Confronting death: Group psychotherapy with terminally ill individuals

A model for group psychotherapy with terminally ill patients is proposed, one in which the group is homogeneous and open-ended. Cancer and HIV infection are used as examples of chronic, terminal illnesses, and the relevant literature on group psychotherapy with these conditions is reviewed. Treatment with both sets of patients has been characterized by considerable variation in the structure, composition, and duration of the group. Being diagnosed with a terminal illness is traumatic and leads to denial, which may be adaptive or maladaptive depending upon its behavioral manifestations. The homogeneous, open-ended group encourages adaptive denial, which fuels hope and the will to live. The mechanism through which this occurs involves the unconscious identification with the group as an entity. This causes the emergence of a fantasy of a mother-infant dyad, within which can occur reworking of the depressive position. Scheidlinger, Turquet and Anzieu are cited to demonstrate this unconscious function of the group. Finally, clinical implications of such a model are highlighted.