Breast Cancer and Supportive Psychotherapy

Breast cancer remains much of a mystery for most of us until it happens to ourselves or to someone that we know. How we deal with this diagnosis depends on many factors. Our personality, cultural background, support system, family heritage and chemistry with the medical staff are all crucial factors in the battle against cancer.

Why supportive psychotherapy may be necessary

Breast cancer is a real emotional roller coaster for the patient and her entire family. Questions like: How will I cope? Why did we get it? Who can we turn to for help? How will this affect my love life and self ? or What will this do to my marriage?, are very pressing questions for the patient. Besides the anxiety attached to the diagnosis the concerns regarding life-style changes are an extra pressure. Support psychotherapy is a very useful aid in dealing with the news in a climate of dignity, respect, care and love.

Supportive psychotherapy is designed for patients and their families. It is the most important tool for the psycho-oncologist and the psychotherapist. Its duration is sustained through the entire course of the illness. The psychotherapist providing this type of assistance must know as much as possible about cancer as a medical disorder. He or she must be skilled in assessing and managing patients psychologically. Also, the therapist must be in tune with his or her own subjective experience in the face of complex and tragic medical situations.

Supportive psychotherapy requires great knowledge, intuition and flexibility in the face of ever-changing psychological needs. Clinical experience and a sound theoretical frame are must haves in dealing with the complexities and challenges of breast cancer. But most importantly the psychotherapist must focus on deep, authentic human interaction.

What is supportive psychotherapy?

Supportive psychotherapy is a therapeutic intervention that aims to assist breast cancer patients in dealing with distressing emotions while strengthening adaptive coping mechanisms. This type of intervention explores the patient’s self, body image and role changes within a relationship of mutual respect and trust. The psychotherapist must be able to provide the patient and her family with appropriate and essential resources that help educate about the nature of the illness. He or she must also be able and willing to work in close relationship with the medical staff and act as a mediator at all times. One of the psychotherapist’s most important and difficult tasks is to allow a flow of information with awareness as to the patient’s coping abilities and with regard for confidentiality.

Cognitive and behavioural therapies, learning theories and problem solving techniques are great tools for improving adaptive strategies. These interventions are appropriate for outpatient, inpatient and home care settings. Sometimes, depending on the situation, the psychotherapist will offer counselling and support via telephone or e-mail.

Good therapists are aware of the importance of flexibility. For specialists who work with breast cancer patients, flexibility is one of the key attributes. Women with a breast cancer diagnosis have rapidly changing concerns, reoccurring fears and an ever-changing emotional landscape that require understanding and the use of creativity.

Breast cancer and the grieving process

During the trying times of acute illness the psychotherapist focuses only on emotional support. Patients may have to deal with a dreaded recurrence, the loss of a body part or decreased mobility. They usually face issues regarding sexuality and self-esteem due to perceived mutilation. These are devastating blows that come with profound sadness. Assisting the patient through this grieving process can only be done from a place of authentic empathy. Dealing with this uncertainty must therefore remain a central focus of the psychotherapy. The therapist must choose the right timing and the appropriate strategy in shifting the conscious focus from support to exploration of deeper emotions and underlying issues related to the illness.

A common stage in the grieving process is denial and this can be manifest when working with a breast cancer diagnosis and prognosis. This stage can occur in many forms ranging from nearly psychotic reactions to useful and healthy coping mechanisms. Pathological denial is unhealthy and often leads to avoidance and poor treatment compliance while healthy denial allows the patient to focus on positive emotions, hope and enthusiasm for treatment. Positive denial may be a barrier in accurate communication with the family but can sometimes generate an atmosphere that is temporarily easier to handle.

Other common manifestations are related to ambivalence and ambiguity. These reactions are closely related to denial and often represent a great cause for frustration for the medical team. The pressure of important decision making often determines the patient and the family to change their minds in very short periods of time. The patient might seem set in their way to follow a type of intervention one day and ignore it the next. This can lead to conflict and tension and get in the way of accomplishing treatment goals. The psychotherapist must act as a mediator between the patient, the family and the medical staff making sure that all negative feelings are addressed in an appropriate manner.

Differences in hospital setting psychotherapy interventions

Caring for breast cancer patients can be very different form other types of interventions a psychotherapist is used to conducting. Usually touching the patient is considered taboo. In supportive psychotherapy for breast cancer the boundaries are often modified. A hug or a pat on the arm can serve as non-verbal support, encouragement and an assurance that the person is not repulsive to the therapist. However, the psychotherapist must be very aware of his or her actions and understand a person’s needs, especially in the case of patients who require physical distance. Sometimes, situations require the psychotherapist to do more than just listen. In a hospital setting, the patient might require some extra physical assistance. A session might not go very well if the patient is thirsty or has an uncomfortable position in bed. The therapist should take the non-verbal messages into account and be willing to assist the patient by giving her a glass of water, adjusting bed commands or giving an extra blanket. This type of assistance builds trust and sends a message of acceptance and empathy that is crucial in the future progress of the intervention.

Breast cancer patients often feel that they have been betrayed by their body. They also undergo challenging and intrusive treatment. The therapist must welcome conversations regarding distortions in body image, sense of self and other topics like: family legacy, guilt, fear of death and spirituality.

The idea of meaning in supportive psychotherapy is really essential. Breast cancer is different to each woman. In order to fully understand the meaning of the illness the therapist must address some unconscious aspects at the right moment. Often with this diagnosis we discover a family history of breast cancer, the loss of a parent and deep unconscious conditioning. These themes must be the subject of therapeutic explorations. Bringing to light the hidden meanings is very helpful as long as the patient understands the difference between past experience and their present identity. The purpose of such explorations is to identify grief, frightening memories, guilt, unfinished situations that burden the patient. Understanding these emotional associations with cancer can bring deep and important insights that allow the patient to start healing.

Understandably, family members are frightened and the illness is viewed as catastrophic. This often puts the patient in the position to offer support to her family. In this case, the psychotherapist must also allow time for the family to offer advice and explanations. There are also families where there is a loving and responsible care giver that takes up the full-time job of caring for the cancer patient. In this type of situation the primary caregiver must also receive the attention of the psychotherapist in order to keep stress in check.

When it comes to support psychotherapy there are no strict rules, only values. Breast cancer transforms the life of the patient and her entire family. It is the psychotherapist’s job to understand the unique psycho-social context and offer custom-tailored support and compassion.

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