Psychosomatics and Psychotherapy—Focus on Psycho-Oncology: Expert Interview with Dr. Claudia Plenge

Dr. Claudia Plenge, M.D., is an experienced specialist in psychosomatic medicine and psychotherapy with particular expertise in psycho-oncology. As medical director of the CuraMed Acute Care Clinic in Allgäu, she brings not only in-depth professional knowledge but also a deep understanding of her patients’ needs to their care. The clinic, which opened in 2022 in the idyllic surroundings of the Allgäu region in Württemberg, offers a modern yet comfortable environment specifically designed to support the healing process.

Under Dr. Plenge’s leadership, the CuraMed Acute Care Clinic Allgäu has established a broad range of treatments covering mental and psychosomatic disorders such as depression, burnout, post-traumatic stress disorder, chronic pain, and many others. A particular focus for Dr. Plenge is psycho-oncology, a new area of specialization at the clinic since April 2024. Here, patients facing the emotional challenges of cancer receive comprehensive care. Dr. Plenge relies on individually tailored therapeutic approaches, which may include both individual and group psychotherapy sessions as well as innovative methods such as mindfulness-based therapies, therapeutic archery, therapeutic boxing, and animal-assisted interventions.

The holistic approach of Dr. Plenge and her team is based on a biopsychosocial model. This approach takes into account not only the physical health of patients but also their emotional and social well-being. Dr. Claudia Plenge stands out not only for her professional expertise but also for her empathetic and patient-centered approach. With her commitment to innovative therapeutic concepts and her tireless dedication to her patients’ recovery, she has had a decisive influence on the CuraMed Acute Care Clinic in the Allgäu region and sets standards in psychosomatic and psycho-oncological care.

The editorial team of the Leading Medicine Guide spoke with Dr. Claudia Plenge and learned more about the psycho-oncological services offered at the CuraMed Acute Care Clinic in the Allgäu region and how important they are for patients.

Psychosomatic factors play a central role in the interplay between the mental and physical health of cancer patients. A cancer diagnosis represents not only a physical but also an immense emotional burden. Stress, anxiety, grief, and other intense emotions triggered by a cancer diagnosis can weaken the immune system and negatively impact the healing process. At the same time, physical symptoms such as pain, fatigue, or side effects of cancer treatment can severely impair mental health and increase the risk of depression or anxiety disorders. In this complex interplay, psychotherapy offers valuable support. 

“In principle, there are psychosomatic connections in all diseases; here at the CuraMed Acute Care Clinic, we naturally focus specifically on the field of psychosomatics, which is not the case in all areas of somatic diseases. That is also why the specialization as a board-certified physician in psychosomatics has not existed for very long. The realms of the psyche and the somatic have been viewed separately from one another for far too long. This is of increasing importance for oncology patients. In the past, for example, a cancer diagnosis was usually a death sentence, but today many cancers are chronic conditions. Thanks to improved diagnostic methods, even very small tumors and markers can now be detected. In addition, there are better treatment approaches, longer survival times, and improved prognoses. “Patients who, for example, are diagnosed with prostate cancer at age 65 undergo surgery and then receive hormone therapy, which allows them to live past the age of 80,” explains Dr. Plenge at the start of our conversation, adding:

“Cancer patients today need a completely different kind of care. Because at the time of diagnosis, the immediate focus is on survival, but despite all treatments, the emotional aspect always lags behind. This is because both a cancer diagnosis and the treatment have a profound psychological impact on well-being. Almost all patients have intense fears of a recurrence, which persist from the very beginning and often continue for years after the initial diagnosis. From a purely physical standpoint, the patients are cured, but they are still psychologically overwhelmed by the entire illness and treatment. Although more and more cancer centers now offer psycho-oncological services, patients are not yet open to them during the acute phase of treatment—which involves surgery, radiation, and chemotherapy—because they are first and foremost struggling with survival, the necessary procedures and anesthesia, and the potential side effects of medications. In recent years, it has become increasingly recognized that psycho-oncological care is necessary well beyond the stage of acute diagnosis and treatment. Particularly in the fields of gynecology, oncology, and general medicine, a basic understanding of psychosomatics is of great importance, so it is encouraging that participation in a course on “Basic Psychosomatic Care” has also been included in the curriculum for these specialty training programs.

The recommendation for the appropriate treatment following a cancer diagnosis must be discussed on a case-by-case basis with the patient. 

“Within the context of primary care diagnosis, this is generally easier because the doctor and patient often know each other well. Ultimately, it is important that the patient decides how to proceed with treatment. This makes the patient an expert on their own illness and prevents them from feeling at the mercy of others or helpless. After all, it is not just about the patient’s body, but also about their mental well-being. In addition, social issues arise regarding the ability to work, professional capacity, financial security, etc., which, unfortunately, are all too often overlooked, so that patients receive insufficient support in these areas. The essence of psycho-oncology is not to prevent or cure cancer, but to maintain or restore quality of life. Here, resources must also be considered: What can be expanded? Who can be involved to help restore quality of life? All of this contributes to coping with the disease. This includes, among other things, providing patients with sufficient information through psychoeducation and helping them develop acceptance of their situation without remaining stuck in fear. “After all, a cancer patient will always remain a cancer patient, even if they are cured, because the diagnosis and the treatments they have undergone mean they have a different risk profile than someone who has never had cancer,” explains Dr. Plenge.

Therapists in psycho-oncology face diverse and complex challenges that vary depending on the stage of the cancer. Each stage brings specific emotional, cognitive, and social stresses that must be addressed individually.

Many patients are confronted with intense fears, existential questions, and a sudden realization of their own mortality. The therapist’s role is to create space for these feelings, validate them, and help the patient process the diagnosis without becoming overwhelmed. “Every patient reacts differently here. There’s anger, there are tears, and there’s fear. That’s perfectly normal, because each person unconsciously chooses their own personal coping strategy, shaped by their past experiences, and you have to let the patient have that. The psycho-oncologist’s role is then to stay engaged. The patient determines the course, duration, frequency, and topics, and our job is to keep offering support and signal our availability, even if the patient repeatedly declines it. It’s helpful to involve family members in the process, of course, in whatever way the patient prefers. It’s always important not to downplay fears or “catastrophize” them, but rather to always conduct a realistic assessment, explain the medical aspects in an understandable way, and give the patient the feeling that they’re in control. “Even if the patient decides against a potentially promising treatment and the family is opposed to it—the patient decides what to do and what not to do,” comments Dr. Plenge at this point. 

During treatment, the focus may be on helping patients cope with physical challenges such as pain or side effects of therapy, as well as on coming to terms with the loss of control that many patients experience. At the same time, conflicts between personal life goals and the limitations imposed by the disease often need to be addressed. In the follow-up phase, once active treatment is complete, feelings of emptiness, uncertainty about the future, and fears of a relapse often arise. Patients often expect a return to normalcy, which can be complicated by physical or emotional long-term effects. Here, therapists must guide the transition to a “new normal” and help patients accept the ongoing presence of the disease in their lives. “During such a phase, a patient often suddenly feels the need to talk about grief and death. Here, you have to be there for the patient and also be open to potentially spiritual aspects,” emphasizes Dr. Plenge, describing the overall course of therapy at the CuraMed Acute Care Clinic:

“I typically treat patients at the CuraMed Acute Care Clinic over a period of six to eight weeks. Unfortunately, the current system is organized in such a way that hospitals always aim for the shortest possible stays for patients. As a result, a large portion of the necessary psycho-oncological care is lost due to the catastrophic state of outpatient care. However, for patients—whether privately or publicly insured—a so-called F-diagnosis (psychiatric diagnosis) is usually required to obtain coverage for outpatient and/or inpatient psychotherapeutic treatment, with breast cancer being the only exception here. Here at the CuraMed Acute Care Clinic Allgäu, we do not offer the type of oncological rehabilitation that is typically provided following cancer treatment. My focus is not on helping people return to work—which is the goal of standard rehabilitation—but rather on helping patients regain their courage, joy, and will to live. The stay at my clinic is an acute inpatient stay in a psychosomatic-psycho-oncological setting. In general, it’s beneficial for patients not to be sent home immediately after an acute episode—partly because there’s usually a significant deficit in somatic and physical abilities. That’s why it makes sense for them to have a transitional period to support their recovery. In “normal” rehabilitation, however, patients are typically processed through the system in three to four weeks. During this time, through contact with other patients, the individual experiences all stages of cancer, hears about recurrences, sees patients suffering hair loss from chemotherapy, and so on—which is a very heavy burden. “It is therefore entirely understandable that patients do not want to put themselves through this and prefer to go home, to their safe space, to avoid these confrontations,” Dr. Plenge explains.

Challenges in psycho-oncological care and rehabilitation for cancer patients.

“A maximum of eight out of a total of 37 patients can participate in the psycho-oncological therapy we offer in-house. This is because we do not ‘segregate’ these patients as cancer patients, but rather fully integrate them into the care process alongside all other patients. They participate in all therapies alongside the other patients. In addition, they receive individual psycho-oncological therapy as well as group therapy together with the other cancer patients, since interaction among those affected is very important. During these six to eight weeks, I am available to the patients not only as a psychotherapist but also as a physician. This is because many patients do not understand most of the medical reports they receive and, in some cases, are not even aware of their exact health status. An important part of psycho-oncological therapy is always dealing with fears, which is addressed, among other things, through behavioral therapy. This also involves addressing issues related to possible physical impairments, the potential loss of sexual function, social interactions, and self-esteem. “If a patient already has a pre-existing condition and is therefore psychologically vulnerable—perhaps already suffering from depression or an anxiety disorder—then the range of treatment options naturally expands. This patient may also require medication or trauma therapy,” Dr. Plenge explains.

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The “F” in an F-diagnosis comes from the ICD-10, the International Classification of Diseases. It stands for mental and behavioral disorders. Every condition in this category is assigned a specific number, e.g., F32 for depression. In medicine, various letters are used to classify groups of diseases—“F” denotes mental disorders.

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In psycho-oncology, the connection between emotional well-being and the course of the disease is intensively researched and utilized therapeutically. Numerous studies show that emotional states such as chronic stress, anxiety, or depression can negatively influence the course of cancer. 

“When it comes to the possible development of depression, I first need to review the patient’s medical records to determine whether it is a reactive depression resulting from a cancer diagnosis or whether the depression was already present before the diagnosis. I then conduct a standard medical history of the patient, including a physical, psychological, and medication history. Based on the information gathered, I can form a comprehensive picture of the situation. Sometimes a cancer diagnosis can trigger something the patient has experienced before, and in that case, as a trained depth psychologist, I would focus my approach here. Even medically necessary examinations can reawaken unresolved negative experiences and lead to intense reactions that are initially difficult to understand. However, through a depth-psychological approach, such unresolved traumas can be brought to the surface and then treated,” explains Dr. Plenge.

Family members often play a vital role as the patient’s primary support system, yet they, too, are confronted with the emotional challenges of cancer. In such cases, therapy offers support not only to the patient but also to family members, helping them learn to better cope with their own fears and concerns and to support the patient in a healthy way.

“Of course, it’s often the case that family members or the patient’s partner suffer greatly as a result. It’s very important to at least offer the possibility of help in such situations. Fundamentally, family members and the patient’s social contacts play a significant role. This can work in two opposite directions. On the one hand, they can provide stability by treating the patient with great understanding and offering help; on the other hand, they can be perceived as a burden by the patient if, for example, the patient is blamed by those around them or pressured regarding treatment. In both cases, it makes sense—with the patient’s consent—to involve family members in the therapy. Here, it is often helpful to form support groups for family members to provide guidance on how best to support the person with cancer. After all, we must not forget that the entire family structure can be affected. For example, if there are young children at home but the mother is ill, the father is left to handle everything alone, may feel overwhelmed, and needs help. Sometimes this “simply” involves organizing social services or hiring a housekeeper. Questions also arise from the children, which I answer with great openness and transparency—but in an age-appropriate manner—or I consult a child psychologist. A spouse must also be made to understand that, in such a case of illness, one must think in the medium and long term, including purely financial considerations. “This isn’t something that’s over after a few weeks,” says Dr. Plenge regarding the family situation.

Mindfulness and fostering resilience are central elements in psycho-oncology, as they help cancer patients cope with the psychological and emotional stresses of the disease and better manage the challenges throughout the course of the illness. 

Both approaches play an important role in supporting mental health and help stabilize patients’ emotional well-being, which can have a positive impact on the overall healing process. Mindfulness, understood as the ability to experience the present moment without judgment and with full attention, is used in psycho-oncology to help patients regulate their thoughts and emotions. This practice helps patients recognize and accept negative thought patterns and fears often associated with cancer, rather than suppressing them or allowing them to overwhelm them. 

“There are various pillars of therapy. First, there is talk therapy—whether individual or in group settings—on topics that affect everyone. Then there are the specific psycho-oncological issues that are addressed on an individual basis. All of this is part of psychoeducation, because many patients simply aren’t familiar with many aspects of the medical side of things and often don’t feel comfortable asking questions. Here, too, interacting with others going through the same experience is important, because they realize that others are in the same boat and that they aren’t alone with their thoughts and problems. Patients often learn from one another—this is what’s known as learning by example—and consider whether what another patient has done might also be an option for them. Here at the CuraMed Acute Care Clinic, I run open groups rather than disorder-specific groups. This way, patients also see that other patients emerge from therapy after six weeks feeling much stronger. A major contributing factor here at the clinic is the distance from home, which helps patients internalize a different perspective. In addition to our core offerings of talk therapy, we provide dance/body therapy, which primarily helps patients who have lost trust in their bodies or access to their bodies and emotions—such as joy. Our creative/art therapy stimulates patients’ intuition and creativity for things that cannot be put into words but need their own space. Emotion-focused and experiential therapies are about accessing one’s own resources. For example, therapeutic climbing on our clinic’s own climbing wall is also about regaining trust in oneself, in one’s own body, and in other people. Patients have the opportunity to discover how they can still successfully climb the wall even with limited strength. “It’s about learning to pace oneself and use one’s strength wisely,” explains Dr. Plenge, adding:

“A clear daily structure is important. That’s why we offer activities even before breakfast to motivate patients for the day ahead. Of course, it’s about physical fitness and the musculoskeletal system, but it’s also about connecting with oneself to train body awareness. This is important because there are patients who feel nothing but pain. Our meditation, yoga, and qigong programs also help in this regard. In addition, we offer pleasure training and therefore have a very high-quality kitchen to demonstrate that eating can be enjoyable again and isn’t just about consuming food. All of this also serves to strengthen resilience, which can be regained and further developed. It’s important for patients to move away from passivity and, if possible, from a victim mentality. The question here should not be “Why me?” but rather, “What now?” This sense of self-efficacy must be cultivated in order to regain a positive outlook on life—one that, while it cannot prevent a recurrence, can improve quality of life. It is therefore very important that psycho-oncology be integrated even more into hospital tumor boards and that its importance within oncology be expanded. In turn, psycho-oncology training should incorporate a greater medical component, and better collaboration between oncologists and psychologists would be important. Above all, however, I would like to see an expansion of psycho-oncological services in outpatient care and greater willingness on the part of health insurance companies to cover these costs. After all, ultimately, a comprehensive range of services can prevent patients from experiencing such a deep psychological decline. Many patients can be helped much earlier.” With this appeal, we conclude our conversation.

Thank you very much, Dr. Plenge, for this empathetic insight into the important and necessary work of psycho-oncology!