I work as a counsellor/psychotherapist in the Breast Care Unit of the NHS. Here are some thoughts I would like to share about my experience to help people who have relatives, loved ones, or friends with cancer.
My approach to supporting breast cancer patients
Cognitive-behavioural therapy (CBT) is a widely recognized psychotherapy approach for breast cancer patients that can help address their negative thoughts and emotions. It can help patients challenge their catastrophic beliefs and reframe their thinking about their diagnosis and treatment, which can lead to improved emotional well-being and quality of life. CBT techniques can also help patients cope with the physical symptoms of treatment, such as pain and fatigue, through relaxation techniques and activity scheduling. The goal of CBT is to empower patients to take an active role in managing their emotional and physical health during and after treatment, and to build resilience for long-term recovery.
CBT and other cognitive-behavioural approaches are often applied to help patients with breast cancer manage the various treatments and procedures they undergo. For example, CBT can help patients manage anxiety related to chemotherapy or radiation therapy, cope with the side effects of treatment, and prepare for medical procedures such as surgeries or biopsies. The therapy may involve teaching patients relaxation techniques, such as deep breathing or progressive muscle relaxation, to manage their physical symptoms. Cognitive restructuring techniques may be used to help patients challenge negative thoughts and beliefs about their illness or treatment, and to develop more adaptive coping strategies. For example, if a patient fears chemotherapy because of potential side effects, cognitive restructuring may involve challenging and modifying the beliefs that chemotherapy is always harmful or that they will not be able to tolerate it.
Additionally, some therapists may also use mindfulness-based interventions, such as Mindfulness-Based Stress Reduction (MBSR), to help patients with breast cancer manage their symptoms, improve their quality of life, and promote overall well-being.
I also use Compassion Focused Therapy (CFT), which is a relatively new form of therapy grounded in evolutionary psychology, social psychology, and neuroscience. It is a transdiagnostic approach that can be applied to a wide range of psychological problems, including those related to physical health conditions such as breast cancer.
The Hidden Struggles of Breast Cancer Patients: What You May Not Know
Cancer patients are not responsible for what happened.
As a psychotherapist, I know first-hand how difficult it is for my clients to hear the opinions of non-experts when it comes to their cancer diagnosis. Breast cancer patients may encounter comments from others implying that their diagnosis was a result of their selflessness or being too nice. While these comments may be intended as compliments, they can actually be harmful and trigger feelings of guilt and self-blame. Such beliefs suggest that the patient brought cancer upon themselves, which is not only inaccurate but also unfair. It is important to acknowledge that breast cancer can happen to anyone, regardless of their personality or behaviour.
Many breast cancer patients struggle with feelings of guilt and self-blame anyway, often due to speculation about what may have caused their cancer. What's especially troubling is the misconception about the development of breast cancer. When clients are diagnosed with metastatic breast cancer, for example, people often speculate about why it happened. Did they miss their mammograms or self-checks? Did they not eat healthily or exercise enough? This can create an immense amount of pressure on people with cancer, even after they've completed their treatment. The truth is that we can do everything right and still get a cancer diagnosis. There's no certainty or evidence to explain why some people get cancer and others don't. Some may wonder if their lifestyle choices, such as diet or exercise, played a role, while others may question whether past trauma or stress contributed to their illness. It is crucial to avoid placing blame on the person or making assumptions about their lifestyle choices. Instead, it is important to provide a supportive and compassionate environment for the person to process their emotions and navigate their recovery journey. It is also essential to educate patients and their loved ones on the complex and multifactorial nature of breast cancer and to reassure them that they are not alone in their experience.
It's important to take a moment and reflect on how we would feel if we were diagnosed with cancer. It's a terrifying experience that can induce existential and philosophical anxiety. It requires us to be hypervigilant about our bodies indefinitely and can result in the loss of body parts and, at times, our sanity.
2. Navigating the Anxiety and Comparison Trap During Breast Cancer Treatment
I have worked with many breast cancer patients who experience anxiety about the treatment process. They often compare their journey with that of others, asking questions such as: "How many times did they have radiotherapy?", "What medication did they use?", "Did they have a lumpectomy or mastectomy?" While it's understandable to seek information and compare experiences, it's important to remember that every patient's journey is unique. There is no "right" or "wrong" way to navigate breast cancer treatment, and what works for one person may not work for another. It's essential to focus on what's best for the individual, taking into account their medical history, personal preferences, and values.
It's not uncommon for breast cancer patients to compare their treatment process with others. However, these comparisons can be unhealthy and only add to the anxiety that already comes with a cancer diagnosis. The uncertainty of the future and the fear of the unknown can often trigger this behaviour, as patients search for some sense of control in a situation that can feel overwhelming. It's important to remember that every patient's cancer journey is unique and what works for one person may not work for another. Comparing oneself to others only leads to further stress and anxiety. As a counsellor, I often remind my clients to focus on their own recovery journey and to trust the expertise of their medical team in making decisions about their treatment plan.
3. Let them be sad, and grieve.
It's not uncommon to hear people say "Don't be sad" to someone who has experienced loss. However, this phrase doesn't always bring the comfort intended. Cancer patients are no exception to this. They deserve the same empathy and support as anyone else facing a difficult situation. Wearing pink clothing to show support, while well-intentioned, is not enough. It's important to understand that cancer is not a competition, and therefore, there is no winner or loser. Rather, cancer patients need support, empathy, and companionship throughout their journey. When we turn cancer into a competition, we reinforce a capitalist culture where everything is about winning and losing, leaving those who are struggling to feel like failures.
As a psychotherapist, it is important to recognize the value of allowing individuals with cancer to grieve and express negative emotions. Society often promotes toxic positivity, which suggests that one must always maintain a positive outlook regardless of the situation. However, this approach is not always helpful for cancer patients who are coping with a difficult diagnosis and the associated challenges. It is important to acknowledge that experiencing negative emotions is a natural and healthy response to a cancer diagnosis, and suppressing these feelings can have negative consequences. Additionally, it is important to recognize that this expectation of constant positivity is not realistic, even for those who are not facing a cancer diagnosis.
I highly recommend reading "Smile or Die: How Positive Thinking Fooled America and the World" by Barbara Ehrenreich to gain further insight into this issue. While it may be well-intentioned, telling someone with cancer that everything will be okay or that they will be fine is not what they need to hear. What they need is understanding and validation of their emotions. They have likely already discussed their diagnosis and treatment with healthcare professionals and are aware of the percentages and medication effectiveness. When they open up to you, they want to be heard and understood as a friend or a compassionate person. It's important to acknowledge that you may not have all the answers and that you are not perfect. Simply listening and validating their emotions can go a long way.
It's important to recognize that individuals with cancer may be grieving for the loss of their body parts or their ability to do things they used to enjoy. They may also be struggling with body image issues and feeling disconnected from their bodies. It's not just fear or anxiety that they experience, but also sadness and loss.
Lastly, it’s important to avoid suggesting that the fight against cancer is a competition that can be won or lost. This mentality is part of a capitalist culture that promotes a sense of failure if we don't achieve certain goals. Instead, we should provide support, empathy, and companionship to those with cancer. Self-worth is also a crucial concept that I plan to write about in more detail later.
4. Transitioning to a new normal takes time
If I had to pick one thing that my clients are very annoyed about hearing, it would be comments from other people about their recovery. People may think that because it's been a year, the recovery is over and my clients should get back to their normal lives, do more things, and so on. The difficult part is that people usually make these comments with good intentions, maybe to make themselves feel more comfortable. It can be difficult to have a sad, existential conversation with someone, and it's easier and more reassuring to say, 'Let's be positive, get over it, come and exercise.' However, every time my clients hear something like this, their emotions are dismissed. Of course, ideally, they want to get back to their usual routine, hobbies, and life. However, there is little acknowledgment of the traumatic part of their experience. Some people need more time to process what has happened, while others are quicker to talk and process. Some people ruminate about the difficult parts of their experience, and some remain anxious about the uncertainty of it all.
Another dimension is that when loved ones or friends make comments like that, my clients feel alone as if their fears and emotions are somehow minimized. It is as if they are not important and have to do better, but they feel like they are failing. We definitely don't want them to feel that way. It is important for us to focus on being gentle and compassionate toward breast cancer patients. Every recovery, every treatment, and every step is different for everyone. People have different reactions, bodies, backgrounds, and lifestyles. It would be great to not put pressure on them to get back to things because things are different for them now. Adapting to change takes time and practice. They need some headspace to think, process, and decide.
While this post has covered several important aspects of working with breast cancer patients, there are many other topics and issues that could not be addressed here. Breast cancer is a complex and multifaceted disease, and each patient's experience is unique. It is important to approach each patient with empathy, compassion, and a willingness to listen to their individual needs and concerns.
Eylul