Psychotherapy for the Terminally Ill

At Corpus Callosum an interesting take on doctors’ reaction to patients’ depression:

Doctors think, “Well, of course she’s depressed — she’s dying of breast cancer,” he said.

And furthermore:

I do see that kind of response sometimes, not just with regard to terminally ill patients. The physician does not think the depression should be treated, because it is felt to be an expected response to the situation.

That’s an interesting attitude, but perhaps understandable.

Another article, appearing at the Washington Post, like the Corpus Callosum piece, includes the finding that talk therapy is almost as effective as antidepressants as treating depression in terminally ill cancer patients. At Corpus Callosum they make the point that a full 25 percent (both articles said “only 25 percent”, which seems a little callous) of these patients have major depression.

So it would make sense that talk therapy would not be quite as effective as an antidepressant. What makes even more sense is that the combination of the two would probably be even more effective. What makes no sense at all is not treating these patients for depression.

The articles raise interesting issues.

  1. Medical model. I think this highlights an important difference in the psychological v. medical model. If it’s an understandable reaction to life, then don’t bother treating = medical model. It may not be fair to criticize doctors for not distinguishing between major depression and a process of mourning that is occurring in the struggle with a terminal illness. Mourning and depression have many similarities. To not treat the depression is negligent at best.
  2. Where psychotherapy works well. Psychotherapy is uniquely effective in addressing pivotal stages in the lifespan. It is also effective at treating major depression, most effectively with the help of an antidepressant. If psychotherapy is effective at treating patients with terminal illnesses, whether depressed, mourning, or both, then they should be getting treatment.

Kalea Chapman, Psy.D.


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Clinical Psychologist practicing in the Los Feliz neighborhood of Los Angeles, California.

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