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Helping Couples Cope with Cancer

Posted By Laura Lynch, Maureen Davey, Tuesday, December 3, 2013
In 2013, it is estimated there will be 854,790 new cases of cancer in males and 805,500 new cases in females in the United States (American Cancer Society, 2013).  The implication is that thousands of couples will be affected by the diagnosis and treatment of cancer. Cancer is a chronic and life-threatening illness that affects not only diagnosed patients but also their partners and spouses.  Many suffer from symptoms of depression and relational distress (McClure, Nezu, Nezu, O'Hea, & McMahon, 2012).  Couple clinical intervention studies suggest that it is possible to improve the psychological and relational well-being for couples who are coping with cancer (Badr & Krebs, 2012; Regan et al., 2012). 

In collaboration with Dr. Ting Liu, PhD., LMFT at Drexel University and Dr. Lydia Komarnicky, MD who is an oncologist at Drexel University’s Radiation Oncology clinic, we recently received pilot funding to adapt and evaluate a couple support group intervention, Hold Me Tight (HMT) (Johnson, 2009) with a diverse sample of couples coping with cancer.  The "Hold Me Tight” Couple Intervention Program: Conversations for Connection is grounded in Emotionally Focused Therapy (EFT) and was developed by Dr. Susan Johnson (2009) to help couples "repair, enhance, and continually grow their love relationship” (Johnson, 2009) in small group settings. With permission from Dr. Johnson, we have integrated cancer-relevant examples and reduced the number of HMT sessions from 8 to 6 sessions, and have trained emotionally focused therapists as group facilitators for our 1-year pilot study.  Because most psychosocial couple cancer intervention studies have included primarily white middle-class samples (Badr & Krebs, 2012), we are intentionally evaluating this intervention with an economically, racially, and ethnically diverse sample of couples in Philadelphia, in order to ensure that it is effective cross-culturally.  


Partners are encouraged to connect so they are not fighting the cancer alone
We believe that oncology patients and their partners/spouses can benefit from this type of brief couple support group for the following reasons.  First, couples where one partner is diagnosed with cancer often experience less intimacy, a lack of mutual support and cohesion, and lower relationship satisfaction (Couper et al., 2006). HMT targets these relationship dynamics. Group facilitators are trained to help partners re-secure their relationship connection while coping with cancer. Specifically, therapists have been trained to help partners openly share any concerns related to the cancer diagnosis and treatment, coping, adjustment, and any feelings of loss and fear. By openly addressing their vulnerable feelings with each other, partners are encouraged to increase their connection to each other so they are not fighting the cancer alone, but together as a securely attached and emotionally responsive couple. Second, an association between a cancer diagnosis and elevated symptoms of depression in both cancer patients and their partners was reported (Kolbasovsky, 2008).  There is empirical evidence supporting the effectiveness of EFT in reducing depressive symptoms by strengthening relationship bonds (Denton, Golden, Walsh, 2003; Dessualles & Johnson, 2003). 

Third, sexual issues (e.g., libido, sexual dysfunction, body image) are common among many cancer patients (Kolbasovsky, 2008) but are often not directly addressed by providers. In our adapted 6-session HMT curriculum, one session was designed to facilitate more open communication between partners about any sexual issues. Finally, compared to couple’s therapy which may be emotionally, financially, and physically overwhelming for oncology patients who are navigating tough treatment regimens, a structured short-term support group intervention (6 sessions: 2 hours/each) may not only reduce relationship distress, but also provide social support in a more feasible and acceptable way. 

Cancer is chronic, life-threatening, and often all-consuming for patients and their partners or spouses.  Our hope is that this brief couple support group program, Hold Me Tight, will decrease couples’ distress and help them turn toward each other while coping with cancer. 

References

American Cancer Society (2013). Cancer Facts & Figures 2013. Atlanta: American Cancer Society.

Badr, H. & Krebs, P. (2012). A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psycho-Oncology. DOI: 10.1002/pon.3200 

Couper, J., Bloch, S., Love, A., Macvean, M., Duchesne, G. M., & Kissane, D. (2006). Psychosocial adjustment of   female partners of men with prostate cancer: a review of the literature. Psycho-Oncology, 15(11), 937-953. 

Denton, W. H., Golden, R. N., & Walsh, S. R. (2003). Depression, marital discord, and couple therapy. Current Opinion in Psychiatry, 16(1), 29-34.  

Dessaulles, A., Johnson, S.M. & Denton, W. (2003) The Treatment of Clinical Depression in the Context of Marital Distress. American Journal of Family Therapy, 31, 345-353 

Johnson, S. (2009). The Hold Me Tight Program: Conversations for Connection. International Centre for Excellence in Emotional Focused Therapy: Ontario, Canada 

Johnson, S., & Talitman, E. (1997). Predictors of outcome in emotionally focused marital therapy. Journal of Marital and Family Therapy, 23(2), 135–152.  

Kolbasovsky, A. (2008). Therapist’s Guide to Understanding Common Medical Conditions. New York: W. W. Norton & Company 

McClure, K. S., Nezu, A. M., Nezu, C. M., O'Hea, E. L., & McMahon, C. (2012). Social problem solving and depression in couples coping with cancer. Psycho-Oncology, 21(1), 11-19. doi:10.1002/pon.1856

Regan, T. W., Lambert, S. D., Girgis, A., Kelly, B., Kayser, K., & Turner, J. (2012). Do couple-based interventions make a difference for couples affected by cancer? A systematic review. BMC Cancer, 12(1), 279-279. doi:10.1186/1471-2407-12-279


Laura Lynch, M.S. is a doctoral candidate in her third year at Drexel University’s Department of Couple and Family Therapy.  She received her Master’s degree in Marriage and Family Therapy at the University of Rochester.  Laura’s clinical research focuses on developing interventions to help couples and families cope with chronic illness. In collaboration with Dr. Maureen Davey and Dr. Ting Liu, she is currently conducting her dissertation study to adapt and evaluate Hold Me Tight for a diverse sample of couples coping with cancer.  She is also completing her doctoral clinical internship at Drexel Medicine’s primary care practice.  Her research interests include addressing health disparities by developing culturally sensitive relational interventions, examining how chronic illness affects couple relationships, and children’s experience of parental illness, in particular parental cancer and diabetes.



Dr. Maureen Davey is a licensed marriage and family therapist in the state of Pennsylvania, an AAMFT approved clinical supervisor, and associate professor at Drexel University in the Department of Couple and Family Therapy. Her clinical research examines how different relational and cultural contexts contribute to the experience of health disparities. She has been the PI on several state level foundation intervention grants designed to develop culturally sensitive family interventions for families coping with parental cancer and is now working on securing funding to further develop the intervention with African American families coping with parental cancer. In collaboration with Dr. Ting Liu, Dr. Lydia Komarnicky, and Laura Lynch, she is currently conducting a pilot study to adapt Hold Me Tight for couples coping with cancer.  

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