Meaning-Centered Group Psychotherapy for Patients with Advanced Cancer Meaning-Centered Group Psychotherapy for Patients with Advanced Cancer A Treatment Manual WILLIAM S. BREITBART, MD Interim Chairman Chief, Psychiatry Service, Department of Psychiatry and Behavioral Sciences Attending Psychiatrist, Pain & Palliative Care Service, Department of Neurology Memorial Sloan-Kettering Cancer Center Professor of Clinical Psychiatry, Department of Psychiatry Weill Medical College of Cornell University New York, New York SHANNON R. POPPITO, PHD Clinical Psychologist/Behavioral Health Consultant Behavioral Health Optimization Program Los Angeles Air Force Base 61st Medical Squadron Los Angeles, California 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2014 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Breitbart, William, 1951- author. Meaning-centered group psychotherapy for patients with advanced cancer : a treatment manual / William S. Breitbart, Shannon R. Poppito. p. ; cm. Includes bibliographical references and index. ISBN 978–0–19–983725–0 (alk. paper) — ISBN 978–0–19–938067–1 (alk. paper) I. Poppito, Shannon R., author. II. Title. [DNLM: 1. Neoplasms—psychology. 2. Psychotherapy, Group—methods. 3. Depression--therapy. 4. Quality of Life. 5. Terminally Ill—psychology. QZ 200] RC271.M4 616.99'40651—dc23 2013047207 This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper But if there is meaning, it is unconditional meaning, and neither suffering nor dying can detract from it. What our patients need is an unconditional faith in this unconditional meaning. Viktor Frankl, The Will to Meaning (1969, p. 156) The image on the title page is a carving that was created by a meaning-centered psychotherapy study patient for his final “Legacy Project.” It depicts his past, present, and future legacy intertwined within the symbol of his Irish heritage and bound together by “eternal love.” Contents Acknowledgments ix Preface xi Introduction: Meaning-Centered Group Psychotherapy Treatment Overview for Therapists xxiii Session 1. Concepts and Sources of Meaning: Introductions and Meaning 1 Session 2. Cancer and Meaning: Identity before and after Cancer Diagnosis 13 Session 3. Historical Sources of Meaning: “Life as a Legacy” That Has Been Given 19 Session 4. Historical Sources of Meaning: “Life as a Legacy” That One Lives and Will Give 25 Session 5. Attitudinal Sources of Meaning: Encountering Life’s Limitations 31 Session 6. Creative Sources of Meaning: Creativity, Courage, and Responsibility 39 Session 7. Experiential Sources of Meaning: Connecting with Life through Love, Beauty, and Humor 47 Session 8. Transitions: Final Group Reflections and Hopes for the Future 55 References 61 Handouts 63 Homework/Experiential Exercises 71 Index 83 vii Acknowledgments We are indebted to our families for their love and support, and re- member those precious to us, both family and patients, who have died during the period of time we conducted the work reflected in this text. We are indebted to our colleagues at Memorial Sloan-Kettering who played central roles in the development and conduct of trials of both meaning-centered psychotherapy (MCP) formats. Special thanks go to Mindy Greenstein, Hayley Pessin, Barry Rosenfeld, Wendy Lichtenthal, Allison Applebaum, and our many research collaborators, research assis- tants, interventionists, pre- and postdoctoral fellows, and research man- agers and coordinators. We thank the National Institutes of Health, the National Cancer Institute, the National Center for Complementary and Alternative Medicine, the Fetzer Institute, and the Kohlberg Foundation, who pro- vided funding for MCP clinical trials research. Finally, our gratitude to the hundreds of patients who participated in the clinical trials of MCP, and their devoted families and caregivers. While most of the patients who participated in the clinical trials of MCP are no longer with us, their legacies are alive and affect the course and meaning of our lives in profound ways. ix