Working with clients living with cancerDate: January 3, 2017
Cancer is one of the most common diseases in the U.S. and across the world. According to statistics from the National Cancer Institute, roughly 1,685,210 new cases of cancer will be diagnosed in the U.S. this year.
There are various forms of cancer, ranging in impact from mild to life threatening. Cancers of the colon, rectum, lung, prostate and bladder are the most common forms of the disease. Blood cancers such as leukemia also are fairly prevalent. However, no matter the type and stage of the disease, in many cases, cancer will accompany a range of emotional response from patients, and counseling can be an effective strategy to helping clients manage this emotional side of the disease.
Counselors can implement a number of useful strategies and approaches to help clients cope. However, counselor Gary Patton told Counseling Today that a common challenge is that counselors typically do not tend to specialize in helping cancer patients manage their mental health. Consequently, there is a considerable chance that many counselors may not be aware of the most effective ways to approach patients living with the condition. This situation is problematic because, as Patton pointed out, cancer is so common that it is likely that counselors already will be working with clients who then receive a cancer diagnosis. It is important, therefore, for counselors to educate themselves about the condition and the common forms of treatments that cancer patients undergo.
In terms of understanding which counseling approaches could be most fruitful, it is necessary to first take a comprehensive look at some of the most common reactions clients have upon receiving a diagnosis of cancer.
The emotional repercussions of a cancer diagnosis
Receiving a diagnosis of cancer is invariably life changing. Given the uncertainty associated with the condition and the threats it can pose, as well as the chronic physical symptoms that accompany both the disease and treatment, it should come as no surprise that most patients experience anxiety, stress or depression. According to an article from researchers at the University of Alberta, published in the Canadian Journal of Counseling, as many as up to 25 percent of cancer patients will experience depression that can be considered clinical.
Study authors elaborated that depression and anxiety usually are concomitant mood disorders that may correlate further with a number of concerns, including:
- Fear of death.
- Worries over the invasive nature of treatments, such as surgery and chemotherapy.
- Anxiety over the consequences of the treatment, such as hair loss and disfigurement.
- Fear of the unknown — cancer treatment is often a long journey with no guarantees of success.
- Concerns about money and the impact of treatment on daily routines.
- Worries over stress placed on relationships and sexuality.
In addition to depression and anxiety, common responses from clients upon receiving a cancer diagnosis include feelings of shock, denial, anger and defeatism. For some individuals, defeatism is a fairly common reaction, with patients assuming that any treatment will be unsuccessful and that the worst will occur. Patton detailed in the Counseling Today article that defeatism can be the result of witnessing close family members or friends experience cancer and then die from the condition.
Shock is also a ubiquitous response because many forms of cancer initially present with relatively benign symptoms. Lynne Shallcross wrote in a column in Counseling Today:
“Sometimes we find with these patients that their symptoms don’t seem to add up to the severity of something like cancer. Many of our patients will say, ‘I’ve been tired, I haven’t had much of an appetite, I’ve lost a little bit of weight and my back’s been hurting.’ That could be the flu. [But] they come here and find out that it’s cancer.”
Recommended counseling strategies
There are various ways to approach counseling a cancer patient. Researchers from the University of Alberta recommended a counseling paradigm that primarily concerns helping patients find ways to focus on personal wellness in the face of the disease. In other words, the goal of this strategy is to help clients create a positive mindset for navigating the tumultuous social and physical terrain of living with cancer.
Counselors can help clients work toward achieving this mindset with the following strategies:
1. Listening to the client’s journey
An important first step is to practice active listening. This action establishes trust, as well as an effective channel of communication between the client and counselor. The best way to make sure clients feel heard is to show attentive behaviors. No matter the delivery, it is important that clients and counselors both understand the situation in its entirety. To do this, counselors use open questions, reflections of feeling and encouraging phrases that allow clients to share their stories.
This process helps shed light on the client’s emotional status, reaction to the diagnosis and feelings in terms of what to expect next.
Study authors elaborated that the objective of this strategy is to establish a sense of hope. The notion of hope in this context does not necessarily mean hoping for a cure — this isn’t a possibility in many cases. Rather, counselors and clients should build hope that clients can regain control of their mental wellness and maintain a relatively normal life in spite of their cancer.
2. Monitoring symptoms of anxiety and depression
It is common for cancer patients to develop mental health conditions such as clinical depression, and for clients already living with a mental health issue, a cancer diagnosis can worsen symptoms. In that regard, strategies already in place to help clients manage their depression should be continued alongside counseling that focuses specifically on the cancer diagnosis. Counseling Today noted that counselors also should be aware of any medications that clients already are taking for mental health conditions.
3. Cognitive Behavioral Therapy
Patton explained, in an interview published in Counseling Today, that counselors can help patients practice techniques that fall under the umbrella of Cognitive Behavioral Therapy (CBT). This strategy is predicated on the premise that negative thoughts and attitudes often precede an individual’s suffering, the National Alliance on Mental Illness explained. The purpose of CBT, therefore, is to help clients reframe, in a more positive way, how they conceptualize themselves and the world around them. With a new perspective, clients are able to cope more easily with external stressors, such as cancer. To practice CBT, counselors should help clients examine negative thought patterns with a critical eye, in a bid to understand why such thinking is detrimental to their emotional well-being. Counselors then may help clients devise healthier thought patterns. For example, a client may dwell on the negative aspects of chemotherapy, such as the sickness and hair loss it can cause. CBT in this scenario would involve having the client focus on the positive aspect of the treatment — that it could lead to a remission.
4. Group work
Encouraging clients to attend support groups is another effective counseling strategy because, although cancer patients often will have the love and support of family and friends, many still feel isolated by their illness. Group work allows clients to interact with others in a similar situation, which can help address feelings of loneliness.
Cancer may be a chronic disease that is strenuous both physically and emotionally. Thankfully, counselors can use a number of effective techniques to help clients through this difficult journey.
If you are interested in helping clients navigate the ups and downs of a cancer diagnosis and treatment, and if you are interested in helping people facing an array of personal issues and life problems, you may consider a career in counseling. Bradley University’s online Master of Arts in Counseling (MAC) program provides students with a CACREP-accredited and comprehensive education in counseling theory and best practices. To learn more about the Bradley online MAC program, click here.