“I went completely numb”, “I couldn’t take it in”, “I felt like I was living a nightmare – nothing felt real”, “I felt myself shut down”. As with other traumatic events, the overwhelm experienced in the moment of impact of a cancer diagnosis leads to the triggering of survival mechanisms of fight, flight or freeze in the face of terror and fear of death. Shock, panic, confusion will often give way to the defensive mechanisms of dissociation, depersonalisation, splitting of the emotional self from the cognitive self and the rapid, unconscious, construction of a wall between mind and body to enable the newly diagnosed patient to manage the situation they are thrown into.
In some cases, events unfold very fast as the patient is subsumed into an often unfamiliar medicalised world. There is so much to assimilate: the terminology, different procedures, treatment options, building critical relationships with hospital staff, a mass of appointments which now take priority over everything, the urgent reorganisation of day-to-day life. There may be no time or space to process any of what is happening.
For others, there may be a long and agonising wait for treatment to start, for information to be given, for a plan to form, time for anxiety to build alongside anger and helplessness. One of the most commonly reported experiences of being diagnosed with cancer, or any other serious and life-threatening illness, is a sense of losing control and agency as the person disappears and only the patient becomes visible to the world around him. Suddenly, strangers are taking decisions for the patient without even knowing who he is. This can be profoundly destabilising and frightening.
In many cases, emotional responses to being diagnosed and living with cancer closely parallel the grieving process associated with a bereavement. Different phases or stages of grief may be experienced, though they wouldn’t necessarily unfold in a linear fashion. Feelings ranging from disbelief, denial, despair, anxiety, anger, resentment, fear, depression, suicidal thoughts, and isolation are common. For many people it can take a long time to reach a state of acceptance of, or at least an adjustment to, a new reality.
An illness like cancer brings with it multiple losses: the loss of health and the sense of physical integrity, the loss of security and autonomy, the loss of a life lived pre-diagnosis, maybe even the loss of dreams for the future. The losses are both real and existential. Serious illness challenges a person’s ‘assumptive world’ – what is taken for granted about the world as it relates to the individual and to others. This can give rise to overwhelming anxiety and fear, not just in relation to the illness but also to the consequences the illness has on other parts of life: relationships, finances, work and social life.
Many people are faced with questions such as: how do I talk to my partner/ parents/ siblings/ friends about my fears, when I am trying to protect them at the same time? What do I say about how I feel when I don’t even have the words for my feelings? How do I have conversations about possible outcomes when what lies ahead is so unknown? Who am I now that all I seem to be is a patient? What about the other parts of me and my life? Who am I if my body changes radically and permanently? Will anyone still love me? What will happen to my children? How will I manage? If I am cured now, will the cancer come back? Will I die?
Therapy can provide a space in which to explore these and many other concerns. In my experience, it can be a place to voice fears and dare to confront a new reality. It can help to reduce feelings of loneliness and increase feelings of acceptance by another. It can be a haven from the medical, institutional setting and one where the whole of the person can be welcomed. It offers a process for deciphering meaning from what has happened and exploring individual existence. It can help to open up awareness to the unexpected benefits that many cancer patients experience, and facilitate what is known as ‘post-traumatic growth’.
I have found that at different stages of the journey through and beyond cancer, clients might use the therapy for different purposes: to manage stress, anxiety and fatigue caused by pain, disability and uncertainty; to contain unbearable feelings so that they can be tolerated and thought about; to re-integrate body and mind; to increase their connectedness to themselves and forge a changing identity; to grieve their losses and find purpose in the experiences they are having; to prepare for the end of life, resolving what can be resolved and, if possible, making peace with what is left.
Everyone’s experience of their own illness is unique. My work with clients who have cancer has taught me the value of flexibility and adaptability whilst maintaining a robust and safe therapeutic frame. The realities of working with those who are in pain or ongoing treatment, mean that scheduling may have to be adjusted, home or hospital visits may be needed, phone or Skype sessions might replace face-to-face sessions. I’ve learned that the ability to draw on a range of therapeutic resources and approaches is crucial to tailoring the therapy to the needs, pace and resilience of the client at different stages of the journey through serious illness.