COUNSELLING TIPS FOLLOWING A BREAST CANCER DIAGNOSIS
The word “breast cancer” often strikes fear in most people while a diagnosis causes even the hardiest of souls to reflect on their well-being. Breast cancer research reports that patients experience a wide-variety of well-being changes such as a decrease in self-esteem, body confidence, femineity, sexual well-being, energy, pleasure, tiredness to feeling unattractive and experiencing hot flushes. Accompanying these changes are distress, pain, fear, guilt, anger, nausea, sleep disturbance, weight loss and relationship changes which are all linked to depression and anxiety. These findings confirm the multiple psychological changes and well-being stressors that are associated with breast cancer.
When cancer strikes an individual, it invades their entire life. Therefore, counsellors are recommended to focus on the entire person and their client's ecological system – micro, meso, exo and macro systems. Also important is understanding the context in which a client experiences breast cancer, their personal values and beliefs and the narratives that surround health, diagnosis, treatment, illness and recovery. It is also recommended to discuss with clients how their “illness” intensifies, changes, challenges, disappears, reappears and alters family patterns of attachment. These points are central to building the therapeutic alliance.
Current research highlights the effectiveness of CBT, psycho-education, group therapy, positive psychology, mindfulness, hope therapy and spiritual interventions. A person-centred framework is additionally recommended, as this approach places an emphasis on the person and not the problem, views clients feelings as normal and creates a safe environment that harnesses hope, possibilities and a future. The role of a counsellor is to also enable clients to experience self-compassion and self-reflection as these have been linked to self-discovery, greater self-control and positive well-being. As with many studies, congruence, unconditional positive regard and being non-judgmental has been highly regarded by clients during their healing journey. Normalization has been noted as a helpful tool combined with a pluralistic standpoint, as no single theory can hold the “truth” when exploring the impact of breast cancer.
Cancer is known to be unpredictable and as such increases the chances of psychological implications because
a) it is silent – it arrives and returns unannounced.
b) sometimes it is difficult to diagnose and there is a delay in diagnosis – which may result in trust issues between patient and doctor.
c) it is known to “strike”, be “invasive” and sometimes “disfiguring” – cancer treatment is emotionally and physically exhausting which results in some patients dreading the treatment more than the disease.
d) it results in grief and loss –such as identity, relationships, self, predictability of life, social acceptance, body function, security and much more.
e) it is connected with death and immortality –some patients may experience immortality thoughts for the first time in their life.
f) it is unpredictable and can literally change one’s life course.
In a nutshell, researchers recommend the below when helping clients:
· Focus on client’s “sense of self” – so they can reclaim their identity.
· Empower clients to identify goals, develop unique problem-solving techniques and reconsider their priorities.
· Explore and gain new and alternative perspectives.
· Recognize changed family attachments.
· Explore difficult feelings, hope and the future
· Help clients connect with supportive networks such as health care systems, family, cancer groups, community and spiritual connections.
· Provide a positive, supportive, collaborative and safe environment.
· Understand the context of a client’s narrative.
· Allow clients to unburden themselves from worries and concerns.
· Enable clients to grieve all their losses - with or without tears.
Based on clinical research, the following is believed to be unhelpful when working with client’s:
· Solving clients problems.
· Disallowing grief and/or not acknowledging loss.
· Avoiding emotions, depression or anxiety.
· Deep exploration and insight must be obtained.
· Dying is the worst thing that could possibly happen to them.
· Clients must go through synchronised stages of healing.
Finally, it is imperative that counsellor’s always remember that living with a life-threatening illness creates a unique professional relationship. The desired outcome for a client-counsellor relationship is one that maintains their clienteles sense of self, pride, dignity and respect.
Morgan, C., & Cooper, M. (2015). Helpful and unhelpful aspects of counselling following breast cancer: a qualitative analysis of post-session aspects of therapy forms. Counselling and Psychotherapy Research, 15(3), 197 – 206.
Ronna, F., Nekolaichuk, C., & Williamson, F. (1998). A model for counselling cancer patients,Canadian Journal of Counselling, 32(3), 213 – 218.
Ussher, J.M., Perz.J., & Gilbert, E. (2011). Sexual wellbeing and breast cancer in Australia: experiences of people with breast cancer and health professionals. School of Psychology, University of Western Sydney, Australia and Breast Cancer Network Australia (BCNA), Melbourne, Australia, 1 – 23.