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Re lec i e w i ing abou b eas cance expe iences as pa o an in e ac i e poe y
he apy g oup p ocess
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Holopainen, J., & Ihanus, J. (2024). Re lec i e w i ing abou b eas cance expe iences as pa o
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Re lec i e w i ing abou b eas cance expe iences as pa o an in e ac i e
poe y he apy g oup p ocess
Johanna Holopainen
a
,
*
,
1
, Juhani Ihanus
b
,
2
a
Depa men o Music, A and Cul u e S udies, Uni e si y o Jy ¨
askyl¨
a, Seminaa inka u 15, PO Box 35, 40014, Finland
b
Depa men o Psychology, Facul y o Medicine, Uni e si y o Helsinki, PO Box 21 (Haa maninka u 3), 00014, Finland
ARTICLE INFO
Keywo ds:
B eas cance
Poe y he apy
Re lec i e w i ing
T ans o ma i e w i ing
W i ing g oup
ABSTRACT
This s udy ocused on ex s w i en by b eas cance su i o s who pa icipa ed in an in e ac i e poe y he apy
g oup p ocess. The w i ing g oup consis ed o 4–6 pa icipan s who me 18 imes du ing 2019. The g oup ac-
i i ies ollowed he RES poe y he apy model, and he poe y he apy in e en ion was implemen ed ollowing
he Re lec i e and T ans o ma i e W i ing P ocess Model. The aim o he s udy was o desc ibe he me hods used
in he g oup and o analyze he hemes iden i ied in he pa icipan s’w i en e lec ions on hei expe iences wi h
hei illness. Speci ically, he s udy sough o answe he ollowing ques ions: 1) Wha kinds o hings we e ound
meaning ul by he pa icipan s in w i ing abou hei expe iences wi h b eas cance ? 2) How we e hese hings
hema ized h ough he p ocess o acili a ed e lec i e and ans o ma i e w i ing? Pa icipan s’w i ings we e
analyzed using In e p e a i e Phenomenological Analysis (IPA). Th ee main hemes, along wi h se e al sub-
hemes, we e iden i ied. The main hemes we e: 1) being seen and hea d as a b eas cance su i o , 2) he
aces le by he disease, and 3) I li e and b ea he despi e he disease. This s udy p o ides new insigh s in o how
b eas cance becomes in eg a ed in o a pe son’s sel hood and li e s o y.
In oduc ion
B eas cance is he mos common cance among women wo ldwide,
wi h 2.3 million cases each yea (Wo ld Heal h O ganiza ion WHO,
2023, xi ). Beyond medical ea men , b eas cance su i o s need
suppo se ices and in e en ions ha add ess hei psychosocial,
spi i ual, and exis en ial needs. Common psychosocial challenges du ing
ea men include s ess, dep ession, anxie y, ea o complica ions
du ing eco e y, ange , and conce ns abou ela ionships, quali y o li e,
body image, spi i uali y, coping, and in ima e ela ionships. Social
suppo se ices can help alle ia e hese symp oms. These se ices
include suppo om amily, iends, and he communi y, such as pee
suppo , a and music he apies, and spi i ual se ices (Wo ld Heal h
O ganiza ion WHO, 2023, xi , 69–70).
A he apy has been shown o ha e an alle ia ing e ec on anxie y,
dep ession, and a igue in b eas cance pa ien s (Tang e al., 2019), and
on a igue du ing b eas cance ea men , imp o ing o e all quali y o
li e (Joly e al., 2022). Addi ionally, a he apy in e en ions ha e been
epo ed o bene i quali y o li e and emo ional well-being in b eas
cance pa ien s (Kie isiene e al., 2020). Howe e , a he apy appea s
o ha e a g ea e impac on educing anxie y han dep ession (Xu e al.,
2020).
An ea lie sys ema ic e iew and me a-analysis (Boehm e al., 2014)
sugges ed ha while a s he apies, including music he apy, a ious
ypes o a he apy, and dance/mo emen he apies, posi i ely a ec
anxie y in b eas cance pa ien s, hey do no signi ican ly impac
dep ession o quali y o li e. A la e me a-analysis (Cheng e al., 2021),
ound ha a s he apies, such as music, pain ing, and dance, can
imp o e quali y o li e and dep ession in pa ien s wi h b eas and gy-
necological cance s and ha e posi i e e ec s on anxie y, pain, and a-
igue in b eas cance pa ien s.
Dance and mo emen he apy can help b eas cance pa ien s cope
wi h he in ense emo ions induced by he disease (Ka a e i e al., 2022)
and has he apeu ic e ec s on pain, a igue, sleep dis u bances,
dep ession, and body image (Sil a da Cos a e al., 2022). Music he apy
has been ound o alle ia e p eope a i e anxie y and pos ope a i e pain
ela ed o b eas cance su ge y (Tola e al., 2021) and educe anxie y
caused by chemo he apy a e su ge y (Kie isiene e al., 2020). I also
* Co esponding au ho .
E-mail add esses: [email p o ec ed] (J. Holopainen), [email p o ec ed] (J. Ihanus).
1
Pe manen add ess: Leh o annan ie 14 a 5 40520 Jy ¨
askyl¨
a, Finland.
2
Pe manen add ess: Vanha H¨
ameenlinnan ie 11 B 4 06100 Po oo Finland.
Con en s lis s a ailable a ScienceDi ec
The A s in Psycho he apy
jou nal homepage: www.else ie .com/loca e/a spsycho
h ps://doi.o g/10.1016/j.aip.2024.102194
Recei ed 20 Janua y 2024; Recei ed in e ised o m 13 July 2024; Accep ed 13 July 2024
The A s in Psycho he apy 90 (2024) 102194
2
has he po en ial o imp o e he physical and men al heal h o b eas
cance pa ien s (Li e al., 2020).
A s udy on a poe y he apy g oup o people wi h cance ound ha
pa icipan s enjoyed he g oup and el i imp o ed hei quali y o li e.
They also epo ed a educ ion in eelings o ange owa d hei cance as
a esul o he g oup p ocess (Tegne e al., 2009.) Speci ically, a s udy
on a poe y he apy g oup o b eas cance pa ien s ound educ ions in
anxie y and imp o emen s in emo ional esilience. This g oup also
acili a ed he o ma ion o bonds and iendships ha con inued a e
he he apy ended (Gozash i e al., 2017). Poe y he apy g oups ha e
been ound o p omo e expe iences o meaning ulness and communi y
(Tegne e al., 2009; Gozash i e al., 2017).
Using a s-based esea ch, Reilly e al. (2018) concluded ha he
exis en ial and pos auma ic g ow h expe iences o women wi h b eas
cance can be mo e deeply unde s ood h ough meaning ul hemes
e oked by ound poe y ( e aming exce p s om in e iews as poe y).
Poe y he apy also allows indi iduals o ee alua e and wo k h ough
hei illness expe iences, in eg a ing hem in o hei li e his o y (Heimes,
2011).
C ea i e a s he apies, including poe y he apy, u ilize cogni i e,
emo ional, and ac ion-o ien ed app oaches. Puig e al. (2006) ound ha
pa icipa ion in g oup-o ien ed a s he apy in e en ions enhanced
psychological well-being by dec easing nega i e emo ional s a es and
inc easing posi i e ones. Consequen ly, hese he apies ha e gained a
oo hold no only in he ea men o psychia ic illnesses bu also in he
ea men o physical illnesses (Heimes, 2011).
The e ec i eness and po en ial o c ea i e a s he apies ha e been
demons a ed in se e al s udies. Howe e , he he e ogenei y o esea ch
designs and me hods, and di e se epo ing p ac ices in quali a i e
esea ch make i challenging o compa e indings ac oss di e en s udies
(Zb anca e al., 2022). E o s ha e been made o de elop models o
guide he design, implemen a ion, and e alua ion o poe y he apy
in e en ions. These models include he in e ac i e biblio he apy p o-
cess by McCa y-Hynes and Hynes-Be y (1986), he RES model by
Mazza (2017), he EFECT model by Al ey e al. (2021), and he
Re lec i e and T ans o ma i e W i ing P ocess Model (RTWPM) by
Ihanus (2019, 2022a).
The RTWPM allows a heo e ical examina ion o w i ing p ac ices in
poe y he apy (Ihanus, 2019, 2022a), while he RES model p o ides a
ounda ion o using and applying a ious echniques o a wide ange o
audiences (Mazza, 2017). The EFECT model acili a es he examina ion
and e alua ion o a g oup wo k a di e en s ages o he p ocess (Al ey
e al., 2021), and he in e ac i e biblio he apy p ocess o e s a ame-
wo k o explo ing he pe sonal meanings gene a ed h ough he he -
apy p ocess (McCa y-Hynes &Hynes-Be y, 1986).
The pu pose o his s udy was o analyze ex s w i en by pa icipan s
in a poe y he apy g oup o b eas cance su i o s, as well as examine
he w i ing p ocess i sel . In his con ex , poe y he apy e e s o an
in e ac i e g oup ac i i y ocused on w i ing, using poe y he apy
me hods. Fi s , he g oup ac i i ies and me hods ha acili a e w i ing
we e s uc u ed based on he c ea i e componen o he RES model
(Mazza, 2017). The poe y he apy in e en ion was hen implemen ed
acco ding o he Re lec i e and T ans o ma i e W i ing P ocess Model
(Ihanus, 2019, 2022a; see Fig. 1).
The ex s p oduced du ing he g oup mee ings we e analyzed using
In e p e a i e Phenomenological Analysis (IPA; e.g., Smi h &Nizza,
2022). The esul s a e p esen ed as hemes eme ging om he pa ici-
pan s’w i ings, which a e consis en ac oss all g oup membe s’ ex s.
The hemes chosen by he pa icipan s aimed o cap u e meaning ul
expe iences o hei illness. Thus, he esul s a e explo ed h ough he
meanings ha a ise om he w i ings and in e p e ed wi hin he
amewo k o he p ocess model o e lec i e (guided) and ans-
o ma i e ( he apeu ic) w i ing. The s udy sough o answe wo
esea ch ques ions: 1) Wha kinds o hings we e ound meaning ul by
he pa icipan s in w i ing abou hei expe iences wi h b eas cance ? 2)
How we e hese hings hema ized h ough he p ocess o acili a ed
e lec i e and ans o ma i e w i ing?
The a ows do no ep esen a linea causal chain bu a he “epigene ically” in e lacing de elopmen al s eps, whe e he o de can
change h oughou he p ocess. These s eps can occu in di e en successions, and a imes, some s eps may be less impo an ,
implici o do man in he ongoing p ocess. No all s eps a e unc ional o e e y pa icipan , bu he de elopmen and execu ion o
w i ing equi e he collabo a ion o cogni ions, emo ions, and mo i a ions wi h he app op ia e b ain p ocesses. Con inuous eedback
and cons uc i e sel -e alua ion h ough w i ing enhance lea ning and ans o ma i e eeling- hinking. Feedback om o he s
p o ides a suppo i e, con aining en i onmen o indi idual and g oup iden i ica ions, explo a ions, compa isons, ecogni ions, and
ans e ences.
The ichness and i ali y o he w i ing expe ience o w i ing a e e iden in he amoun o play ul ew i ing, which helps shape and
ans o m iden i y and li e s o ies o he u u e. I am no jus one pe manen , epe i i e s o y bu a cons an ly e ol ing cons ella ion
o s o ies. My meanings a e ne e comple e; hey ma e ialize and change h ough dynamic dialogues be ween he sel and o he s, as
well as be ween he eade /w i e and he ex in i s a ious con ex s. (Ihanus, 2019.)
W i�ng → Cogni� e condi�ons → Emo�onal condi�ons → Mo� a�onal condi�ons → De enses
and coping s a egies → Feedback om o he s → Iden�fica�on, explo a�on, compa ison,
ecogni�on, ans e ence → C ea� e an asy and language play → Fu he pe sonal eflec�on and
exp essi e communica�on → Dialogical meaning nego�a�ons → Unde s anding and insigh →
In e nalizing, ela� izing, and in eg a�ng in o he pas , p esen , sel , o he s, and en i onmen →
Me a eflec�on = me acogni�on and me a-emo�on → Rew i�ng → Holding and ans o ming
iden� y s o ies and li e s o ies owa d he u u e
Fig. 1. The Re lec i e and T ans o ma i e W i ing P ocess Model (Ihanus, 2019).
J. Holopainen and J. Ihanus
The A s in Psycho he apy 90 (2024) 102194
3
Ac i i ies o he b eas cance su i o s’w i ing g oup
The main pu pose o he B eas Cance Su i o s’W i ing G oup was
o pa icipan s o w i e abou hei expe iences wi h he disease. The
g oup me 18 imes, wi h each mee ing las ing wo and a hal hou s, a
wo–week in e als h oughou 2019. The mee ings and ac i i ies we e
guided by poe y he apy me hods and acili a ed by a ained poe y
he apis . The ac i i ies we e based Mazza´s RES-model and he s eps
ou lined in he Re lec i e and T ans o ma i e W i ing P ocess Model
(Ihanus, 2019, 2022a).
The RES model consis s o ecep i e, exp essi e and symbolic/ i ual
elemen s (Mazza, 2017), which a e iden i iable in he g oup ac i i ies.
The RTWPM includes cogni i e, emo ional, and mo i a ional ac o s
and hei in e ac ions (Ihanus, 2019, 2022a). The componen s o each
amewo k may no always be dis inc o ollow a speci ic o de , bu
hey a e embedded in dynamic and ecip ocal ela ionships (Mazza,
2017; Ihanus, 2019, 2022a).
Mazza’s model was chosen because i sui ed he s udy’s needs and
e ec i ely desc ibed he s uc u e and main s ages o he g oup mee -
ings. O he models, such as he in e ac i e biblio he apy p ocess
(McCa y-Hynes &Hynes-Be y, 1986) and he EFECT model (Al ey
e al., 2021), we e conside ed bu ound o ha e di e en s a ing poin s
and a b oade ocus on he en i e p ocess. In con as , Mazza’s RES
model allowed o a mo e de ailed and s uc u ed examina ion o indi-
idual mee ings. Ihanus’model was selec ed o in e p e a i e pu poses.
I p o ides a heo e ical amewo k o analyzing he w i en ex s and
he hemes ha eme ged om hem as pa o he g oup p ocess.
Mazza’s RES model was used o s uc u e he sessions in he
ollowing ways. Each session included h ee phases. In he i s phase,
pe spec i es and expe iences ela ed o he heme we e explo ed using
ma e ials, discussions, o lis -w i ing ac i i ies. In he second phase, one
heme was selec ed o deepe examina ion, ollowed by guided w i ing
exe cises. Some imes a second exe cise was conduc ed, shi ing he
pe spec i e o ano he heme. In he hi d and inal phase, he ins uc o
helped he pa icipan s eo ien o he p esen by discussing posi i e
opics. Acco ding o Mazza’s model, he i s phase in ol ed o ien ing
elemen s, he second phase ocused on exp essi e w i ing, and he hi d
phase inco po a ed i ualis ic elemen s.
The pu pose o his pape is o desc ibe he me hods used in he
g oup and how he pa icipan s’w i ings and e lec ions we e acili a ed
h ough he g oup p ocess. Table 1 p esen s he heme, o ien ing
elemen , w i ing me hod, and i ual o each mee ing.
O ien ing w i ing me hods in he b eas cance su i o s’w i ing g oup
The p ocess o e lec i e and ans o ma i e w i ing aims o s imu-
la e wo king memo y and ac i a e au obiog aphical memo y, in ol ing
he o ien a ion o p ocedu al memo y and ocused a en ion on objec s
o obse a ion (Ihanus, 2019, 2022a). Mazza (2017) cha ac e izes
ecep ion as pa icipan s’awakening o he session’s heme o en
h ough ex ual o ms like poe y. In ou g oup o b eas cance su i-
o s, we e e ed o hese ma e ials as he o ien ing elemen s, which
could be w i en ex s, images, o music. The acili a o ’s deep unde -
s anding o b eas cance and pe sonal expe ience in nu sing pa ien s
wi h his illness p o ed ad an ageous in selec ing hese ma e ials.
Mo i a ion o w i ing was nu u ed h ough ex s p esen ed by he
acili a o , poe y collages, collec i ely chosen songs (lis ened o
oge he ), pic u e ca ds, landscape images, ca oons, and
emo ion-explo ing ill-in- he-blank cha s. The aim was o e oke e-
sponses in he pa icipan s (c . Mazza, 2017). Mo eo e , he o ien ing
ma e ials also suppo ed pe sonal g ow h, de elopmen , and ans-
o ma ion h oughou he sessions (Papunen &Kosonen, 2022). Pa ic-
ipan s we e equen ly encou aged o c ea e hei own lis s ele an o
he mee ing hemes, such as hei encoun e s wi h he illness, discus-
sions abou diagnoses, medica ions, and mo e. In hese ins ances, he
meanings pa icipan s a ibu ed o he o ien ing ex s we e deeply
pe sonal, os e ing a meaning ul connec ion wi h he sel media ed
h ough he ex s (Papunen &Kosonen, 2022).
W i ing exe cises as a medium o w i ing abou b eas cance expe iences
The b eas cance su i o s’g oup cen e ed i s ac i i ies on w i ing,
s uc u ed a ound speci ic w i ing exe cises in each mee ing. Themes
we e designed o ini ially explo e b oad emo ions (e.g., emo ional p o-
cess, meanings o li e, my landscape) be o e del ing in o mo e de ailed
issues ela ed o b eas cance , such as medica ion and co po eali y. The
aim was o ansi ion om gene al emo ional and exis en ial hemes o
mo e speci ic aspec s o he ea men jou ney. Themes we e de eloped
Table 1
G oup mee ings depic ed acco ding o he RES model.
MEETING
THEME
ORIENTING
ELEMENT
WAY OF WRITING RITUAL*
Emo ional
p ocess
“Good mood”
ca ds
Lis o emo ion
wo ds
F ee w i ing Ag eeing on
common ules
Wo ds le unsaid Tex : Human
longing
Le e s ( o he sel +
o he s)
Pos ca d w i en
o he sel
Meanings o li e Follow-up s o y
( oge he )
"Minu e exe cise" “Good mood”ca d
My Landscape Landscapes F ee w i ing,
d awing
“Inspi a ion”ca d
Told by a poem Poe y collage W i ing poems A e se o poe y
as a gi o he
o he pa icipan s
Encoun e s Lis (posi i e &
nega i e)
F ee w i ing Discussion:
mee ing a “sis e ”
Places Mee ing place “Minu e exe cise” “Emo ional li e”
ca d
Diagnosis Lis (who I old) F ee w i ing Discussion: “a
gen le mee ing”
Iden i y wo k Discussion
abou changes
F ee w i ing P esen a ion o a
pho o collage
Empowe ing
song
Pa icipan s’
songs
F ee w i ing “Good mood”ca d
Ou side and
belonging
Lis (momen s,
si ua ions)
F ee w i ing
(insigh s)
Posi i e hings
abou he day/
week
Medica ion Lis (medicines) Pe soni ica ion
+s o y w i ing
Discussion: hings
ha make you eel
be e
Womanhood Discussion +lis
compiled
oge he
“Minu e exe cise”Haiku w i ing
+ eading
Co po eali y Comic s ip F ee w i ing Discussion:
posi i e eelings
Moods "Emo ional
owe "
F ee w i ing and
dialogue wi h
emo ions
Bes posi i e
eeling
Dea h Poe y collage,
lis (discussions)
F ee w i ing: igu e
o dea h
+discussion abou
dea h
Things ha b ing
joy in li e
B eas cance ,
meanings
Discussion: aids,
suppo ,
ea men s,
guides
F ee w i ing abou
he meanings o
hings he acili a o
said
Pos -disease
desi es and
d eams
Fa ewell o b eas
cance
(independen
p ocessing)
Lis o c ying
places +song:
“Hunge o li e”
Desc ip ions o
c ying, exis en ial
meanings o
pe sonal li e
Song: “Tea s o
happiness”
+ a ewell le e
o b eas cance
End session “Powe animal”
ca ds
Desc ip ion o
cu en eelings
W i en g ee ings
o o he
pa icipan s
*
Ri ual: The i uals o each mee ing include a s a , a w i ing exe cise, a
discussion, a co ee b eak and a closing. The able shows no speci ic i ual o
closing he mee ings, as he closing i ual is no he same o all mee ings. The
closing i uals helped o conclude each session and acili a e a smoo h ansi ion
back o he p esen .
J. Holopainen and J. Ihanus
The A s in Psycho he apy 90 (2024) 102194
4
wi h a ocus on c i ical aspec s o he ea men p ocess, in o med by he
ins uc o ’s clinical expe ise in b eas cance and insigh s om p e ious
s udies on he opic. Addi ionally, hemes eme ged om discussions
among pa icipan s, wi h conside a ions gi en o opics like ‘ou side and
belonging.’.
The g oup was ecognized as a poe y he apy g oup due o i s
inhe en na u e. The aim was o suppo pa icipan s in sel -exp ession,
enhance sel -awa eness, and os e in e ac ion skills h ough he use o
ex s and w i ing o acili a e e lec i e p ocesses (see, e.g., Linnainmaa
&M¨
aki, 2022;Na ional Associa ion o Poe y The apy NAPT, 2024).
Acco ding o he Na ional Associa ion o Poe y The apy (Na ional
Associa ion o Poe y The apy NAPT, 2024), poe y he apy ‘ elies upon
he use o poems, s o ies, song ly ics, image y, and me apho o acili a e
pe sonal g ow h, healing, and g ea e sel -awa eness.’Va ious ma e ials
we e employed o o e di e se pe spec i es on expe iences and o
cons uc meanings and na a i es. Fo ins ance, poems p o ide ich
me apho s, comics o e in e p e i e possibili ies, song ly ics and music
connec wi h emo ions, and images depic en i ies and illus a e
emo ional s a es h ough colo .
W i ing se es as a pa hway o access eelings, c ea e o de in li ed
expe iences, and ac as a ool o conc e iza ion (Mazza, 2017).
Engaging wi h poe ic and me apho ical ma e ials and a achmen s
(Ihanus, 2022a, 2022b), such as w i ing poems, haikus, and le e s,
helped pa icipan s p ocess hei eelings ela ed o b eas cance . These
ac i i ies enabled hem o dis ance hemsel es om hei disease- ela ed
emo ions and decide how in ensely hey wan ed o con on speci ic
si ua ions, eelings, o momen s.
Fu he mo e, using me apho s as a means o dis ancing and
pe soni ying medica ion accompanied he pa icipan s in hei w i ing
abou hei cance expe iences (Holopainen, Maanmieli e al., 2021) and
enabled hem o imme se hemsel es in he ic ional wo ld o ex s
(Ihanus, 2022a, 2022b). Th ough hese me hods, and by ex e nalizing
discussions (c . Whi e, 2008), pa icipan s we e able o explo e he e -
ec s and side e ec s o b eas cance ea men medica ions and he
b oade implica ions o managing hei li es.
A“one-minu e exe cise,”whe e pa icipan s w o e o one minu e
based on sen ences spoken by he ins uc o , p o ided a s uc u ed
ansi ion and imme sion in o non- ic ion. This exe cise was employed
o explo e he meanings associa ed wi h places o ca e and cu en li e
si ua ions. Wi hin a s ic ime limi , pa icipan s had o quickly ecog-
nize and espond o he i s associa ion igge ed by he ins uc o ’s
wo ds, hen w i e abou i be o e mo ing on. The exe cise lowe ed he
ba ie o w i ing, as he ime limi le li le oom o con en ional
w i ing cons ain s such as g amma , sel -censo ship, o edi ing.
F ee-w i ing echniques we e equen ly u ilized in he g oup as hey
p o ed e ec i e o he pa icipan s. Fo ins ance, pa icipan s o en
engaged in ee w i ing on opics selec ed om a lis hey c ea ed
hemsel es. W i ing acili a ed he exp ession, e alua ion, and egula-
ion o hough s and eelings (Ihanus, 2022a). Mo eo e , iden i ying
s eng hs and posi i e eelings h ough w i ing p omo ed empowe -
men , in eg i y, and eelings o adequacy and wo hiness (Maanmieli,
2022), e en when add essing challenging memo ies and expe iences
ela ed o b eas cance .
Re lec ion and ans o ma ion in he b eas cance su i o s’w i ing g oup
W i ing abou b eas cance expe iences was based on g oup ac i -
i ies, mu ually ag eed ules, and he oppo uni y o in e ac wi h o he s
who had simila expe iences. A he beginning o each mee ing, pa ic-
ipan s sha ed how hey we e doing. A e ha , hey we e in oduced o
he heme o he mee ing and began ac i i ies such as w i ing lis s,
eading comic s ips, o lis ening o ex s ead by he ins uc o .
Nex , he ins uc o guided a w i ing exe cise and sugges ed a
me hod, such as ee w i ing o a ‘minu e exe cise.’A e w i ing, pa -
icipan s could ead hei ex s aloud o commen on hem. O he s we e
allowed o p o ide eedback on wha hey hea d. The ex s we e no
e alua ed, bu expe iences ela ed o b eas cance o w i ing we e
sha ed. I he e was mo e han one w i ing exe cise planned, he p ocess
was epea ed.
Finally, he mee ing concluded wi h a posi i e i ual, such as
selec ing a pic u e ca d and explaining he choice o discussing posi i e
opics (see Table 1).
Me a e lec ion in a g oup occu s when me aemo ional and me a-
cogni i e skills de elop oge he (Ihanus, 2019). The g oup engaged in
ex ensi e discussions abou hei b eas cance expe iences, p ima ily
based on hei w i en e lec ions. This acili a ed iden i ica ion, ecog-
ni ion, explo a ion, empa hy, ans e ence, and p oximi y, os e ing a
p ocess o e lec i e and ans o ma i e w i ing (Ihanus, 2019). Pa ic-
ipan s lis ened o each o he ’s expe iences, ecognizing and iden i ying
wi h hem, which acili a ed he exp ession o eelings, a sense o being
unde s ood, and pee suppo .
The i ual-like s uc u e o he mee ings, including he exchange o
news, o ien a ion o he opic, w i ing exe cises, discussions, a co ee
b eak, and a closing i ual, suppo ed he sa e y o he g oup wo k (see
Holopainen, Maanmieli e al., 2021). Sha ing pe sonal s o ies p omo ed
e lec ion and communica ion, deepening he poe y he apeu ic p o-
cess bo h pe sonally and collec i ely (Ihanus, 2019). Lis ening o each
o he ’s s o ies allowed pa icipan s o e lec on how hey p ocess and
wo k h ough hei own expe iences. This led o new insigh s and deepe
unde s anding, helping hem connec hei expe iences o hei li e
s ages, bo h pas and p esen , as well as o hei sense o sel and hei
en i onmen (see Ihanus, 2019).
The guided w i ing exe cises enhanced he w i ing p ocess and
c ea ed a space o nego ia ing meaning be ween w i e and ex , ex
and eade , and among he pa icipan s (Ihanus, 2019). The g oup
p ocess gene a ed a sense o belonging and p o ided membe s wi h an
oppo uni y o shape hei u u e iden i y and li e na a i es. One
pa icipan desc ibed he ac i i y as ollows: “I hink his is g ea ,
e i ic. Like o me and ce ainly o o he s. We can see each o he and
c y oge he and laugh and go on li ing.”
Me hod
Resea ch ques ions
As men ioned in he In oduc ion, his s udy ocused on he ollowing
ques ions: 1) Wha kinds o hings we e ound meaning ul by he pa -
icipan s in w i ing abou hei expe iences wi h b eas cance ? 2) How
we e hese hings hema ized h ough he p ocess o acili a ed e lec i e
and ans o ma i e w i ing?
Pa icipan s and ec ui men
Six people ook pa in he g oup, wi h ou ac i ely pa icipa ing
un il he mee ings concluded. Two pa icipan s d opped ou midway
h ough he mee ings o pe sonal easons. Rec ui men was conduc ed
in coope a ion wi h he Cen al Finland Cance Associa ion and he
B eas Cance Associa ion-Eu opa Donna Finland. The s udy was
ad e ised on he a ge g oup’s social media channels, he associa ions’
websi es, and no ice boa ds. In e es ed indi iduals we e in i ed o
con ac he esea che ia email. A lea le de ailing he s udy was sen o
hose in e es ed, desc ibing he g oup as a w i ing g oup u ilizing poe y
he apy me hods. Pa icipa ion equi ed he comple ion o b eas cance
ea men s and he absence o concu en men al heal h ea men s
du ing he g oup in e en ion.
Da a collec ion
Tex s w i en by he pa icipan s du ing he 18 mee ings comp ised
he s udy da a. The mee ings we e s uc u ed consis en ly, using well-
known w i ing exe cises in poe y he apy (see Table 1), and ollowed
a se o ma : o ien a ion, wo king, and ending. The w i ing was done by
J. Holopainen and J. Ihanus

The A s in Psycho he apy 90 (2024) 102194
5
hand and add essed opics ela ed o b eas cance , such as medica ion,
sha ing he diagnosis, being a woman, and he pe sonal ele ance o
b eas cance - ela ed issues (e.g., wigs, pee suppo , e c.). Pa icipan s
we e asked o label hei ex s wi h hei pseudonyms. Copies o he ex s
we e hen made and yped ou , esul ing in 85 single-spaced A4 pages o
da a o analysis.
Analysis
The w i ings we e analyzed using In e p e a i e Phenomenological
Analysis (IPA), which aims o unde s and indi iduals’li e expe iences
and hei sel -pe cep ions wi hin hei pe sonal and social con ex s
(Smi h &Nizza, 2022). Since b eas cance expe iences a e unique o
each pe son, each pa icipan ’s ex s we e ini ially analyzed sepa a ely.
The IPA analysis p oceeded h ough ou s ages:
1. The pa icipan ’s w i ings we e ead mul iple imes and, he e-
sponses hey e oked (desc ip i e, linguis ic, s uc u al) we e eco -
ded as explo a o y no es.
2. Based on hese no es, expe ien ial s a emen s e lec ing he pa ic-
ipan ´s expe iences, we e o mula ed.
3. Connec ions and key ac o s we e iden i ied and clus e ed.
4. Pe sonal expe ien ial hemes we e o mula ed om hese clus e s.
These ou s eps we e epea ed o all six pa icipan s. The expe i-
en ial hemes om each pa icipan s’w i ings we e hen conside ed
collec i ely. Themes we e examined o common elemen s and di e -
ences wi hin hose common elemen s, leading o he o mula ion o
g oup expe ien ial hemes ha uni ied he en i e g oup (see Smi h &
Nizza, 2022).
E hical conside a ions
The Resea ch E hics Commi ee o he Uni e si y o Jy ¨
askyl¨
a con-
duc ed an e hical e alua ion o he esea ch. In e es ed pa icipan s
we e in e iewed indi idually be o e he g oup mee ings began o
ga he in o ma ion abou hei a i udes owa d b eas cance and i s
ea men s. Du ing hese in e iews, in e es ed pa icipan s we e
in o med abou he s udy’s pu pose, objec i es, and he me hods ha
would be used in he g oup. They we e also assu ed o he con iden i-
ali y o hei da a, he olun a y na u e o hei pa icipa ion, and hei
igh o wi hd aw a any ime du ing he da a collec ion p ocess. All
pa icipan s p o ided w i en in o med consen o hei pa icipa ion
and he use o hei da a o esea ch pu poses be o e en e ing he s udy.
Resul s
The hemes cap u e signi ican aspec s o he b eas cance expe i-
ence and appea ed in a ious con ex s wi hin he pa icipan s’ ex s (see
Table 2). Being explici ly seen and hea d as a b eas cance su i o was
impo an o he pa icipan s. Thei w i ings equen ly desc ibed he
aces le by he disease, e e ing o he physical, social, and men al
changes i induced. Addi ionally, he heme o su i al eme ged,
encompassing he su i o ’s eelings o coping, in ospec ion, and desi e
o sel -de elopmen , as well as he linge ing e ec s o he disease e en
yea s a e he end o ac i e ea men (su ge y, chemo he apy, adia-
ion he apy).
Au obiog aphical w i ing se es a ious unc ions, including acili-
a ing sel -awa eness and sel -exp ession, and achie ing a is ic and
aes he ic goals. I can help indi iduals o achie e sel -awa eness and
sel -exp ession, as well as a is ic and aes he ic goals. I can also be
com o ing and nu u ing, helping o s uc u e one’s pe cep ions o e-
ali y and li e ajec o y. Th ough au obiog aphical w i ing, indi iduals
p oduce ex s ha e isi , ep oduce, and e i e memo ies om hei
own pe spec i e. One challenge lies in he dynamic na u e o he sel ,
whe e memo ies and li e u hs a e ne e s a ic and ully cap u able.
Howe e , each momen p esen s an oppo uni y o disco e new ace s
o he sel , allowing o ongoing sel - ec ea ion (Kosonen, 2019).
The au obiog aphical elemen s iden i ied h ough he sub- hemes
we e disce nible in each pa icipan ’s ex s. Despi e he agmen ed
na u e o he ex s, hey p omp w i e s o e lec on meaning ul mo-
men s and explo e emo ions ied o pi o al li e expe iences. This p ocess
does no necessa ily lead o a cohe en au obiog aphical na a i e bu
a he di ec s a en ion o signi ican li e phases and eelings. The
hemes and hei sub- hemes a e p esen ed in Table 2.
Being seen and hea d as a b eas cance su i o
This heme encapsula es he necessi y b ough abou by he disease
o in e ac ion wi h a ious g oups including p o essionals, lo ed ones,
pee s, and o he s wi hin one’s age g oup. Encoun e s wi h o he s,
pa icula ly heal hca e p o essionals, we e no ed as p o oundly mean-
ing ul. The da a illus a ed momen s and si ua ions ela ed o he dis-
ease, o en in challenging he apeu ic con ex s, highligh ing he
signi icance o being acknowledged and unde s ood as a b eas cance
pa ien . The ole o amily membe s and close iends was also empha-
sized as pi o al in expe iencing e en s and momen s, equen ly
accompanied by angible ges u es o suppo and exp essions o g a i-
ude and app ecia ion.
The impo ance o suppo and p esence om heal hca e p o essionals
du ing he illness
The suppo o heal hca e p o essionals was pe cei ed as c ucial,
especially du ing pe iods o anxie y and when pa ien s we e i s con-
on ing hei illness. Pa icipan s i idly ecalled and documen ed he
exac wo ds o doc o s and nu ses, de ailing hei encoun e s in he ex s.
Table 3 highligh s he signi ican ole heal hca e p o essionals play
in p o iding suppo , com o , a en i e ca e, and guidance o pa ien s
du ing hei illness jou ney, pa icula ly du ing c i ical and unce ain
momen s.
The pa icipan s’na a i es highligh he need o in o ma ion
a ising om hei new si ua ion and unde sco e hei app ecia ion o
he encou agemen and e bal suppo p o ided by heal hca e p o-
essionals. The w i ings o en con ex ualize he ea men expe iences
and emphasize he signi ican ole o heal hca e p o essionals’p esence
du ing hese c i ical momen s. These insigh s om he pa icipan s’
ex s illus a e how in o ma i e and suppo i e in e ac ions wi h
heal hca e p o essionals a e alued and c ucial in na iga ing he chal-
lenges associa ed wi h b eas cance diagnosis and ea men .
The emo ional elemen s emphasized in he ex s o en e lec he
w i e s’emo ional s a es, while, among he cogni i e unc ions, he
ac i a ed memo y sys ems ep oduce e ba im exp essions and speci y
emo ional expe iences. In he example p o ided, he exac epe i ion o
wha was said by he nu se and he ecollec ion o he wo king du ing
he own ee ime can be seen as a symbolic ac h ough which pa ic-
ipan s c ea e a psychological dis ance be ween hemsel es and hei
emo ions. This in e p e a ion sugges s ha by symbolizing hei
Table 2
Expe ien ial hemes in he B eas Cance Su i o s’W i ing G oup.
THEMES SUBTHEMES
Being seen and
hea d
as a b eas cance
su i o
The impo ance o suppo and p esence om
heal hca e p o essionals du ing he illness
In ol emen o signi ican indi iduals
The aces le by he
disease
Physical/co po eal changes caused by he disease and
ea men s
The impac o he disease on pe sonal ela ionships
P esence o cance a e ea men s
I li e and b ea he despi e
he disease
Su i al men ali y
Ini ia ion o spi i ual g ow h spu ed by he disease
Li ing in con inuous in e ac ion wi h he disease
J. Holopainen and J. Ihanus
The A s in Psycho he apy 90 (2024) 102194
6
expe iences h ough de ailed ecollec ions, pa icipan s can gain cla i y
and esilience in coping wi h he emo ional impac o hei b eas can-
ce . This p ocess helps s eng hen hei sense o sel and acili a es a
heal hy de achmen , he eby os e ing a new ela ionship and pe spec-
i e on he emo ional s a es associa ed wi h he expe ience ha has
a ec ed hei heal h (c . Lindquis , 2022).
In ol emen o signi ican indi iduals
One o he mos signi ican hemes ha eme ged om he w i ings
was he in ol emen o lo ed ones and hei impac on he pa ien ’s
e e yday li e. Pa icipan s highligh ed he p esence and a en ion o
lo ed ones du ing hei illness, desc ibing momen s whe e hei ac ions
di ec ly suppo ed he pa ien ’s well-being (see Table 4).
The w i ings show ha he conc e e ac ions o paying a en ion o
and helping he sick pe son we e meaning ul. The abo e ex ac s illus-
a e he impac o cance ea men on he pa ien and how i was
alle ia ed by he p esence and in ol emen o hose close o he ,
including bo h amily membe s and close iends.
The impo ance o he p esence o lo ed ones was explici ly s a ed in
he pa icipan s’w i ings ha illus a e hei c ucial ole in p o iding
emo ional suppo , p ac ical assis ance, and companionship. De-
sc ip ions o challenging momen s we e accompanied by desc ip ions o
people impo an o he w i e . Thei ac ions and he eelings hey e oke
a e highligh ed when he w i e is in a s a e o ulne abili y. The ac o
w i ing b ings back wa m memo ies ha may help o mi iga e he e u n
o challenging momen s and si ua ions. Such w i ings mani es he
pa icipan s’desi e o ac as expe ience s and shape s o hei own
na a i es, in e p e ing and sea ching o meaning in a mo e unde -
s andable o m. This p ocess enables hem o meaning ully con ex u-
alize hei expe iences in hei own li e his o y.
T aces le by he disease
This heme e e s o w i ings on he impac o b eas cance and i s
ea men on he pa ien . The sub- hemes a e g ouped acco ding o hei
impac on physicali y and he body, ela ionships, and hough s.
Physical and bodily changes caused by he disease and ea men s
The w i ings desc ibed isible signs o he illness and i s ea men ,
such as sca ing, changes in hai s yle and weigh gain. Ano he impo -
an aspec was he impac o he disease on unc ional and physical
capaci y, such as expe iences o a igue and educed physical pe o -
mance (see Table 5).
The pa icipan ’s ex ac (P2) shows he impo ance o hough and
judgmen , esul ing in he au ho coming o e ms wi h he impac o he
issue on he ac i i ies and seemingly accep ing he new s a us quo, e en
i his is no easy. In ano he pa icipan ’s ex ac (P3), he desc ip ion o
s anding in on o a mi o and seeing he ma ks on he body le by he
b eas cance es i ies ha he disease is eal o he . The image e lec ed
in he mi o and he e alua ion o he ex e nal aspec s o he sel igge
an emo ional eac ion as he bodily si ua ion becomes eal.
Desc ip ions o physical and bodily e ec s we e qui e common, o en
accompanied by s o ies o how ex e nal changes had been no iced by
o he s. In he abo e example, he obse e in he mi o is posi ioned as
an objec i e obse e o he sel . In he p e ious example, he physical
changes seemed o be expe ienced om wi hin, wi h he w i e no ing
hei impac on he abili y o unc ion, such as shi ing om unning o
walking and, inally, o jus udging along. Ihanus s a es ha insigh s
can eme ge h ough e lec ion on pe sonal expe iences and he dialog-
ical communica ion be ween w i e and ex . This makes i possible o
ela e such expe iences o one’s pe sonali y and li e cou se. (Ihanus,
2019.).
The impac o he disease on pe sonal ela ionships
The w i ings also e lec on how disease can ei he d i e people away
o b ing hem close o he su e e (see Table 6).
In one pa icipan ’s exce p (P2), he au ho app oaches he issue by
con empla ing i s causes. Th ough a se ies o ques ions, he w i e seeks
o a ionalize wha happened a he han exp ess pe sonal emo ions.
The exce p also indica es ha he issue has eached a s age whe e i can
be app oached and examined a ionally h ough w i ing.
The pa icipan e lec s on he side e ec s o he ea men s o he
illness as he eason o he end o he ela ionship. The ex sugges s ha
he e en is now consigned o he pas . Wi h ime, men al heal h can
eco e , and psychological balance can be es o ed by con on ing
emo ionally dis u bing issues. The p ocess o w i ing can be psycho-
logically pain ul. Howe e , h ough w i ing, one can come o ealize
ha no hing bad is ac ually happening, which helps in ole a ing
exposu e o auma ic e en s and g adually acqui ing desensi iza ion o
he auma (Lindquis , 2022).
In con as , he disease can o ge a close bond be ween he su e e
and hei lo ed ones in a new way. As illus a ed in he pa icipan ’s
exce p (P4), he pa ien pe cei es he sel as a aluable sou ce o in-
o ma ion and in e es , which pu s he own eelings in o pe spec i e.
This exce p e eals a no el app oach o iewing he pa ien , one
ha acknowledges he pe spec i e while es ablishing a di e en oun-
da ion o in e ac ion compa ed o wha she was accus omed o. The
pa icipan e lec s on lea ning a wo le els: he own insigh in o he
dynamics om a cogni i e s andpoin , and he o he pe son’s in e es in
lea ning some hing new, wi h he w i e he sel assuming a ole akin o a
Table 3
The impo ance o suppo and p esence om heal hca e p o essionals du ing he illness.
When I was in he wa d a he beginning o he illness, I el e y unsa e. I ied calling he cance nu se e en hough my wo k hou s we e o e . He came o me and lis ened o me all nigh . (P1)
Con ol isi : eeling a ease. The doc o will ake ca e o i . You can ask any hing. (P2)
A e his, needle biopsies we e aken om bo h b eas s, and she old me when hey would gi e me he answe s, and I emembe a his poin she said wo ds ha I ca ied wi h me, especially when I
was wai ing o ea men s. ‘This is no a dea h sen ence; his can be ea ed.’(P3)
This woman had ime o me and she could say exac ly wha was supposed o be said in ha momen o a sca ed, e e ish cance pa ien : ‘This ge s be e , li e goes on, e e y hing will be ine.’(P4)
Then he says ha magical ph ase ha will suppo me mo e han he e e imagined: ‘We ha e he idea he e ha we will ge you well, and i is good i you eel he same way oo.’(P6)
Table 4
In ol emen o signi ican indi iduals.
The e is a close bond in my amily. The child en al eady li e elsewhe e, bu we ha e a lo o do oge he . (P1)
I wan ed o p o ec my a he , bu i u ned ou ha he was my mos impo an esou ce du ing he ea men s, and he con inues o be. (P2)
Whene e I could, I would si a leas an hou and a hal in he cooling sauna. Some imes, my husband would come o check on me o ensu e I hadn’ ain ed he e. (P3)
Ca e, wa m h, lo e. I wish we could all be as o una e o ha e a iend like his by ou side when we un ou o s eng h. And I hope we could be his kind o iend o ou lo ed one when s/he needs
i mos . (P4)
My husband’s ac ions wa med my hea du ing my cance ea men s. E e y day, he b ough me some hing good o ea ha I migh enjoy. He was a spi i ual suppo and ook ca e o many hings.
He also kindly cu my hai when i began o all ou . He pa ien ly endu ed my “co isone hype”and b ough pain , e c. o ge he doo pain ed, and o change he doo handles, e c. wha e e came
o my mind. Child en and iends equen ly called o check on me and see how I was doing. (P5)
My pa ne ´s p esence, his genuine ca e, and his lo e we e in aluable. A ew o my iends also came when hey hea d abou i . They all ied o ins ill in me a belie in healing and good ea men .
(P6)
J. Holopainen and J. Ihanus
The A s in Psycho he apy 90 (2024) 102194
7
“ eache ”in he si ua ion.
O he w i ings also explo ed he e ec s o changes in one’s agency
(such as seeking help, losing con ol, and inc easing social ac i i y) on
ela ionships. These w i ings can be in e p e ed as showing ha he
w i e s ac i ely engage wi h hei pe sonal auma ic expe iences, po -
aying hemsel es as c ea o s and ac i e pa icipan s in hei own
na a i es a he han passi e ic ims o e en s un olding.
P esence o cance a e ea men s
The pa icipan s’w i ings e ealed ha due o hei illness and
cance ea men s, he limi a ions o hei li es became mo e angible,
and he ea o ecu ence pe sis ed (e.g., du ing ollow-up isi s).
Howe e , he expe ience o he disease and i s ea men s, along wi h
hei side e ec s, was also seen as jus one pa o li e (see Table 7).
The exce p (P6) indica es ha he w i e ’s pe sonal expe ience wi h
cance has al e ed he pe cep ion and a i ude no only owa d cance
i sel bu also owa d o he s acing he disease.
The au ho men ions an inc eased unde s anding, seeing cance now
as some hing ex e nal, "pa o someone’s li e," while also acknowl-
edging i s pe sonal na u e h ough he own jou ney. In w i ing abou
cance , main aining a sense o dis ance is c ucial o he expe ience o
being in con ol. Wha becomes meaning ul is he p ese a ion o a
cohe en , s uc u ed sel and he expe ience o being an agen o a ional
hough and an ac i e subjec o emo ions, wi hou being o e whelmed
by hem (Lindquis , 2022).
The emphasis on cogni i e ac o s, pa icula ly me acogni ion, en-
ables indi iduals o concep ualize and a icula e he subjec on a
b oade , mo e abs ac le el, os e ing in ospec ion and acili a ing a
econside a ion o one’s ou look on li e wi h empa he ic men aliza ion
(see Ihanus, 2019, 2022a).
I li e and b ea he despi e he disease
F om se e al desc ip ions o he expe ience o he disease, a heme o
su i al eme ged, ei he h ough discussing he disease o coping wi h
i s ea men . The e we e also no able e e ences o he need o pe -
sonal g ow h and de elopmen as a consequence o he illness, as well as
managing i s pos - ea men e ec s.
Coping men ali y
The su i al o coping men ali y was exp essed in he ex s as being
achie ed h ough he in luence o ex e nal ac o s, such as suppo om
close ela i es and o he s who lea ned abou he illness, as well as
h ough unc ional ac o s like unde going ea men s (see Table 8).
Telling an ou side abou one’s disease seems o make he si ua ion
mo e concei able and enables one o eel ha i is possible o cope wi h
i . The desi e o communica e abou one’s in e nal o ex e nal eali y
was pe cei ed as meaning ul. In he pa icipan s’exce p (P3), he
w i e e lec s on he momen she da ed o ell a s ange abou he
si ua ion. This momen was signi ican , and he w i e clea ly wan ed o
cap u e how ou wa d communica ion ( alking abou he illness) led o a
sense o coping. She el ha sha ing he inne eali y ( he sense o
su i al) was impo an . In ano he exce p (P6), he w i e desc ibes an
inne eali y in which eelings a ising om ac ions a e a ionally
explained.
The ea men s we e pe cei ed as a con inuum, wi h su i al being a
s ep-by-s ep p ocess. The exce p indica es ha he w i e is making
e o s o p epa e o he consequences o he ea men hus a . He
desi e o ehabili a e he sel o he nex s age o ea men shows a
commi men o unde going i and aking ad an age o he oppo uni y
o ge be e . In hese sho exce p s, one can disce n a ibu ions, pe -
spec i es, and meanings aimed a p ocessing pas expe iences and
s uc u ing wha will be expe ienced in he u u e (Lindquis , 2022).
Ini ia ion o spi i ual g ow h spu ed by he disease
Re e ences o he desi e o pe sonal de elopmen , sel -explo a ion,
ying new hings, and e lec ing on one’s alues as a esul o he
illness we e e iden in some o m in each pa icipan ’s w i ings (see
Table 9).
Men al changes induced by e lec ions on acing and expe iencing
he illness a e ollowed by a need o e lec on and w i e abou changes
Table 5
Physical/co po eal changes caused by he disease and ea men s.
My eminini y is made up o small pieces. A b eas , ano he b eas . The epai o my body o e ime. A wig se les on my head. This es ained mo emen b ings back memo ies o in a ua ion, o
alling in lo e, o eeling ca ed o . My sexuali y has been los due o he huge weigh gain. My mind hinks o he wise, bu he shell o he body is a mo e mons ous sigh . (P1)
Du ing my b eas cance ea men s, he pace slowed down. Running u ned in o walking, walking in o udging. I el bad a i s , sad, bu soon I hough I needed o slow down and gi e mysel
ime o igh he cance cells. (P2)
I looked a mysel in he mi o o a momen and hough , ‘I’m so hideous.’I hink I said i ou loud. My i s eeling was con usion—had all ha eally happened o me? Bald head, long ed sca
on he le b eas , sligh ly smalle sca on he igh . The skin on he le b eas nex o he sca was blue- ed. I made me c y. (P3)
I cu my hai e y sho and wi h a new hai s yle, i came up wi h a lo o acquain ances. I I didn’ wan o ell someone wonde ing abou my hai , I joked abou he hea and swea ing o he
summe (i had been shockingly cold!), and o people close o me, I could ell hem I was expec ing a much oughe hai s yle. (P4)
When I hink abou my illness, I emembe a lo o bad hings om he ime o he ea men s. Feeling unwell, di icul y alling asleep, swelling, dehyd a ion, e c. (P5)
Table 6
The impac o he disease on pe sonal ela ionships.
I eel a he momen ha I ha e los iends in my li e, and somehow a nice con iden ial,
elaxed way o li e. (P1)
A i s , he slep nex o me, and once I ell asleep, he would lea e. In e ospec , he
was al eady pulling away. Why? Because I was bald? Because I was sick, and my
skin was so e? Because I didn’ wan him inside me, I wan ed him nex o me? (P2)
The people a ound me we e impo an , hey could lis en and help wi hou
complaining. (P3)
He was ex emely in e es ed in e e y hing abou cance cells, cy os a ic agen s and
he body’s eac ions. I was a elie o mee someone who was cu ious and inquisi i e
abou e e y hing. No so much abou eelings and symp oms, bu ac s. Fo him, my
b eas cance was an oppo uni y o lea n some hing new. (P4)
They can be as s ong as you and may wan o sha e you bu den and be he e o
you. T us o he s o pe se e e. I may eel com o ing o hem and ce ainly o you.
(P5)
Impo an ela ionships ha e been concen a ed and e ined. (P6)
Table 7
P esence o cance a e ea men s.
Li e is indeed limi ed and sho , e en i you li e o be o e 70 −80 yea s old (when you a e heal hy). Now, wi h he illness, i has become mo e angible. (P1)
Mammog aphy always sca es in ad ance o abou a week. In mammog aphy, cool on he ou side, bu inside ea and panic. (P2)
Recu ence could cause qui e a collapse. Some imes I wonde i I su i ed he ea men s again. (P3)
My cance ca ies a high isk o ecu ence. No oncologis will di ec ly quo e pe cen ages, bu I know ha i ’s close o 50 %. So, when you ge a headache, back pain, o go o bed a nigh wi h an
uneasy hand sea ching o a new lump, e o immedia ely se s in. (P4)
I become sad when I hink abou he possibili y o he disease ecu ing. How could I go h ough he same hing again? (P5)
A whole new wo ld has opened up. I used o be e i ying o know ha someone had cance . Now, I unde s and i is jus a pa o someone’s li e. I ealize ha i doesn’ s igma ize a pe son o
de ine e e y momen o hei li e. (P6)
J. Holopainen and J. Ihanus
The A s in Psycho he apy 90 (2024) 102194
8
in one’s inne wo ld and a i ude owa d he ex e nal wo ld.
One o he pa icipan s (P2) obse es how he illness and ea men s
s opped he in he acks, leading he o e lec on wha is impo an in
li e. This obse a ion is signi ican because i e lec s on how he illness
a ec ed o he s and hei abili y o espond o he needs. I also e e s o
le ing go o he old li e alues and unde s anding he alue o being able
o unc ion, e en in small ways. Ano he exce p (P5) e lec s on pausing
o app ecia e and pay a en ion o o dina y hings ha ul ima ely ma e
mos and make li e ul illing. The ealiza ion ha hings happen and a e
no necessa ily unde one’s con ol p o ides an oppo uni y o unde -
s and and app ecia e he mundane and o en unno iced aspec s o li e.
These wo pa icipan s’w i ings demons a e some hing essen ial
abou he p ocess o ans o ma i e w i ing. Bo h exce p s embody in-
sigh s ha eme ge h ough in e ed ‘causal’explana ions, ans o ming
he li es and wo ld iews o hose who expe ience hem. In bo h cases,
he e is a s ong sense o he w i e ’s desi e and o eshape hei li es in
new di ec ions a e he s agna ion imposed by hei illness.
Li ing in con inuous in e ac ion wi h he disease
Being diagnosed wi h b eas cance a ec s one’s abili y o unc ion,
bo h physically and men ally. Pa icipan s w o e abou hei hope o
main aining hei unc ional capaci y a e eco e y, despi e becoming
accus omed o hei exis ing and esidual symp oms. E en a e
ecei ing a “clean bill o heal h,” he p esence o cance pe sis s in he
mind, epea edly causing ea and necessi a ing igilance. Exce p s
illus a ing hese sen imen s can be ound below (see Table 10).
A pe son wi h he disease has no choice bu o accep i as pa o li e.
How ac i ely one hinks abou i o how p esen i is in one’s li e, such as
when ac ing as a pee suppo pe son, can a leas in pa be sel -
de e mined. Howe e , he e is always he possibili y o elapse; he e
a e esidual physical limi a ions and a mind ha con inues o wo k
h ough he expe ience. The w i e engages wi h he expe ience o he
illness and c ea es meanings om i . The sha ed g oup p ocess o
hinking, eeling, w i ing, memo izing, and desi ing es uc u es he
pa icipan s´ongoing explo a i e and e lec i e discou ses and meaning-
making a ached o hei illness and su i al (Ihanus, 2019).
Discussion
This s udy analyzed a g oup w i ing p ocess on he expe ience o
b eas cance . The s uc u e o he mee ings and he w i ing me hods
used wi h he g oup ollowed The RES poe y he apy model. Pa ici-
pan s’w i ings we e analyzed using In e p e a i e Phenomenological
Analysis (IPA). Th ee main hemes and sub- hemes we e iden i ied.
The e we e “Being seen and hea d as a b eas cance su i o ”;“The
aces le by he disease”; and “I li e and b ea he despi e he disease”.
Pa icipan s’w i ings we e in e p e ed using The Re lec i e and
T ans o ma i e W i ing P ocess Model.
The esul s o he s udy p o ide insigh s om an in o ma ional
pe spec i e, highligh ing he w i ing p ocess as d i en by a communi-
ca i e mo i e. Unde s anding b eas cance om he pa ien ’s iewpoin
is c ucial. The e ec s o he disease and i s ea men p o oundly impac
pa ien s’li es, a ec ing bo h appea ance and physical unc ioning. The
illness also p omp s a shi in pe spec i e o he pa ien , equi ing
eassessmen o p e-diagnosis alues, ou ines, and cogni i e capaci ies.
The e o e, enhancing unde s anding o pe sonal expe iences o he
illness is aluable, pa icula ly among heal hca e p o essionals, he pa-
ien ’s close ci cles, and o he s a ec ed by he pa ien ’s si ua ion.
P e ious esea ch in e en ions wi h b eas cance pa ien s ha e
u ilized he exp essi e w i ing me hod de eloped by Pennebake
(1997). This me hod in ol es w i ing abou eelings associa ed wi h a
auma ic expe ience o 15–20 min daily o e se e al consecu i e days.
Table 8
Su i al men ali y.
Someone once said ha he o es heals. And he e’s a healing agen aken om he ees in he cy os a . I he o es had jus been cu down, I usually s ayed and smelled i . In he ea ly s ages o my
illness, I walked a lo . (P1)
When I looked a my child and saw he way he looked a me wi h con idence, I knew I wasn’ going o die om his. I ga e me s eng h, and ha powe has only g own wi hin me. (P2)
So, she was he i s pe son ou side my amily who knew abou my cance . I was eally glad ha I old he , and ha ’s when i occu ed o me ha I’m going o ge h ough his. (P3)
One o he main hough s when I hea d abou cance was ha I was hank ul i hi me. Fo una ely, i didn’ a ec my mo he , my daugh e , o anyone nea and dea o me, because endu ing a
lo ed one’s illness would ha e been much ha de han endu ing my own. (P4)
I don’ eally emembe how I old he kids abou cance and how hey eac ed. I immedia ely explained he good healing a es o b eas cance . (P5)
When I lea e he cance wa d, I eel elie ed in a way. Ano he s ep o wa d. Now I jus ha e o deal wi h he consequences and ge i o he nex ime. (P6)
Table 9
Ini ia ion o spi i ual g ow h spu ed by he disease.
New doo s opened: s udies, new ields in olun ee ing. (P1)
I changed du ing he ea men s. Time s opped. The he e and now became impo an . Being wi h people o eal became impo an . I ealized who ca ed abou me and who was impo an o me.
Du ing ea men I lea ned a lo abou iendship and us . When you’ e a aid o dying, you unde s and who wan s o be p esen in you li e. My li e alues we e ede ined. Heal h became he
mos impo an hing—being well, no being in pain, and being able o do some hing. (P2)
I am a wo hy old lady who has begun o ind he sel a such a ipe age. My new hobbies ha e been accep ed by my amily because my amily has no iced ha I am eeling be e . (P3)
I need a lo o ime o cope wi h all his. I wonde i I can become a whole pe son om my sh apnel. Bu he e is so much o be happy and li ely abou , o a leas o y o appea ha way. I eel ha
my lo ed ones a e su e ing mo e om my illness han I am. (P4)
I like o no ice he li le good hings in e e yday li e, o s op and hink abou hem, and o enjoy he eeling ha now is good! The mos impo an hing is ha e e yday li e is good. A lo o hings
happen ha you can’ do any hing abou , bu i ’s hose li le ‘mic o-momen s’ ha se hings igh . (P5)
This gi es me he abili y o see mo e clea ly wha is impo an . The need o please dec eases and he e is heal hy sel ishness, s eng h, and he cou age o say no. (P6)
Table 10
Li ing in con inuous in e ac ion wi h he disease.
Now, I can be e hink abou une al a angemen s, bu my lo ed ones s ill don’ wan o alk. (P1)
W i en s o ies abou b eas cance . I ead e e y hing ha comes up. I wan o hea o he people’s s o ies o su i al, s uggle, and g ow h. Ve y impo an and ascina ing. Maybe someday I’ll
w i e and publish some hing mysel . (P2)
A he momen I don’ hink much abou cance , p obably because I’m eeling p e y good and ha e much nice hings o hink abou . I’m so used o he side e ec s o he d ugs ha hey don’
bo he me much anymo e. (P3)
I has become clea o e he las ew yea s ha cance is no some hing you jus ‘ge o e ’( he wo d makes me ang y!), bu ha i accompanies you in one way o ano he o he es o you li e.
Fo some, i is a cons an ea , a daily eminde o yea s o p olonged medica ion; o o he s, i is new symp oms, new lumps, new ea men cycles. (P4)
The illness b ough abou a emendous men al p ocess in me ha con inues o his day. One has had o look o a balance o mind con ol o be able o con inue li ing wi h con idence, o a leas in
some way wi h peace o mind. I wish I could li e my li e o he end. (P6)
J. Holopainen and J. Ihanus