Charles A. Foster is a 2012 graduate of the PhD Program in Leadership and Change at Antioch University


holding environment, health care, adaptive change, psychosocial transitions, breast cancer, grounded theory, leadership, organizational change, neoplasms, Winnicott, cancer survivors, survivor, social support, qualitative research, leading change, healthcare

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The holding environment concept, developed by Donald Winnicott, has been used to represent the type of support that encourages adaptive change during psychosocial transitions. The leadership and change literature posited that the holding environment had the ability to shape the trajectory of the transition, yet did not test this empirically. The psychosocial breast cancer literature empirically researched support during and after treatments ended, but did not incorporate the holding environment concept. This presented the opportunity to inform both the leadership and breast cancer fields by studying holding environments in the breast cancer setting. This study had a twofold purpose: 1) to explore empirically the adaptation process using the context of the breast cancer psychosocial transition, and 2) to consider if the holding environment concept, as it is used in the leadership literature, is supported by the results of this study. Grounded theory methodology was used to interpret interviews, diaries, and observation data gathered from breast cancer survivors during the after treatment transition period. This study presented the grounded theory categories in two organizing frameworks, a transition phase diagram and a person-environment situating diagram. The results suggested that the leadership adaptive change literature should integrate an understanding of coping and searching into organizational change interventions. In addition, incorporating the social interaction represented by situating would enrich any attempts to intervene in adaptive change, including the psychosocial breast cancer literature. The electronic version of this dissertation is at Ohiolink ETD Center