Psychosocial Adjustment of Adult Cancer Survivors: Their Needs and Counselor Interventions

The author presents an overview of the literature on the psychosocial adjustment of cancer survivors, identifying 4 areas that may pose difficulties for cancer survivors as they learn to live with a life-threatening chronic illness: coping with the late physical effects of treatment; living with the uncertainty of long-term survival; resolving problems related to intimacy, marriage, and reproduction; and combating employment discrimination. Counseling interventions are proposed for counselors working with cancer survivors on these issues.     

An Interpretative Phenomenological Examination of Psychosocial Changes among Breast Cancer Survivors in their First Season of Dragon Boating

This study used an interpretative phenomenological perspective to qualitatively examine changes in body image and social support experienced by novice participants in breast cancer survivor dragon boating programs. Fourteen women were interviewed at the beginning and end of their first dragon boating season. The participants typically experienced increased perceptions of strength and fitness, and a shift towards discussing body image with respect to fitness, strength, and musculature rather than weight and appearance. Many women discussed an emerging athletic identity. Social benefits included connecting to women who understood the breast cancer experience and could share first-hand information. Some women also reported struggling with the constant reminder of being a survivor. Overall, breast cancer survivors experienced benefits, but further work should explore how they cope with challenges and how dragon boating could inform other physical activity contexts for this population.     

Autobiographical Memory Disturbances in Childhood Abuse Survivors

Summary

Clinicians have noted that childhood abuse survivors frequently report that they have forgotten large parts of their childhood. While memory for abusive experiences has attracted a great deal of attention from researchers, other types of memory disturbances may also accompany a history of childhood trauma. Many clinicians report that certain types of sexual abuse, and abuse at certain developmental stages, is more likely to result in reports of gaps in memory for the abuse. However, because information has been mainly collected in clinical populations, the possibility of confounding between abusive experiences and psychological disturbances cannot be ruled out. This article reports on data gathered from a large, epidemiologic study conducted within a health maintenance organization. A history of childhood physical or sexual abuse doubled the prevalence of general autobiographical memory loss for women, while for men, the rate increased 1.5 times over those with no abuse history. Higher rates of autobiographical memory loss were noted where both types of abuse were reported. Further, multiple incidents of sexual abuse, sexual abuse by a relative, and more severe sexual abuse increased reports of autobiographical memory loss. Theoretical perspectives on changes in the memory system that may affect trauma survivors are discussed.     

Posttraumatic Stress Symptoms and Stressful Life Events Predict the Long-term Adjustment of Survivors of Childhood Cancer and Their Mothers

Objectives: To examine prospectively the impact of posttraumatic stress symptoms (PTSS) in response to childhood cancer and treatment on general adjustment while accounting for the role of other stressful life events and appraisal of life threat and treatment intensity. Methods: As part of a larger study assessing PTSS, 56 childhood cancer survivors, aged 8 to 18, and 65 mothers completed self-report measures of PTSS and appraisal of the intensity and life threat associated with cancer treatment at time 1 and self-report measures of stressful life events and general adjustment at time 2 (approximately 18 months after time 1). Results: For child survivors and their mothers, posttraumatic stress at time 1 significantly predicted general adjustment at time 2, over and above the significant contribution of lifetime stressful events. The life events variable did not function as a mediator in the association of PTSS and general adjustment. Conclusions: Trauma responses to childhood cancer and its treatment have implications for the long-term adaptation of children and their families. Early signs and symptoms of posttraumatic stress and stressful life experiences require early assessment and intervention.     

Development of Force Adaptation During Childhood

Humans learn to make reaching movements in novel dynamic environments by acquiring an internal motor model of their limb dynamics. Here, the authors investigated how 4- to 11-year-old children (N = 39) and adults (N = 7) adapted to changes in arm dynamics, and they examined whether those data support the view that the human brain acquires inverse dynamics models (IDM) during development. While external damping forces were applied, the children learned to perform goal-directed forearm flexion movements. After changes in damping, all children showed kinematic aftereffects indicative of a neural controller that still attempted to compensate the no longer existing damping force. With increasing age, the number of trials toward complete adaptation decreased. When damping was present, forearm paths were most perturbed and most variable in the youngest children but were improved in the older children. The findings indicate that the neural representations of limb dynamics are less precise in children and less stable in time than those of adults. Such controller instability might be a primary cause of the high kinematic variability observed in many motor tasks during childhood. Finally, the young children were not able to update those models at the same rate as the older children, who, in turn, adapted more slowly than adults. In conclusion, the ability to adapt to unknown forces is a developmental achievement. The present results are consistent with the view that the acquisition and modification of internal models of the limb dynamics form the basis of that adaptive process.     

Promoting Positive Adaptation in Adult Survivors of Natural Disasters

This article integrates the guidelines of American Red Cross and the Psychological First Aid: Field Operations Guide (Brymer et al., 2006) with adult development theories to demonstrate the promotion of adaptive functioning in adults after a disaster. Case examples and recommendations for counselors working in disaster situations are included.     

The Role of Optimism,Social Constraints,Coping, and Cognitive Processing in Psychosocial Adjustment Among Breast Cancer Survivors

The social-cognitive processing model suggests that a socially constrained environment may impede adjustment to a chronic illness. The present study primarily investigated the mediating psychological pathways through which social constraints on cancer-related disclosure, low optimism, disengagement-oriented coping, and brooding could be associated with low levels of psychosocial adjustment. One hundred twenty-five female breast cancer survivors participated in a cross-sectional study. Path analysis was used to examine the proposed model. Low optimism, increased social constraints, and higher levels of brooding appeared to be risk factors for poor psychosocial adjustment to breast cancer. Disengagement-oriented coping and brooding partially mediated the relationship between social constraints and adjustment. Brooding totally mediated the relationship between disengagement-oriented coping and adjustment. The current findings provide support for the value of the social-cognitive processing model among breast cancer survivors. The mapping of psychological pathways of adjustment to breast cancer may have useful clinical implications for better adjustment outcomes.     

Maternal Directiveness in Childhood Survivors of Acute Lymphoblastic Leukemia

Parental intrusiveness is associated with internalizing problems in healthy children. Given the unique demands that childhood cancer places on parents, it is important to determine whether intrusiveness operates differently in survivors of childhood cancer. The current study tested whether cancer survivorship moderates the relation between maternal directiveness—one aspect of intrusiveness—and children’s internalizing problems. Survivors (7–12 years old) of acute lymphoblastic leukemia (ALL) (n = 25) and their mothers, and healthy controls (n = 22) and their mothers engaged in parent–child interactions. Mothers completed a measure of children’s psychosocial adjustment, and observations of 10-min parent–child interactions were obtained. Cancer survivorship moderated the relation between directiveness and children’s withdrawn/depressed symptoms. Maternal directiveness was associated with increased withdrawn/depressed symptoms for children in the control group. This association was not significant for survivors of ALL. Findings suggest that childhood cancer may alter the context in which children experience maternal directiveness.     

Siblings as Selfobjects in Childhood: An Interview Study of Factors and Consequences

This study explores the factors psychotherapists working with adult clients identify as contributing to their clients' use in childhood of relationships with siblings to meet selfobject needs or the use of clients by their siblings for selfobject purposes in childhood, and the consequences of this to the children's intrapsychic development as evidenced in their adult psychotherapy. Using interviews with six psychotherapists practicing within the framework of self psychology, this research determines that the emotional and physical unavailability of parents was a common factor causing children to use their siblings for selfobject purposes. The research also explores the lasting impact of these selfobject ties on the psychological development of both the child using a sibling for selfobject purposes and the child who serves this function for another, as well as the role of psychotherapy in understanding these relationships. These findings give psychotherapists from a variety of disciplines, including social work, an enhanced conceptual framework from which to consider the role of siblings in psychological development.     

Relationship of Order and Number of Siblings to Perceived Parental Attitudes in Childhood

Abstract

Despite the increasingly recognized link between perceived parenting behavior and the onset of psychopathology in adults, studies of the possible determinants of perceptions of parenting behavior are rare. In a sample of 1,145 pregnant Japanese women, correlations were examined between the numbers and sexes of siblings and perceived rearing practices, as rated by the Parental Bonding Instrument (PBI; Parker, Tupling, & Brown, 1979). The participants with more elder sisters viewed their parents' attitudes as less caring, whereas those with more brothers, particularly younger brothers, viewed their parents' attitudes as less overprotective. However, the proportion of the variance of all the PBI scores explained by different types of siblings was very small.     

Treatment Techniques for Adult Female Survivors of Childhood Sexual Abuse

The author reviews recent empirical, case study, and conceptual literature that examines or discusses treatment techniques for adult female survivors in individual therapy. These techniques are divided into the following 11 categories: relationship-building techniques; questioning: family-of-origin techniques; writing techniques; gestalt work, role playing, and psychodrama; transactional analysis and inner-child work: hypnotherapy and guided imagery; cognitive techniques; behavioral techniques; life-skills training; and other techniques. The author concludes with implications for researchers and practitioners.     

A Group Design for Adult Female Survivors of Childhood Incest

This paper will describe short term groups for women sexually molested as children. The goals of such a group were to provide an atmosphere in which women could discuss the experience of sexual abuse, explore the consequences of incest, be exposed to the probably phases of recovery and discuss practical coping skills. The design of the group is detailed, as are recommendations and relevant issues for therapists. Women's responses to the group, such as increase in self-esteem, trust level, assertiveness and confrontation with the abuser, are also discussed.     

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.     

Psychosexual Dysfunction Among Gynecological Cancer Survivors

The purpose of this paper is to summarize the empirical findings related to the assessment and treatment of sexual difficulties commonly experienced by gynecological cancer survivors and to make suggestions for future research and practice in this area. First, we describe the sexual problems that are most frequently reported by gynecological cancer patients and some of their common medical and psychological correlates. These include pain, premature ovarian failure, changes in vaginal anatomy, emotional distress, body image, and sexual self-concept. The complex interaction of physiological and psychological variables plays an important role in the development of sexual dysfunction in this patient population. Furthermore, we review the empirical studies that have examined the effects of sexual rehabilitation therapy on the sexual functioning of gynecological cancer survivors and provide relevant research and clinical recommendations. We also discuss reasons to involve patients' sexual partners in psychosocial oncology research, given the complex interplay between patients' and partners' psychosexual issues.     

Assessment of Long-Term Psychosocial Sequelae Among POW Survivors of the Korean Conflict

Psychological and psychiatric assessments were performed among 20 prisoner-of-war (POW) Korean-Conflict survivors. Results revealed extraordinary biological and psychological abuse with weight losses exceeding 35% of preservice weights and long-term cognitive, emotional, and behavioral sequelae. The full range of posttraumatic stress disorder symptoms was seen in 90% to 100% of the cases with high prevalence of co-morbidity, specifically mood (75%), other anxiety disorders. Documented by clinical investigators at (45%), and alcohol abuse (20%) POW release and now more than 30 years later, symptoms of apprehensiveness, confusion, detachment, and depression reflect the persistence of psychiatric morbidity over time.     

Spirituality and the Current Adjustment of Adult Survivors of Childhood Sexual Abuse

We explore the role of spirituality in the current adjustment of adult survivors of childhood sexual abuse (CSA). A sample of 101 men and women survivors of CSA completed questionnaires on spirituality (relationship with God or higher power), person factors (blame attributions, self-acceptance, hope), and current adjustment (mood, personal growth, resolution of the abuse). Results indicated that relationship with a benevolent God or higher power is related to the experience of less negative mood and a greater sense of personal growth and resolution of the abuse. Also, relationship with a higher power is related to other person factors such as self-acceptance and hope. Relationship with a benevolent God appears to have an indirect link to depressive mood and resolution of abuse through the mediating pathways of hope and self-acceptance. In contrast, relationship with God appears to have a more direct association to the outcome of personal growth for these survivors .     

Childhood Peer Relationship Problems and Psychosocial Adjustment in Late Adolescence

Using prospective longitudinal data from the Christchurch Health and Development Study, this paper examined the relationship between teacher reported peer relationship problems at age 9 and psychosocial adjustment in late adolescence. Results showed that, by age 18, children with high rates of early peer relationship problems were at increased risk of externalizing behavior problems such as criminal offending and substance abuse, but were not at increased risk of anxiety disorder or major depression. Subsequent analyses revealed that these associations were largely explained by the effects of child and family factors associated with both early peer relationship problems and later adjustment. The most influential variable in explaining associations between peer relationship problems and later adjustment was the extent of children's early conduct problems. These results suggest that reported associations between early peer problems and later adjustment are noncausal, and appear to reflect underlying continuities in behavioral adjustment.