Objective: To describe some clinical issues encountered in individual and group therapy with women with metastatic breast cancer.
Conclusions: The pressure to 'keep positive' poses dilemmas for patients and therapists alike, whether in individual or group therapy. The basis of skilled supportive care rests on the ability of therapists to assist patients and their families to face death rather than avoid it. Paradoxically, facing issues of death and dying leads to a greater sense of control, and empowers patients to reorder life's priorities, thus improving quality of life and relationships. In addition to the obvious need to detect and treat illness such as depression, working with women with metastatic breast cancer requires flexibility on the part of the therapist to adapt to her physical state of health, to include partners and family members where possible, and to liaise with colleagues in the treating team to facilitate communication and understanding of specific difficulties that may be encountered.