Academic journal article American Journal of Psychotherapy

The House That's on Fire: Meaning-Centered Psychotherapy Pilot Group for Cancer Patients

Academic journal article American Journal of Psychotherapy

The House That's on Fire: Meaning-Centered Psychotherapy Pilot Group for Cancer Patients

Article excerpt

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.


As described in another paper in this issue (1), Dr. William Breitbart and I have been developing the Meaning-Centered Group Psychotherapy intervention with the hope of helping people find a sense of meaning while struggling with cancer illness and treatment. During the course of our first pilot group, completed in May, 2000, one of the participants seemed to allude to this struggle while describing his father's work as a former Philadelphia firefighter. "The fireman," Mr. D. proudly explained to us, "is the one running into the building that everybody else is running out of. No matter what," he continued, "you gotta overcome your fear of the house that's on fire if you're gonna do your job." This seemed an apt metaphor for what many cancer patients go through as they try to overcome their fear of the fire in their own house, and live their lives fully despite knowing how limited their time might turn out to be.


Group leaders were the author and Dr. William Breitbart, the developers of the intervention. Two of the group members were patients of one of the leaders, and the others were recruited via a letter in the hospital's outpatient psychiatric clinic. There were no restrictions based on primary cancer dx, but it was felt that some homogeneity in stage of illness was appropriate, and all group members had relatively advanced disease. They were also informed that this was part of a new group therapy program and that we would be eliciting feedback from them later. This may have lent the group an additional mission-not only to help themselves, but also to help the group leaders and future group members through their input. We had strongly recommended that they read Viktor Frankl's Man's Search for Meaning (2) before the first session.

The group comprised four men, an unusual gender composition in the literature. There initially had been a fifth member, the only woman. However, Ms. S. left after the first session, when she began a very aggressive treatment protocol, though there may have been some other contributing factors as well. The four participants had seven cancer diagnoses between them. Psychiatric diagnoses tended to be adjustment disorder, and depression or anxiety disorder, with no psychosis or current substance abuse. All group members were in continuing individual treatment at the counseling center. We met for eight weekly ninety-minute sessions, for which participants were not charged. Given this small number of members, we were fortunate that only once during the whole course of the group, one member was absent, due to medical condition.


Mr. D. is a thirty-nine-year-old single white man with a history of skin cancer, now with recurrent esophageal cancer. A metastasis was diagnosed during the course of our meetings. Mr. D. grew up in Philadelphia, the middle of three children, and is a former police officer. In addition, he is an amateur photojournalist who shoots footage of fires and other disasters. (It was he who inspired the title of this article.) He feels his long acquaintanceship with other people's tragedies helped normalize the experience when it was his turn, though, in fact, he always had been attracted to these kinds of scenes since childhood.

Mr. R. is a seventy-five-year-old divorced white male originally from Minnesota. He is a retired trade magazine editor and a veteran of World War II, currently presenting with rectal cancer. In addition, he has a significant history of alcoholism. Though his problem was once severe enough to force him to live on the streets, he presently is an active AA member and recently celebrated his thirty-fifth year of sobriety. …

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