Reflective writing about breast cancer experiences as part of an interactive poetry therapy group process

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY 4.0 h ps://c ea i ecommons.o g/licenses/by/4.0/ 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 © 2024 The Au ho (s). Published by Else ie L d. Published e sion Holopainen, Johanna; Ihanus, Juhani Holopainen, J., & Ihanus, J. (2024). 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. A s in Psycho he apy, 90, A icle 102194. h ps://doi.o g/10.1016/j.aip.2024.102194 2024 The A s in Psycho he apy 90 (2024) 102194 A ailable online 17 July 2024 0197-4556/© 2024 The Au ho (s). Published by Else ie L d. This is an open access a icle unde he CC BY license (h p://c ea i ecommons.o g/licenses/by/4.0/). 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