Izvješće o slučaju, psihoterapeutski postupak s pacijenticom s karcinomom dojke

IntroductionBreast cancer is the most common cancer in women [1]. It is estimated that one in eight women in the world is affected by this illness during her life [2]. Breast cancer is the leading cancer in women in Croatia, too. Out of all women suffering from all kinds of cancers, 24% are those suffering from breast cancer [3]. Although it is usually found in women over 50 years of age, today there is an increase in frequency of this cancer in younger women as well [1]. This younger population of women fighting breast cancer has more problems adjusting to diagnosis, has frequent anxiety symptoms as well as other psychological symptoms that my lead to a decrease in life quality [1]. Since in addition to regular somatic symptoms the affected women often have psychological symptoms, it is important to recognize and adequately treat them in order to prevent the decrease in life quality [1,4]. Studies show that almost 30-40% of affected women develop psychiatric symptoms, such as depression, anxiety or adjustment disorder [1,5]. It is necessary to point out that the diagnosis of breast cancer and the subsequent surgery are important (traumatic) events for every patient that may lead to low self esteem, developing poor body image or sexual dysfunctions [6]. Everything said above indicates the need for psychosocial interventions [6,7] that can influence the life quality factors, such as normal sleep, reduction of fatigue, mood disorders, vitality increase, pain reduction and the like [7]. Various psychotherapeutic techniques can be used to influence these factors. Studies show that cognitive-behavioral techniques [8-10] reduce depression, anxiety, fatigue, improve sleep [8] or reduce pain [10].Hypnosis also has a special place in this kind of interventions. Hypnotic trance can be used for relaxation, insomnia or chronic pain reduction with an emphasis on patient's learning through hypnosis about relationship improvements, which may have a lot of benefits for the patient [11]. Visualization in hypnotic trance is a special technique that can be used to reduce depression [12], which is very common in breast cancer patients [1,5]. Moreover, it is important to point out that psychological and psychotherapeutic treatments are beneficial for immunological system as well [12].The aim of this case report is to emphasize the importance of psychotherapeutic procedures in treatment of cancer patients.The main problem as well as the aim of psychotherapy with cancer patients is confrontation with the illness, accepting the illness and long treatment, accepting role changes in the family and professional life. Along with individual psychotherapy, it is important to include family members in therapy, which deals with role changes, lifestyle changes and goal changes. There are also support groups with other patients. It is important to set short-term and long-term goals.Individual psychotherapy can be combined with problem visualization or problem personification in hypnotic trance.Working with cancer patients is very hard for the therapists as well as for the patients. Psychotherapists usually avoid working with patients suffering from this 'frightening' disease, but for the patients psychotherapy is of great importance.The experience I gained while working with this breast cancer patient suggested that there are reasons to be much more optimistic than I used to be about this kind of psychotherapy.My hope is that this case report will be encouraging for the colleagues who would like to invest their knowledge and energy in this field of psychotherapy.Case reportThe story begins a few years ago when a 38-year-old patient, suffering from persistent headaches, came for psychotherapy. The neurological and somatic examinations did not indicate firm signs of any organic background of headache.The patient had been married for 16 years, with marriage passing through many crises. …