A pilot study evaluating feasibility and acceptability of a psychosexual intervention for couples post-allogeneic haematopoietic stem cell transplantation

Intervention The pilot intervention will comprise two components: 1) Psychosexual education about medical and behavioural treatment options for sexual dysfunction 2) EFT-based relationship education program for couples Psychosexual Education A 60-minute individual psychosexual education session will be delivered to couple participants by a specialist nurse. This session will include information about medical and behavioural management of sexual dysfunction (including the use of hormone treatment, topical treatments, lubricants and vaginal dilators for women, and PDE5 inhibitors). The session will be delivered using the PLISSIT model (i.e., Permission, Limited information, Specific Suggestions and Intensive Therapy model). Emotionally Focused Therapy (EFT) -based relationship education program for couples The couples’ relationship education program will comprise four 90-minute sessions and be delivered fortnightly over 8 weeks to each couple by a clinical psychologist. It will use an EFT framework, aimed to assist couples in building and enhancing the attachment bond to improve the quality of their relationship and enhance sexual intimacy. The intervention material was adapted from three EFT resources developed for couples (listed below), and modified to make it relevant to the HSCT population. In Session 1, the goal will be to establish an alliance with the couple, to introduce the program and to allow each of them the opportunity to talk about the different ways that cancer and the HSCT has affected their relationship. Session 2 will focus on identifying negative interactional cycles and attachment vulnerabilities within the dyad that trigger such interactional patterns. The session will help couples to access underlying emotions supporting the reactive moves in the cycle and then reframe the problem in terms of the negative cycle (rather than each other). The couples will also be taken through an explanation about different types of vulnerable emotions that can trigger negative interactions as well as ways to communicate more effectively. Session 3 will assist the couple in sharing fears and needs with each other in a manner that helps their partners respond to them. This will facilitate the deeper expression of attachment emotions and needs, creating more open emotional engagement within the couple. In addition, psychoeducation regarding the impact of cancer and HSCT on the sexual relationship will be provided. Session 4 will aim to elicit discussion about the couple’s sexual relationship, including previously formed perceptions of self, other and the relationship, and how this can be related to sexual intimacy. Other topics of discussion will include adopting a flexible view of sexual intimacy after disease and treatment stressors and practical ways to continue to nurture the relationship moving forward. Finally, an overview of sessions will be provided. This EFT intervention aims to equip couples with skills to establish a more secure bond and create new positive interactions within the dyad, in the context of living with a haematological cancer and undergoing an intense treatment. Participants will be provided with written information to support the interventions sessions. The information was adapted from “Hold Me Tight: Conversations for Connection” by Sue Johnson and “Healing Hearts Together Relationship Education Program” by Dr Heather Tulloch, Dr Paul Greenman, Dr Natasha Demidenko, and Dr Sue Johnson and “An Emotionally Focused Workbook for Couples: The two of us” by Veronica Kallos-Lilly and Jennifer Fitzgerald. A Case Report Form will be used by the project team to assess referral rates into the study, uptake of the intervention and patient adherence to the intervention. In particular, data will be collected regarding number of patients who were referred to the study, those that refused intervention despite meeting eligibility criteria, and number of intervention sessions completed. The clinician administering the treatment will also complete a session checklist after each session.