“Double awareness” in psychotherapy for patients living with advanced cancer.

Abstract

The term double awareness has been used in the context of advanced cancer to describe a person's capacity to be engaged in the world while preparing for impending death. This phenomenon holds great import for psychotherapeutic interventions geared toward those coping with a fatal illness, but research on this phenomenon has only emerged recently. The aims of this article are (a) to describe the phenomenon of double awareness and (b) to present a developing, rational model of how double awareness might be cultivated in the process of a recently developed, integrative psychotherapy called "Managing Cancer And Living Meaningfully." Task analysis method was used to guide construction of this rational model. The article integrates relevant knowledge from existential, experiential, humanistic, and psychodynamic psychotherapy related to the problem of advanced disease and impending mortality and offers a framework for future research on this important topic.

The effectivness of a strengths‐oriented therapeutic conversation intervention on perceived support, well‐being and burden among family caregivers in palliative home‐care

“…Patients with advanced cancer have also reported improved well‐being after having had the opportunity to talk about the impending death in a therapeutic conversation (Nissim et al, ). It has been argued that the phenomenon “double awareness” is achieved when the tension experienced between being alive and approaching death is tolerated (Colosimo et al, ). Therefore, participation in the FAM‐SOTC may promote the presence of “double awareness” not only for the patient but also among other family members, when given the space to express their thoughts and feelings (Wright, ).…”

“…It has been argued that the phenomenon "double awareness" is achieved when the tension experienced between being alive and approaching death is tolerated (Colosimo et al, 2017). Therefore, participation in the FAM-SOTC may promote the presence of "double awareness" not only for the patient but also among other family members, when given the space to express their thoughts and feelings (Wright, 2015).…”

Early Palliative Care: Pro, but Please Be Precise!

“…Physicians must not confuse hope with supporting false expectations or denial by conveying the impression of disease "control" [19] . Instead, realistic treatment goals and information about the availability of hospice or PC services can be understood as "double awareness" [25] . This allows patients to "hope for the best" (even a miraculous case of healing) "but be prepared for other courses".…”

“…Instead, PC issues can be introduced in a sense of "double awareness" [25] , which allows patients to get informed and prepare for the realistic (but unwanted) scenario, whilst giving them the chance for forgetting about the likely course of the disease in the meantime (or even hope for a miraculous cure from the disease). This can be referred to as "realistic preparation followed by temporary denial".…”

Existenzielles Leiden und sinnbezogene Interventionen

“…B. die Sicherstellung hochgradiger Flexibilität des Settings angesichts der schweren Krankheitsphasen dieser Patienten und schließlich CALM-spezifische Wirkmechanismen, nämlich die Verhandlung von Sinn und Bestimmung, die Stabilisierung des Bindungssystems sowie die Erarbeitung einer Toleranz doppelter Bewusstheit. Das Potenzial für Doppelte Bewusstheit wird charakterisiert durch die Fähigkeit, entsprechend den Anforderungen der aktuellen Situation flexibel zwischen diesen multiplen Ich-Zuständen, die Lebens-wie Sterbethemen betreffen, hin und her zu wechseln (16). Die klinische Anwendbarkeit dieses Therapieansatzes und seine Akzeptanz bei den Patienten ist ausgesprochen hoch (38).…”