Guest blog by Victoria Heath
February 4th is World Cancer Day; an opportunity to reflect on the impact cancer has on those who have been touched by it. From a psychotherapist’s point of view, it is encouraging that attention is paid to the emotional impact of what can be a devastating diagnosis, and that today there is some good support available, both in the form of cancer support groups and individual counselling for cancer sufferers and their loved ones.
What perhaps isn’t so well acknowledged is the concept of Survivorship. ‘Survivor’ is a word we hear often associated with violent trauma, for instance, being a sexual assault survivor, or surviving domestic abuse. But we don’t talk as much as a society about what it’s like to survive cancer, and the difficulties of adjusting to life after treatment.
In fact, clients who have been discharged from successful treatment sometimes say things like ‘I should be feeling very grateful’, ‘I know I’m very lucky’, and ‘I mustn’t complain; other people are suffering much more’. Knowing that other cancer sufferers might not survive, perhaps experiencing survivor’s guilt, can make it feel shameful and selfish to talk about difficult feelings. This can be exacerbated by not wanting to burden loved ones, who perhaps, having been through the mill themselves, seem keen for everything to get back to normal.
Everyone’s journey is different, and some people do find that they can move on with their lives without too much challenge. But others find it very difficult to move on or to go back to normal, to pick up where they left off. For these people, Survivorship can be painful and destabilising and they can feel lost and alone.
Survivors in this position are often dealing with significant loss. This can be literal, for example, the client who lost her job because she was unable to carry on with it while she was having treatment. Or the client whose new relationship didn’t survive his cancer journey. Some people have lost a physical part of themselves, perhaps having had surgery or having lost their hair during chemotherapy. People can also feel that they have lost their life as it used to be. Like any kind of bereavement, these losses need to be mourned, a process which can take time.
The loss of the medical-care environment can also be frightening. People may have been in firefighting mode, moving quickly from diagnosis to treatment, with medical appointments taking up chunks of time. Their focus has perhaps been on managing the physical aspects of their illness. Once people are discharged from treatment, this framework and focus falls away, and they can be left feeling alone and destabilised. Sometimes, focussing on medical treatment has been a helpful way to disassociate from the trauma of the diagnosis, allowing feelings to be pushed aside. But once the framework disappears, these feelings can re-surface.
There is another kind of traumatic loss, associated with serious illness, which can help explain difficulties in Survivorship. Irvin Yalom, the American psychologist, names it as the myth of ‘personal specialness’ in his book ‘Existential Psychotherapy’ (1980), or our strongest defence against the fear of death. He explains that although we understand rationally that we will inevitably die, to make this bearable, we hold onto an irrational sense that we are somehow special, and this specialness makes us the exception to the fate of everyone else; I know bad things happen, but they happen to other people – they won’t happen to me.
The diagnosis of cancer can mean a deeply traumatic ripping away of this sense of protective specialness, or, as one client described it, ‘the carpet was pulled out from under me’. This comforting sense of safety may never be regained, and as such survivors can be left with profound fear about what the future holds and in particular, the possibility of illness returning. Health anxiety can therefore be particularly difficult to deal with.
How can therapy help?
If you are finding it hard to navigate Survivorship, it may be that therapy can help. Therapy can offer people a safe, non-judgemental and compassionate space to bring their experiences. This can mean that clients have an opportunity to express difficult feelings that might be causing them guilt and shame. Some clients describe this as being a relief; they don’t have to take care of or protect their therapist, and at the end of the session, they can get up and walk away without having to consider the impact of what they’ve shared.
A good therapist can listen, offer support and empathy and reassure clients grappling with Survivorship that their feelings are normal. They can help their clients gently explore painful and traumatic experiences so that they can start to process them and work towards acceptance. They can help their clients acknowledge and mourn what they’ve lost. They can help their clients challenge painful beliefs about what they ‘should’ be feeling. They can work collaboratively to develop ways of managing anxiety, and regaining a sense of agency. They can help to re-evaluate priorities, which may have changed as a result of clients’ health challenges. They can help explore hopes and fears for the future, working towards a new normal that feels sustainable.
Resources:
The author Victoria Heath is a Humanistic Psychotherapist
For more information on how to find a suitable therapist, take a look at David Chalmer’s guide to finding your perfect therapist for The Greenhouse Therapy Rooms.
You can also access 24 hour online support through Macmillan https://community.macmillan.org.uk
Lastly If you would like to talk to anyone about the issues raised in this blog click here to find a therapist in Chiswick at The Greenhouse Therapy Rooms