New Form of Psychotherapy Might Ease Emotional Suffering of Terminally Ill Cancer Patients

Pictured: At Eternity’s Gate by Vincent van Gogh

Vincent van Gogh completed this oil painting, called “At Eternity’s Gate,” a few months before his death, while recovering from a critical relapse in his health.

“Finding a sense of meaning is always possible — even during the final months, weeks, and days of our lives,” says psychiatrist William S. Breitbart, Vice Chair of Memorial Sloan Kettering’s Department of Psychiatry and Behavioral Sciences.

In a recent study, Dr. Breitbart and his colleagues found that people in the late stages of cancer might benefit from meaning-centered psychotherapy, a treatment aimed at helping patients sustain and enhance a sense of meaning, purpose, and peace.

Published in the April 20 issue of the Journal of Clinical Oncology, their findings show that the therapy, which involves talk sessions and contemplation exercises, can temporarily improve the quality of life of terminally ill patients.

Finding Meaning and Purpose toward the End of Life

Dr. Breitbart explains that meaning-centered psychotherapy was developed to fill a void in the area of palliative cancer care, as not much research had explored support for terminally ill patients in dealing with loss of meaning and spiritual well-being.

“During their final weeks or months of life, many of our patients suffer from feelings of despair, demoralization, and hopelessness, which in extreme cases can lead to a wish to end one’s life sooner,” he explains. “Our studies have shown that such distress often is related to an existential crisis people struggle with at the end of their lives, when questions emerge about mortality and the ultimate value of our existence.”

Helping people develop and maintain a sense of purpose might be an effective way to alleviate this type of suffering – within or outside a religious context, Dr. Breitbart notes.

The study enrolled 120 people with late-stage tumors who were being treated at Memorial Sloan Kettering, and who had six months or less left to live, according to the prognosis given by their physicians. Patients were randomly selected to receive seven sessions of meaning-centered psychotherapy or massage therapy. Those receiving psychotherapy met for one hour with a therapist to explore personal sources of meaning such as love, relationships, and work, and to talk about universal themes such as hope, legacy, and the impermanence of life.

After their last treatment session, people receiving meaning-centered psychotherapy reported an improvement in their quality of life and spiritual well-being, and also reported feeling less burdened by physical symptoms such as pain. In contrast, no significant benefit was observed in patients receiving massage therapy.

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Individual and Group Therapy for Patients, Survivors, and Caregivers

Dr. Breitbart and his colleagues have developed different models of meaning-centered psychotherapy for individuals as well as groups of eight to ten patients. The current study focuses on the individual model, which is more suitable for people with terminal disease.

Additional studies are now under way to validate the benefit of meaning-centered psychotherapy for a larger group of patients with advanced cancer. Memorial Sloan Kettering researchers are also adapting the therapy for people who are not terminally ill — including cancer survivors and caregivers — but who may be experiencing a decline in spiritual well-being.

Dr. Breitbart says his research on meaning-centered psychotherapy has been influenced by the work of the late Viktor Frankl, an Austrian psychiatrist and neurologist. In his famous 1946 book titled Man’s Search for Meaning, Dr. Frankl, a Holocaust survivor, argues that life never ceases to have meaning, not even in the face of intense suffering and death.

“My experiences caring for people with terminal disease have taught me the same,” Dr. Breitbart affirms. “I never cease to be amazed at the clarity with which dying people are capable of viewing their lives in light of what ultimately has mattered to them the most.”

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I was surprised when I read this was a "new form of psychotherapy" because being familiar with Victor Frankl and his School of Psychiatry, it is actually not new at all, but perhaps "revived" might be a better way to describe it. I was also surprised since it was being touted as "new" to see Dr. Frankl's name given credit way down at the bottom of the article almost in an incidental way when he (underline he) was actually the originator of this kind of therapy. Frankl should have received credit much earlier in the article in order for it to appear as truly authentic. Aliza1, MLS (Master of Library Science)

Aliza1, thanks for your comment. We shared it with Dr. Breitbart and he said, “Our intervention was truly inspired by the writings of Victor Frankl and his observations of the importance of meaning in human existence — a concept upon which he developed a specific form of psychotherapy called logotherapy for physically healthy individuals. But meaning-centered psychotherapy is not the same as logotherapy. Rather, it is a structured educational and experiential counseling intervention, specifically directed toward the goal of helping patients with advanced cancer sustain their sense of meaning and hope in the face of limited time.”

Requesting suggested readings.

Dear Suzan, we sent your inquiry to Dr. Breitbart and he responded:

“If you are interested in reading more about meaning-centered psychotherapy (MCP), a good alternative to reading the scientific papers describing the clinical trials done at Memorial Sloan Kettering, I suggest reading Viktor Frankl’s “Man’s Search for Meaning”. Dr. Frankl’s work on the importance of meaning in human existence and the availability of sources of meaning such as work, love, legacy and one’s choice in how one responds to adversity was the source material I used in developing AMCP for cancer patients. Dr. Frankl developed a therapy he called “logotherapy”, but he intended it for, and it is primarily used to treat healthy people who are struggling with finding a sense of purpose or meaning or direction in their lives. We took some of Frankl’s basic ideas about meaning and created a Meaning-Centered Psychotherapy for cancer patients. So, Frankl’s “Man’s Search for Meaning” ( it’s easily available on Amazon or ibooks or book stores in 57 languages) is a great place to start in trying to understand the basic ideas of MCP.”

Thank you for your comment.

I should have explained that I read Frankel before I was diagnosed. I found that his sense of meaning came from his working as a doctor to fill the time and his belief and hope of being reunited with his wife again (unaware that she was dead his was a false hope). I found this inappropriate at the time and even more so now. He had meaning and hope of continued life with his wife, but for those of us facing certain death by cancer where is the hope.

Greetings. I learned about your work while attending a caregiver group at the Wellness House in Hinsdale, IL, and I would like to get involved in this.
I am a nurse 40 years experience, lastly as a hospice nurse case manager. My son is going through treatment again, and I would like us, and our family to build more meaningful experiences.
Thanks, and take care,

Dear Janice, we recommend that your son make an appointment with a psycho-oncologist who offers this type of meaning-centered therapy. Perhaps his oncologist can provide a referral to someone where he’s being treated. Thank you for reaching out to us.

I am just at a talk in Canada that mentioned your work. They said there was a training course for doctors through your organization to learn how to use this therapy with patients. Coudl you send me the info on this course? Thank you!
: ) Alyssa Boyd