoring treatment response using self-report symptom assessment scales, as recommended by clinical practice guidelines [1]. Psychodynamic psychotherapy is understood to be based upon the principles of psychoanalysis and encourages patients to speak openly and freely without any agendas or "goals" on the part of the therapist. Treatment frequency ranges from one to three times per week and lasts for a few weeks to a few years. The method involves analyzing and interpreting conflicts and other psychic forces outside of the patient's awareness. It is the resolution of these conflicts that leads to symptom improvement [2]. By contrast, manualized therapies, such as cognitive behavioral therapy (CBT), involve the use of standardized treatment guidebooks that prescribe specific techniques to be applied and goals to be attained in a designated number of therapy sessions, measuring responses with validated symptom rating scales. CBT is a time-limited intervention (with weekly sessions lasting 45-60 minutes for approximately 8-12 weeks) that emphasizes the patient's ability to change his or her emotions by modulating thoughts and behaviors [3].

When Cancer Enters the Therapy Room: The Lived Experience of Psychodynamic Therapists Working with Clients with a Recent Diagnosis of Cancer

“…Several case studies and articles (Burke, 2013; Goldie, 2005; Judd (in Burke, 2013); Himes, 2005; Orbach, 2020; Parkinson, 2006; Postone, 1998; Straker, 1998, 2013, 2020; and Yuppa & Meyer, 2017) demonstrate the effective use of psychodynamic thinking and interventions when confronting cancer. Despite the presence of cancer and medical realities of the treatments, the analytical process remains the same—‘about the patient's unconscious and how it manifests in the present’ (Judd, 2013, p. 30).…”

“…Perhaps the approach of looking at specific measurables, as well as everyone's anxieties around cancer, have led to the provision of support that relates to dealing with the immediate conscious crisis of cancer through cognitive‐behavioural therapy (CBT). Yuppa and Meyer (2017) suggest the use of manualised treatments is preferred over psychodynamic therapy because they reduce the practitioner's anxiety stemming from exposure to patients facing disability or death.…”

Psychodynamische Psychotherapie bei existenzieller Belastung und schwerer Erkrankung

“…Basierend auf den Hypothesen der individuellen Psychodynamik kann eine Reaktivierung früher Beziehungskonflikte in der aktuellen Erkrankungssituation bearbeitet werden, ohne dabei funktionale Abwehrmechanismen zu unterlaufen. Abhängig vom Erkrankungsverlauf und aktuellen Veränderungen werden Abwehrmechanismen benötigt, um vor Überlastung der Ich-Funktionen zu schützen, sodass Stabilisierung, Unterstützung bei Problemlösung und Ressourcenaktivierung im Vordergrund stehen können [6].…”