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1/11. Psychotherapeutic practice in paediatric oncology: four examples.

    psychotherapy, often used with children treated for a solid tumour, is seldom described. We present four examples of such therapies: a mother who refused enucleation for her 7-month-old boy; a boy's jealousy towards his sister who was being treated for a brain tumour; a teenager troubled by his scar; a 7-year-old boy embarrassed by the unconscious memory of his treatment when he was 5 months old. All names have been changed, for reasons of privacy. Psychotherapies aim to help children and parents to cope with the violent experience of having cancer, to recover their freedom of thought and decision-making concerning their life, their place in the family, their body image, their self-esteem, their identity. These descriptions of brief psychotherapy could help paediatricians to gain a more thorough understanding of the child's experience, to improve collaboration with psychotherapists and to confront clinical skills of psychotherapists.
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ranking = 1
keywords = psychotherapy
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2/11. The house that's on fire: meaning-centered psychotherapy pilot group for cancer patients.

    People with advanced cancer face an existential crisis in addition to their physical suffering. The principles of a new group therapy intervention (MCGP) were introduced in another paper in this issue. This paper is a report of some of the themes and issues that arose during the first pilot group.
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ranking = 4
keywords = psychotherapy
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3/11. Current management of depression in cancer patients.

    depression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be considered when prescribing medications from an ever-growing antidepressant armamentarium, including selective serotonin-reuptake inhibitors, serotonin norepinephrine-reuptake inhibitors, serotonin antagonist-reuptake inhibitors, norepinephrine dopamine modulators, monoamine oxidase inhibitors, reversible inhibitors of monoamine oxidase type A, tricyclic antidepressants, and psychostimulants. Other treatment options include electroconvulsive therapy and numerous forms of psychotherapy. The judicious use of medication and supportive therapies should significantly alleviate depression and enable the patient to navigate the cancer course with dignity, purpose, and the best quality of life possible.
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ranking = 1
keywords = psychotherapy
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4/11. hypnosis and existential psychotherapy with end-stage terminally ill patients.

    Existential psychological theory was employed as a conceptual and theoretical foundation for the use of hypnotically facilitated therapy in the management of intractable pain, nausea, and vomiting in 3 end-stage, terminally ill cancer patients. The existential principles of death anxiety, existential isolation, and existential meaninglessness were addressed with a combination of classic and Ericksonian techniques. The intractable nature of the presenting physical symptoms was conceptualized as a possible manifestation of the impact of the terminal prognosis. Direct hypnotic suggestions for the management of pain, nausea and vomiting were avoided. It was hypothesized that, as the existential conflicts associated with the patients' terminal status resolved, the physiological symptoms would become responsive to medication. After 6 sessions grounded in the principles of Existential psychotherapy, the intractable status of the physical symptomatology remitted, and the patients responded to medical management. This paper addresses the usefulness of Existential psychotherapy in hypnotic interventions for mediating somatic and psychosomatic symptomatology.
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ranking = 4
keywords = psychotherapy
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5/11. Psychological staging of pediatric cancer patients and their families.

    Advances in the treatment of childhood cancer have required a shift in our approach to the patient and family. Previously parents were helped to cope with the inevitable decline of the child's health over a rather short period of time; the child was acutely ill and crisis-oriented intervention was utilized. Today, the family unit can be helped to maintain normal life amidst intensive medical treatment; the child is acutely ill at times, but also chronically ill, and even well. crisis intervention is still appropriate, but so is education, ego-supportive counseling, and insight-oriented psychotherapy. Psychological staging of pediatrics cancer patients and their families is essential in order to properly anticipate psychological adjustment and plan appropriate interventions. Assessment and staging require a multi-dimensional perspective including stage of disease, socioeconomic vulnerability, degree of psychopathology, family cohesion, and personal/family history. This article discusses this multi-dimensional perspective and implications for intervention. Illustrative case material is utilized.
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ranking = 1
keywords = psychotherapy
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6/11. psychotherapy of patients with serious intercurrent medical illness (cancer).

    Exploratory psychotherapy of patients with chronic intercurrent illness has received little attention by psychoanalysts. A young woman with life-long characterologic problems presented herself for analytic psychotherapy shortly after surgery and radiotherapy for a malignancy. The debility of her illness facilitated a slowdown in an action-prone patient and permitted the necessary introspection and regression. willing One finds in these patients a readiness to reorder priorities and a willingness to examine and make the most of their lives, and psychotherapy can therefore become an opportunity for positive change rather than just support for a medical catastrophe. The therapy must address itself to childhood losses and betrayals symbolically repeated in the current medical state.
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ranking = 3
keywords = psychotherapy
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7/11. The psychological treatment of cancer: the patient's confusion of the time for living with the time for dying.

    It has been shown that it is possible to influence cancer growth by a form of intensive meditation, although it is not yet established whether it can be influenced to the point of cure. In working with these patients it has been observed that the course of the illness has often been influenced by the patient's confusion of the biologically appropriate time for living and the time for dying. Without recourse to any formal psychotherapy, the family physician aware of this reaction may be able to enhance the immune defences and increase the quality of life of such patients.
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ranking = 1
keywords = psychotherapy
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8/11. psychotherapy during radiotherapy: effects on emotional and physical distress.

    The authors determined the effects of ongoing weekly individual psychotherapy on the symptoms of patients undergoing a 6-week course of radiotherapy for cancer. Forty-eight patients were given weekly psychotherapy sessions for 10 weeks; another 52 patients served as control subjects. A statistically significant reduction was found in both emotional and "physical" manifestations of distress in the patients receiving psychotherapy compared with the control group. This was true regardless of gender, ward or private patient status, or knowledge of diagnosis. Patient gender and knowledge of diagnosis did affect the pattern and magnitude of the response to psychotherapy.
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ranking = 4
keywords = psychotherapy
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9/11. Social psychotherapy and course of the disease. First experiences with cancer patients.

    This paper is designed to introduce a new therapeutic approach into the treatment of cancer patients and to give some first results of our work. The basic idea is that the development of cancer depends to a great extent on a patient's social environment and the interrelation between environment and patient. A disturbed attitude on the part of the patient towards it and towards himself can influence adversely the development of cancer. The aim of social psychotherapy is to modify such attitudes, i.e. to influence the disease by psychological means.
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ranking = 5
keywords = psychotherapy
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10/11. Group psychotherapy during radiotherapy: effects on emotional and physical distress.

    OBJECTIVE: The purpose of this study was to ascertain whether group psychotherapy during radiotherapy for cancer significantly decreases patients' emotional and physical distress. METHOD: Twenty-four patients receiving radiotherapy were randomly selected for group psychotherapy (six patients per group, 90-minute weekly sessions for 10 weeks). Another 24 patients served as control subjects. Each patient was given the Schedule for Affective Disorders and schizophrenia (SADS) at the onset of radiotherapy, midway through radiotherapy, at the end of radiotherapy, and 4 and 8 weeks after radiotherapy ended. RESULTS: The combined SADS items for depression, pessimism and hopelessness, somatic preoccupation and worry, social isolation and withdrawal, insomnia, and anxiety and agitation were used as a measure of emotional distress. The combined SADS items for anorexia, nausea and vomiting, and fatigue were used as a measure of physical distress. By 4 weeks after the end of radiotherapy, the patients who received group psychotherapy showed significant decreases in both emotional and physical symptoms, and the decreases were greater than those for the control patients. The subjects who initially seemed unaware of their cancer diagnoses had the lowest baseline levels of emotional and physical distress, but 4 weeks after the end of radiotherapy they had high distress levels. CONCLUSIONS: Group therapy may enhance quality of life for cancer patients undergoing radiotherapy by reducing their emotional and physical distress. The degree to which patients acknowledge the diagnosis of malignancy may be a factor in their initial distress level and their response to radiotherapy and group therapy.
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ranking = 7
keywords = psychotherapy
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