As a relationship therapist, I often work with couples where one, and occasionally both, have a cancer diagnosis.
A couple should expect to face cancer
The latest forecast is that one in two of us will get cancer, so on average anyone in a long-term relationship should expect to face it at some point. While the interval from diagnosis to death can be tragically short, medical advances mean that many patients will survive and live years cancer free; others will experience periods of remission, with the possibility of the cancer’s return never quite out of sight; for some, cancer will be a long-term health condition, with a mix of treatments, involving radiotherapy, chemotherapy, surgery or some combination of the three, becoming part of life’s routine.
The couple is a system
Cancer is a physical condition. Only the patient experiences the symptoms, treatment and outcome, good or bad. But a couple is a system: what impacts one affects the other. So, the treatment regime (keeping track of medication, attending countless appointments and hospital stays) involves both. More importantly, the psychological pain is felt by both. If the partner with cancer dies, it is the survivor who must bear the grief. Even when there is a good outcome, few couples will be unchanged, with many having to adjust to shifts in their relationship, including their economic situation, gender roles and sexual relationship.
Towards the end of her life, the bowel cancer campaigner, Dame Deborah James, wrote a powerful tribute to her husband, Sebastien. “As cancer brings my life to an end” she wrote, “I feel this cruel realisation that I’m not fully able to be myself with the one person I have adored and needed in my life more than anyone else. I feel robbed of a body without pain to kiss with, the freedom for us to make whimsical plans for our future and retirement together.”
As a therapist, I aim to provide a safe space where both halves of the couple can open up about the very difficult emotions cancer brings, and hear each other, without fear of judgement.
The cancer patient may be experiencing fear (of treatment as well as of death), guilt (at leaving their partner too soon), anger (why me?), frustration (at the endless waiting around for callbacks or results) embarrassment or shame (is everyone in the street looking at me?). Some cancer treatments are painful, and the side effects can be brutal, but there is also the intrusion: the body is compromised by the cancer and opened up to the eyes of strangers. One cancer patient said to me “they talk about people fighting cancer; but you don’t fight cancer; the NHS fights it; your body is just the battlefield”.
The partner of a cancer patient may also feel fear (of being left alone), guilt (for taking any time for themselves, when their partner’s needs are so much greater), frustration (at the additional load that caring brings), anger (why didn’t you take more care of yourself, why didn’t you go to the doctor sooner?) and irritation (why is everything always about cancer now?).
There is nothing wrong or shameful about voicing what we think of as “negative” emotions, indeed keeping all this inside can be more damaging; couples can feel closer when they can understand and express compassion for what the other is feeling.
Some couples also use therapy to think together about changes to the cancer patient’s body, for example those brought by having to use a stoma (common after bowel surgery) or a penis pump (prostate surgery) or a mastectomy (breast cancer surgery), with many couples embracing new ways to be intimate.
The gift of time
We must all die one day of something. A wise colleague, when speaking of their parent’s death, said “cancer gives you time”. While the popular fantasies of either dying quietly in our sleep or “popping our clogs” have undoubted attractions, they rob us of the time to say a proper goodbye, to put old battles to rest, to say the words that were always in our hearts, but maybe never made it onto our lips. As therapists, it is our role, and our privilege, to help couples use that time well.
You can get in touch with Ann Hardy directly here https://www.counselling-directory.org.uk/counsellors/ann-hardy
If this article resonates, or you know someone who might need to talk, we’re here https://thegreenhouserooms.com/