1. An action research on the Intimacy Relationship Group counseling with breast cancer patients and their partners: Description of the development of a group project Presenter: Li, Pei-Yi, Associate Professor Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan 16th Reach to Recovery International Breast Cancer Support Conference /16th RRI Conference

2. Introduction  Collaboration between Taipei Counseling Psychologist Association/TCPA and Taiwan Breast Cancer Alliance/TBCA  Started with a continuing education course － Practicum on medical counseling, hosted by TCPA in 2009  The practicum included: individual counseling with breast cancer clients and group counseling with breast cancer patients and their partner (referred to as “the couples” in the following presentation)

3. Method  In order to promote the psychological well-being of breast cancer patients and the sense of intimacy between the couples  The invited couples participated in the Intimacy Relationship Group/ IRG after informed consent was obtained from each member

4. Method  Two IRGs were held respectively in Dec. 2009 and Sep. 2010.  The first workshop was held on three consecutive Sundays (18 hours in total).  The second workshop was held on Sat. and Sun. in one weekend (13 hours).  There were six couples in the first workshop and five couples in the second workshop. No couple participated in both workshops.

5. Theoretical Background of the Group Project  According to Manne & Badr (2008), “the relationship intimacy model of couple adaptation to cancer”  Relationship-enhancing behaviors: reciprocal self-disclosure, partner responsiveness, relationship engagement  Relationship-compromising behaviors: avoidance, criticism, and pressure- withdraw

6. Group Goals 1. To improve communication and interaction between the couples 2. To reduce the impact of breast cancer on the intimate relationship of the couples 3. To promote intimacy between couples

7. Activities to improve communication and interaction between the couples  “How nice of my partner”—to introduce the virtues of one’s partner  “Our story of love”—to create a storybook based on their romance by art materials  “Have I ever told you about…”—to show by painting the experiences of caring and being cared

8. Activities to reduce the impact of breast cancer on the intimate relationship between the couples  “Intimate dialogue” — to share the experience of being a BC patient and being a caregiver  “Journey of having breast cancer” — to create by art materials a four-stage journey that describes how the couples cope with BC

9. Activities to reduce the impact of breast cancer on intimate relationship between the couples  “Sculpture of breast cancer” — to create a sculpture of breast cancer with clay and, after discussion, to reshape it to a candleholder and to pray  “How about our sexual life?” — to share the impact of BC on their sexual life

10. Activities to promote intimacy between the couples  “Comfortable massage”– to receive a gentle massage from one’s partner  “Take a walk hand-in-hand”—to walk hand-in-hand peacefully in a garden

11. Most helpful activities  Goal 1 --“Our story of love”  Goal 2 --“Journey of having breast cancer”  Goal 2 --“Sculpture of breast cancer”  Goal 3 --“Comfortable massage”  Goal 3 --“Take a walk hand-in-hand”

12. Satisfaction with the workshop project  The average score of satisfaction obtained in the second workshop is higher than that in the first workshop, suggesting that the members in the second workshop were more satisfied with the group than those in the first workshop.

13. Applicability to breast cancer couples Members reported that activities could help them achieve the three goals of the group

14. First goal To improve communication and interaction between the couples In groups ：  Communication and empathetic understanding were improved.  Patients realized that their partner really cared about them and their relationship.  Members felt the love of their partner through massage.  The couples re-experienced their deep love for one another like in the old days, when they took a walk hand-in-hand.

15. Second goal To reduce the impact of breast cancer on the intimate relationship between the couples  Patients gradually accepted their body image through the process of the group.  The couples openly shared the usually unspoken difficulties of their sex life.  The couples discovered the impacts of breast cancer on their intimate relationship and transformed the negative impacts by the activity “Sculpture of breast cancer”.

16. Third goal To promote intimacy between the couples  Many activities provided the opportunities to facilitate interaction between the couples, such as verbal and non-verbal communications, art creation, etc.  Those activities did promote intimacy between the couples.

17. Results: Effects of IRG for the couples  Patients who had been given the diagnosis for more than a year were more suitable to join IRGs with their partner for following reasons: 1.their physical condition was more stable after cancer treatment. 2.the couples faced many intimate issues during this period of time. 3.the impacts of cancer treatment started to emerge  Evidence suggested that IRG had short- term effects on the couples, but further research is needed to determine whether it has longer-term effects.

18. Limitations of and challenges facing IRG  Under-explored intimacy issues outside IRG could influence the group dynamics, e.g. extra-marital affairs.  Personal issues could also influence the group dynamics, e.g. depression, suicidal ideation, sense of inferiority.  Partners (males) of breast cancer patients lacked motivation to participate the group. They resisted joining the group and didn’t think it could be helpful.  Challenges presented to and curiosity toward the leader, e.g. marriage, intimate relationship, etc.

19. Suggestions  Forms of group: long-term group, psycho-educational group, experience- oriented group  Project design should take into account gender differences, and different needs of patients and their partners. Do not neglect the needs of partners.

20. Suggestions  Regarding sex issues of the couples and body image, we need to approach those in a culturally-sensitive way. Verbal expression in group may not be the best way to deal with sex issues in Chinese culture.  Individual counseling and couple therapy are recommended after IRG.  The screening of couples is very important. Don’t skip the step before the group begins.

21. Thank you for your attention!