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Young clinicians dealing with death: Problems and opportunities

Published online by Cambridge University Press:  23 November 2015

Kathrine G. Nissen
Kathrine G. Nissen*
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
*
Address correspondence and reprint requests to: Kathrine G. Nissen, Department of Psychology, The Faculty of Social Science, University of Copenhagen, Oester Farigmagsgade 2a, 1353 Copenhagen K, Denmark, European Union. E-mail: kathrine.nissen@psy.ku.dk.
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Abstract

Objective:

The formation of a strong bond between patients and therapists can lead to successful treatment outcomes. Yet, little is known about the mechanisms that function to control this relationship. The objective of this case report was to examine the ruptures and repairs in the working alliance between a young therapist and an elderly caregiver, and to suggest ways in which to deal with age-related challenges to such an alliance.

Method:

In order to examine the ruptures and repairs in a working alliance, this case report reflects on the interdependent relationship among therapist variables, patient variables, and the therapeutic alliance. The clinical experience presented describes a newly educated psychologist's struggles to overcome the challenges in forming a strong working alliance with an elderly dying cancer patient's spouse. The spouse was enrolled in the DOMUS study (Clinicaltrials.gov: NTC01885637), an ongoing randomized controlled trial of a patient-and-caregiver intervention for facilitating the transition from an oncology ward to palliative at-home care, and then bereavement. As part of the DOMUS study, the patient and spouse received a psychological intervention based on existential-phenomenological therapy.

Results:

A therapist's therapeutic approach to breaking down age-related barriers to communication matters greatly. The existential-phenomenological method of epoché offers a way to effectively address ruptures and repairs in a working alliance, as it enhances the therapist's openness to learning. In addition, the insights of senior supervisors can promote a therapist's openness to learning.

Significance of results:

In conclusion, the method of epoché benefits the working alliance in several ways, as it enhances personal insight and provides methods for repairing an alliance. The reflections in this paper may be applied to clinical settings in oncology, gerontology, and palliative care, which are likely to be of great interest to young clinicians experiencing age-related challenges in their daily work.

Keywords

Therapeutic allianceAdvanced cancerCaregiverDistressPsychological intervention
Type
Case Report
Information
Palliative & Supportive Care , Volume 14 , Issue 5 , October 2016 , pp. 587 - 592
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260.Google Scholar
Callahan, J.L., Almstrom, C.M., Swift, J.K., et al. (2009). Exploring the contribution of supervisors to intervention outcomes. Training and Education in Professional Psychology, 3(2), 72–77.CrossRefGoogle Scholar
Chochinov, H.M., McClement, S.E., Hack, T.F., et al. (2013). Health care provider communication: An empirical model of therapeutic effectiveness. Cancer, 119(9), 1706–1713.Google Scholar
de Vries, A.M.M., de Roten, Y., Meystre, C., et al. (2014). Clinician characteristics, communication, and patient outcome in oncology: A systematic review. Psycho-Oncology, 23(4), 375–381.Google Scholar
Fegg, M.J., Brandstätter, M., Kögler, M., et al. (2013). Existential behavioural therapy for informal caregivers of palliative patients: A randomised controlled trial. Psycho-Oncology, 22(9), 2079–2086.Google Scholar
Freitas, G.J. (2003). The impact of psychotherapy supervision on client outcome: A critical examination of two decades of research. Psychotherapy, 39(4), 354–367.CrossRefGoogle Scholar
Gabbard, G.O. (1994). Psychodynamic psychiatry in clinical practice. Washington, DC: American Psychiatric Press.Google Scholar
Hoerger, M., Epstein, R.M., Winters, P.C., et al. (2013). Values and options in cancer care (VOICE): Study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers. BMC Cancer, 13, 188. Available from http://www.biomedcentral.com/1471-2407/13/188.CrossRefGoogle ScholarPubMed
Holland, J.L. (1997). Making vocational choices: A theory of careers. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Huppert, J.D., Bufka, L.F., Barlow, D.H., et al. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69(5), 747–755.Google Scholar
Kierkegaard, S. (2009). Kierkegaard's writings, XXII: The point of view. Princeton, NJ: Princeton University Press.Google Scholar
Kogler, M., Brandstatter, M., Fegg, M.J., et al. (2015). Mindfulness in informal caregivers of palliative patients. Palliative & Supportive Care, 13(1), 11–18.Google Scholar
LeMay, K. & Wilson, K.G. (2008). Treatment of existential distress in life-threatening illness: A review of manualized interventions. Clinical Psychology Review, 28(3), 472–493.Google Scholar
Lo, C., Hales, S., Jung, J., et al. (2014). Managing cancer and living meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliative Medicine, 28(3), 234–242.Google Scholar
Martin, D.J., Garske, J.P. & Davis, M.K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450.Google Scholar
Meystre, C., Bourquin, C., Despland, J.N., et al. (2013). Working alliance in communication skills training for oncology clinicians: A controlled trial. Patient Education and Counseling, 90(2), 233–238.Google Scholar
Nordly, M., Benthien, K., von der Maase, H., et al. (2014). The DOMUS study protocol: A randomized clinical trial of accelerated transition from oncological treatment to specialized palliative care at home. BMC Palliative Care, 13, 44. Available from http://www.biomedcentral.com/1472-684X/13/44.Google Scholar
Norton, P.J., Little, T.E. & Wetterneck, C.T. (2014). Does experience matter? Trainee experience and outcomes during transdiagnostic cognitive-behavioral group therapy for anxiety. Cognitive Behaviour Therapy, 43(3), 230–238.CrossRefGoogle ScholarPubMed
Oddli, H.W. & Halvorsen, M.S. (2014). Experienced psychotherapists' reports of their assessments, predictions, and decision making in the early phase of psychotherapy. Psychotherapy, 51(2), 295–307.Google Scholar
Parry, C., Kent, E.E., Mariotto, A.B., et al. (2011). Cancer survivors: A booming population. Cancer Epidemiology, Biomarkers & Prevention, 20(10), 1996–2005.Google Scholar
Plato (2009). The republic of Plato. Cambridge: Cambridge University Press.Google Scholar
Rowland, J.H. & Bellizzi, K.M. (2014). Cancer survivorship issues: Life after treatment and implications for an aging population. Journal of Clinical Oncology, 32(24), 2662–2668.Google Scholar
Spinelli, E. (2005). The interpreted world: An introduction to phenomenological psychology. Thousand Oaks, CA: Sage Publications.Google Scholar
Taber, B.J., Leibert, T.W. & Agaskar, V.R. (2011). Relationships among client–therapist personality congruence, working alliance, and therapeutic outcome. Psychotherapy, 48(4), 376–380.CrossRefGoogle ScholarPubMed
Trevino, K.M., Fasciano, K. & Prigerson, H.G. (2013). Patient–oncologist alliance, psychosocial well-being, and treatment adherence among young adults with advanced cancer. Journal of Clinical Oncology, 31(13), 1683–1689.CrossRefGoogle ScholarPubMed
Trevino, K.M., Maciejewski, P.K., Epstein, A.S., et al. (2015). The lasting impact of the therapeutic alliance: Patient–oncologist alliance as a predictor of caregiver bereavement adjustment. Cancer, 212(19), 3534–3542.Google Scholar
Watkins, C.E. (2011). Does psychotherapy supervision contribute to patient outcomes? Considering thirty years of research. The Clinical Supervisor, 30(2), 235–256. Available from http://www.tandfonline.com/doi/abs/10.1080/07325223.2011.619417.Google Scholar
Yalom, I.D. (1980). Existential psychotherapy. New York: Basic Books.Google Scholar
Yalom, I.D. & Greaves, C. (1977). Group therapy with the terminally ill. The American Journal of Psychiatry, 134(4), 396–400.Google ScholarPubMed