Negotiating the traumatic impact of cancer
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It is well established that cancer can precipitate psychological morbidity, including Post Traumatic Stress Disorder (PTSD), in patients. Recent research has shown that the impact extends beyond the individual to create stress and even secondary traumatization in the partner of the patient. However, very few studies have looked at how the couple dyad as a whole is impacted by the diagnosis and course of illness. Furthermore, the research that has been conducted in this area, generally does not explore how the individual and couple are intertwined during their struggle. The current study explores the manner in which individuals and couples mutually negotiate the traumatic experience of cancer. The theory of the dialogical self (DS) and semiotic mediation (SM) are applied in a grounded theory research paradigm to analyze the experiences of 14 couples that have survived cancer. Subjects were interviewed using a semi-structured interview process that explored the experiences of both partners as well as the couple dyad. Four theoretical constructs emerged: 1) Cancer raises uncertainty, which ruptures the dynamic stability of I-positions that mutually constitute the individual and couple 2) Dynamic stability is sought in the dialogical self via semiotic regulation of I-positions 3) The relational matrix fosters dynamic stability through the reorganization of the couple dyad and heteroregulatory semiotic mediation of I-positions, and 4) Innovation is achieved through the development of new I-positions and the reorganization of dialogical relations in the dialogical self and couple dyad. These findings suggest that the individual and couple dyad adapt to the trauma of cancer through the regulation of signs that link the dialogical self with the other (i.e., SM). This model offers a perspective on trauma that underscores the relational nature of the self and offers new insights into the regulatory processes that individuals and couple dyads engage in when confronted with cancer.