Social Work Department,St Vincent's Hospital,Fitzroy,Victoria,Australia.
Department of Psychiatry,School of Clinical Sciences at Monash Health,Monash University,Clayton,Victoria,Australia.
Palliat Support Care. 2019 Feb;17(1):13-20. doi: 10.1017/S1478951518000871. Epub 2019 Jan 2.
Understanding the way therapy works is a complex undertaking. Historically, such enquiry has been dominated by "outcomes" leading to a lack of discourse about clinical processes. In the cancer setting, identifying clinical process can be even more complex because of the added challenges of an ongoing illness. This study investigated the therapeutic processes used in a meaning-based intervention developed for the advanced cancer setting: Meaning and Purpose therapy.
Four sessions of therapy were delivered to 24 participants. Transcribed sessions (n = 96) of the intervention were analyzed by two independent researchers to describe participant themes, therapeutic processes, and patterns of change related to common points in the intervention.ResultAlthough both suffering and meaning were present in all sessions, when we tracked the focus of the content across sessions, there was a clear progressive shift toward meaning-centered content for all participants. This finding is in spite of the fact that all participants had progressive disease and were living with ongoing challenges.Significance of resultsProcesses such as focusing on meaning, reflecting a sense of significance, joining with participants to explore their unique meaning, and directing them away from a preoccupation with suffering were identified as clear influences of a shift toward a meaning-based focus. These processes offer a fresh focus on meaning and a buffer to the distress of advanced cancer.
理解治疗机制是一项复杂的任务。从历史上看，这种探究一直受到“结果”的主导，导致缺乏关于临床过程的讨论。在癌症环境中，由于持续疾病带来的额外挑战，确定临床过程可能更加复杂。本研究调查了一种基于意义的干预措施在癌症晚期环境中使用的治疗过程：意义和目的疗法。
对 24 名参与者进行了四节治疗。对干预措施的 96 次会话记录进行了两位独立研究人员的分析，以描述参与者的主题、治疗过程以及与干预措施中的常见点相关的变化模式。
尽管所有会话中都存在痛苦和意义，但当我们跨会话跟踪内容焦点时，所有参与者的内容都明显朝着以意义为中心的内容转移。尽管所有参与者的疾病都在进展，并且都在持续面临挑战，但这一发现仍然存在。
诸如关注意义、反映意义感、与参与者一起探索其独特意义以及引导他们摆脱对痛苦的过分关注等过程，被确定为向基于意义的焦点转移的明显影响。这些过程为意义提供了新的关注焦点，并为晚期癌症的痛苦提供了缓冲。
