Group Psychotherapy for
Women with Breast Cancer
Relationships among Social Support,
Emotional Expression, and Survival
David Spiegel & Rachel Kimerling
As oncological treatment has become more effective, cancer can be thought of more as a chronic than a terminal illness. However, given the progressive nature of the disease and the fact that approximately half of all people diagnosed with cancer will eventually die of it, a realistic approach to cancer care involves attention to emotional support for patients who are coping with the disease. In particular, the affective responses of patients and their families to life threat is often viewed as a problem rather than an opportunity for intervention. This review of psychosocial problems and interventions for cancer patients will emphasize attention to the management of emotion in the context of illness.
Supportive/expressive group psychotherapy, an empirically validated psychological intervention for breast cancer patients conducted at the Psychosocial Treatment Laboratory at Stanford University Medical Center, is presented as a means for facilitating emotional adjustment. First, we review the main components of the therapy and the empirical support for the relationship of these elements to psychological adjustment and health. We then review the literature regarding group psychotherapy interventions for cancer patients and their effects on psychological adjustment and survival. A critical analysis follows, which delineates potential mechanisms by which the social support and emotional expression facilitated in these interventions might affect the survival time of cancer patients. We propose that both the provision of social support and the opportunity for emotional expression are beneficial to health and psychological adjustment in cancer patients. We also propose that an interaction between these two factors— where relationships with similar others develop in an emotionally expressive context—may be especially potent in the impact on the psychological adjustment,