Talk by LIZ BACKHOUSE
We had an extremely useful and interesting presentation by LIZ BACKHOUSE, CANCER COUNSELLOR.
“PSYCHOLOGICAL PROBLEMS EXPERIENCED BY PEOPLE LIVING WITH A CANCER DIAGNOSIS AND HOW COUNSELLING CAN HELP MANAGE THESE PROBLEMS”
Being told you have cancer can be devastating. It can produce feelings of shock, worries about the future, fear of treatment, financial worries and can trigger anxieties and problems from the past. I feel that counselling intervention can help manage some of the problems that arise and can facilitate adjustment, enabling a person with a cancer diagnosis to maintain a good quality of life.
The British Association for Counselling and Psychotherapy definition of counselling:
Counselling takes place when a counsellor sees a client in a private and confidential setting to explore a difficulty the client is having, distress they may be experiencing or perhaps their dissatisfaction with life, or loss of a sense of direction and purpose. It is always at the request of the client as no-one can properly be sent for counselling.
By listening attentively and purposely the counsellor can begin to perceive the difficulties from the clients point of view and can help them to see things more clearly, possibly from a different perspective. Counselling is a way of enabling choice or change or of reducing confusion. It does not involve giving advice or directing a client to take a particular course of action.
Although this is one definition I feel that counselling on a more basic level offers the experience of being truly listened to without judgement and for some people this is a unique experience.
The cancer journey that is undertaken by a patient starts when they have their symptoms investigated and following the results are given a cancer diagnosis .
When someone receives a cancer diagnosis it may evoke many possible emotional reactions. People generally experience some or all of these reactions:
Fear and Anxiety
Sadness and Despair
Guilt and Shame
Relief (perhaps after a long period of worrying diagnostic uncertainty)
A sense of challenge
Sometimes people are unaware that the symptoms they are experiencing may indicate they have cancer and therefore they are totally unprepared for a cancer diagnosis following investigations. With the discovery of cancer in an instant you can feel that you have become a patient with a life-threatening disease. This can cause feelings of confusion and a sense of loss of control.
As time goes on an emotional adjustment evolves and this can be described as a sequence of emotional stages.
Shock, numbness or disbelief on first learning the truth; the bad news seems too much to ‘take in’.
Acute distress as the full reality dawns:
Sadness and despair, which may be on-going
Gradual adjustment and acceptance, often taking several months or longer.
I think illness at one level is a private and individual matter. At another level it has implications for family and social relationships. A diagnosis of cancer for a person can be like throwing a pebble into the water the ripples extend a long way.
Someone on a cancer journey can feel like they are riding a huge rollercoaster. They are propelled along by the momentum of diagnosis, investigations and treatment on a ride which they feel unable to get off and which can hit incredible highs and lows. The lows experienced by people can see them being admitted during treatment because they are so unwell, loss of hair, change in body image following surgery. The highs described to me by patients are those moments when they feel held by the healthcare team…feel someone is truly listening to their anxieties, or when they have been given good news about scans or how treatment is progressing.
When treatment comes to an end everyone around them - friends and family may expect them to experience the same level of elation you experience after being on a rollercoaster ride. However for some people this can be the start of a very low period as they struggle to adjust to what has happened to them and attempt to return to normal living whatever that may be for them. Sometimes this low period can be experienced some time after treatment has finished.
Contributing Factors to Emotional Problems
Losses and threats which stem from the cancer itself: physical, emotional, mental, spiritual practical and social.
Past stressful life events which are still troubling or re-emerge with the cancer diagnosis I often see people for counselling who have issues such as childhood physical and sexual abuse which have re emerged . For some who have had multiple difficult life events the cancer diagnosis can be one trauma too many.
A past history of psychiatric illness or alcohol/drug abuse can make some people more fragile when being confronted with a stressful event such as cancer.
Poor relationships with healthcare professionals: lack of communication, fear of being abandoned as the disease progresses. If patients feel that the bad news interview was not handled well they can suffer a loss of confidence in the healthcare system which can impact hugely on their experience of treatment.
Lack of good support network - friends and family. Someone who is happily married or has a supportive partner and family may struggle less than someone who has little support. The experience of having cancer can be very lonely even with lots of support so can be more difficult for those without a good support network.
Problems with body image - there can be a sense of grief which emanates from the changes which can occur after surgery for cancer.
Past experience of cancer can affect how you feel about your own diagnosis .
Persistent pain can be difficult to manage but perception of levels of pain can be altered by anxiety. Sometimes pain can become more manageable with a reduction in anxiety but I must make the point that you are not whingeing or being a wimp if you tell your GP or members of your healthcare team that you are in pain! On-going pain wears you down and undermines your ability to cope¨
Cultural attitude and Ethnic Group
Time has changed our attitude to cancer but I still come across people I work with in counselling who have been upset that people they know have crossed the street rather than talk to them or family/friends have not been as supportive as they thought they would be. In some ethnic groups cancer is seen as a subject not to be discussed .
POSITIVE MENTAL ATTITUDE
People with a cancer diagnosis often struggle with the idea that they should think positively. This is fine if you can do it but it is misguided and naïve to expect all cancer patients to be consistently positive without being allowed to express feelings of sadness or anger, giving themselves time to absorb and adapt to their experience.
For most people it is important to maintain some sense of control either by treatment choices or by continuing to make decisions and maintaining control in their personal life. However to believe that personal control is the main determinant of cancer onset or outcome is an illusion. A belief such as this can give rise to guilt and a sense of a battle between body and mind rather than being empowering. This can be exhausting for the person.
There needs to be recognition that health and disease depend on a mixture of factors not all governed by personal choice. This can be more helpful for people rather than them constantly feeling they have to strive for full self responsibility over cancer.
I’ve seen patients who have been caused a lot of distress by being told they need a positive mental attitude. They are left feeling that they will influence their prognosis negatively if they do not. Not having a positive mental attitude may affect your quality of life but will not bring your cancer back.
For some people denial as a short term solution is a good coping mechanism. Many people that I have worked with in therapy have described the feeling that they are observing themselves go through treatment as if they were watching a film in the cinema. It can all feel unreal.
Having a cancer diagnosis can make you feel that your body has let you down in some way. You may no longer feel quite so confident about your ability to be healthy. Surgery can affect how you look and changes in your body may mean that you feel the need to dress differently which can also affect your self esteem. This may have an affect on your physical relationships. It is sometimes difficult to feel that you are still sexually attractive when you are struggling to adjust to the change in your body.
You may feel too vulnerable and emotionally raw to talk about this issue and it is particularly the one problem that people find almost impossible to talk about with friends and family. It is ‘the elephant in the room’
Partners, family and even friends can find supporting someone with cancer very stressful as well. Partners and close relatives often feel that they cannot express how they feel honestly because they need to be seen as being ‘strong’ in order to be as helpful and supportive as possible to their loved ones. It can be very difficult to see someone you love and care for being distressed and in pain. Conversely occasionally the person with cancer is managing well but the partner/relative is struggling to adjust to this crisis in their life.
Cancer has traumatic psychological effects which counselling can reduce. The experience of having cancer is a highly individual one which involves upheaval on every level of existence and evokes strong emotions’ (Curtis T and Kibler S 1990)
WHAT CAN COUNSELLING OFFER?
It can enable the following:
It helps people to adjust to living with fear and uncertainty
It provides a space to explore their problems and anxieties. People often feel that families and friends find it difficult to listen to continuing problems and fears
Time to explore the personal meaning of their illness –how do they view cancer, how have they coped with previous life events, traumas, illness.
Normalizing of fears can be very important. explaining to someone they are having a perfectly normal reaction to an abnormal situation.
Stress management - People with a cancer diagnosis can experience high levels of stress while undergoing treatment but especially if their treatment is prolonged they can experience low self esteem, depression and physical manifestations of stress such as panic attacks which can impede their return to normal living once their treatment has finished. Stress management techniques can be very useful in helping people deal with these problems.
Help people to begin and develop their adjustment to the diagnosis of cancer
Help people to develop coping strategies which will enable them to return to normal living. Counselling can enable people to find ways of managing anxiety so that it isn’t overwhelming and affecting their quality of life
LOOK GOOD… FEEL BETTER WORKSHOPS
Look Good Feel Better is the Beauty Industry’s charity formed in 1994. It runs make-up workshops staffed by trained beauty professionals who volunteer their time and expertise to help female cancer patients manage the physical and emotional side effects of cancer treatment in a practical and positive way.
Each woman attending one of the two hour workshops gets a wonderful bag of cosmetics and skin care products which they take home with them.
I approached the Look Good...Feel Better charity in 2000 and we finally got this fantastic service at Essex County Hospital in 2007.
We are the 47th hospital to become a host to the workshops and are really pleased to be able to offer them as part of the psychological support offered to patients with cancer. This free service runs once a month on a Tuesday afternoon and is available for any women with any type of cancer. We have been amazed at how successful they have been. Women generally find it very helpful to meet up with other women who may be experiencing similar problems following treatment. The workshops are great fun and participants seem to get a real boost to their self-esteem when they attend one.
You can obtain more information about these workshops by going onto www.lgfb.co.uk or by phoning the Booking service and speaking to Karen Reeve on 01206 744408
Odyssey holidays are free 5 day courses for people living with a cancer diagnosis which aim to help participants rebuild confidence and regain their zest for life.. Everyone I have referred has had an amazing time. Some more information can be found on www.odyssey.org.uk
To apply for a place on one of these holidays contact Liz Backhouse on 01206 213046
I firmly believe that counselling is complementary to the other treatment that patients receive and is about promoting quality of life. We cannot afford to ignore the psychosocial aspects of caring for cancer patients if we are to provide people with high quality care which addresses the person in a holistic manner rather than a patient with a disease process. - Liz Backhouse can be contacted on 01206 213046 and has a web-site www.lizbackhouse.com