Living in the shadow: a personal construct model of adjustment to breast cancer survival and tests of its clinical usefulness

This research demonstrated the contribution that personal construct theory makes to understanding women's experiences of breast cancer, and based on this understanding, showed how to effectively support these women as they adjust to the ongoing task of living as breast cancer survivors. To achieve this aim a personal construct model of women's adjustment to breast cancer survival was developed. Study 1, a qualitative study, was conducted with focus groups and individual interviews to elicit from the participants (n =59) their major concerns. The findings showed that breast cancer survivors live with threat to their core understandings about themselves, their relationships, and their ways of being in the world. Study 2 (the Retreat study) examined the role of validation of current meanings, and Study 3 (the group therapy study) evaluated validation and elaboration of new meanings on women's levels of emotions. Study 2, with 40 breast cancer survivors, showed that validation of current meanings alone is not enough to effect lasting improvement in women's levels of threat to their physical and psychological integrity, threat to existence, dislocation, or in levels of hope. Study 3 evaluated personal construct group therapy with 42 breast cancer survivors. The findings showed that the group therapy, providing opportunities for women to have their current meanings confirmed, and to elaborate new and more helpful meanings, resulted in significant initial decreases in threat, threat to existence and dislocation, and gains in levels of hope, which were maintained at the three month follow-up. The limitation of this series of studies, suggestions for future research on the mediational processes of adjustment to breast cancer survival, the usefulness of the personal construct model, and the clinical implications of the research, are discussed.