The poorly coping COPD patient: a psychotherapeutic perspective.

An etiology of maladaptive coping in Chronic Obstructive Pulmonary Disease is proposed and a model for psychotherapeutic intervention with poorly coping COPD patients is presented. Failure in mourning, manifested by a lack of shift in patient's expectations and goals leads to: 1) difficulty in accepting illness related feelings of loss; 2) chronic anxiety; 3) attribution of responsibility for feelings and behavior to external factors; and 4) poor compliance with medical regime. Recommendations for establishing a therapeutic alliance with the poorly coping patient are discussed. Psychotherapeutic intervention aims at: 1) facilitating acceptance of losses and restructuring of life goals; 2) interrupting the cycle of alienation and social withdrawal; and 3) increasing patient's control over affective arousal and respiratory functioning. Utilization of supportive individual psychotherapy, family or marital therapy, and specific behavioral techniques is discussed. Family or marital therapy is seen as the treatment of choice. The psychotherapeutic model proposed is useful in promoting more adaptive coping in the COPD patient.