Choosing a Therapist after Cancer

Julia H Rowland, PhD, FAPOS; Smith Center for Healing and the Arts

 

Reasons to seek therapy

Most individuals diagnosed with and treated for cancer find it helpful to talk with someone about their experience and how they are coping. Cancer and its treatment are stressful. Even the most resilient and resourceful of individuals can struggle at some point.

Indeed, it is the rare individual who goes through cancer--and does well--alone. Although, those who get by alone still benefit from someone checking in and who understands what they are going through. Having support is important for all of us, and perhaps even more so in the context of cancer. Family, friends and a supportive cancer treatment team may be sufficient for many. However, sometimes these individuals do not have the time or ability to meet your specific needs.

Asking for help takes courage. It is not, as some worry, a sign of weakness. Rather, seeking therapy often reflects an important need to re-establish a sense of balance and control in what can be an upsetting experience. Talking to someone about what is on one’s mind or causing problems can help individuals get back on a path to feeling better, making sense of what is happening and, as needed, finding additional resources. The first reaction to seeing a therapist is frequently a feeling of relief, of letting go of the tension that can come from holding in thoughts or giving voice to deeply felt emotions.

 

When to seek help

Individuals vary in when help may be needed. There is no ‘correct’ time to pursue therapy. Some reach out after they learn of their cancer diagnosis; others may wait until their treatment is done when they find themselves struggling to cope or manage the myriad changes that have occurred. Other times, cancer survivors can experience feelings of distress or anxiety years after treatment is done or, like what is happening now, when external crises re-evoke feelings of fear and concern for health. The short answer to when seeking therapy makes the most sense is when the person needs it. In the end, only the individual can decide that.

 

Whom to select

Here are key things to consider when searching for a therapist:

• Do you feel comfortable with this person?
• Do you have a sense that she or he understands you and you can say what is on your mind?
• Is she or he a good listener?
• Is the advice useful and the feedback insightful?
• Do you trust this person?

This latter is key because you want to talk to your therapist about anything on your mind. You do not want to hide or sensor how you are feeling or thinking.

In finding the right match, it can be helpful to meet with two or three therapists then choose the one who is the best fit for you. It is okay to ‘go with your gut’. Pick a person who feels right to you. Not just because they are nice, but because they say things that stay with you afterward, that resonate with you in a meaningful way. How the first session goes, how you felt, how it was handled, how the environment (wherever this was held) did or did not facilitate the conversation, may let you know right away this is going to work. Other times it may take a second visit to be sure one way or the other.

When you are deciding who to meet with, other more practical considerations are:

• Where do they practice?
• Is this convenient for you?
• Can you find a mutually agreeable time to meet?
• How often can or will you meet?
• How much do they charge for their services?
• Do they take insurance? Note: there is large variability in the cost of therapy based on what type of treatment is provided (e.g., counseling costs less than pharmacotherapy when drugs are used)
• The state or region in which you live
• Where the care is delivered (home office or clinic, or often today, remotely by phone or online)
• The training of the person delivering the care (physicians are more expensive than social workers for example).

It is important to note that low cost or free services may be available in any given region, so it is worth looking into this if cost is---as it is for many after expensive cancer care---an important consideration.

 

Finding a therapist

In looking for a therapist, a good first place to start is with your cancer care team if you are still in treatment or being regularly followed for your cancer. Social workers associated with the team are a good source of information on local therapists. Social workers at large, nearby cancer centers are well positioned to provide referrals to local therapists.

Your primary care physician may also know of a therapist that she or he can recommend. Another good source of referrals is local cancer support organizations or groups. The staff for these as well as the organization’s participants or the support group’s members themselves often have wise ideas about individuals who work well those treated for cancer.

A national organization that provides brief online counseling and can help find local referrals for more in-depth therapy is CancerCare. Based in New York City, their staff are all oncology-trained social workers. They can be reached at 1-800-813‑HOPE (4673) or www.cancercare.org

 

Do you need someone with training in cancer?

People often wonder if it is necessary to see someone trained specifically in psycho-oncology or the psychosocial and behavioral care of individuals being treated for or with a history of cancer. The short answer is no, but….

Most well-trained therapists with experience (i.e., are not new to or just starting out in practice) are well qualified to care for a patient with a history of cancer. However, experience working with individuals with chronic or life-threatening illness is preferable.  Therapists who have worked with people with major illness conditions are best equipped to understand and address the acute and long-term effects these can have on emotional and social well-being.  

The number of therapists trained or certified in psycho-oncology remains relatively small. If specific training in cancer is important to you, you can contact the American Psychosocial Oncology Society or APOS at:  www.apos-society.org   

APOS is a national professional organization which advocates for the psychosocial and behavioral care of individuals with cancer and those who care for and about them. Its members include the majority of mental health providers specifically trained in the field of psycho-oncology in the U.S. These include psychiatrists, psychologists, social workers, nurses, and chaplains. They keep a roster of individuals around the country who see patients and may be able to link an individual to a practitioner in their area of the country. As noted above, you can also go back to your cancer provider or team or reach out to other cancer patients themselves to see if you can find someone with that specific training.  

Living with, through and beyond cancer can be challenging. In stressful times like these, this burden can feel even greater. It’s normal to want to talk with someone who is there just for you, where you don’t have to worry about upsetting or ‘making them feel bad,’ someone who will listen and to whom you can say what is on your mind. The benefits of therapy can be many, depending on what is needed.

Regardless of the goal, reports by those who have sought therapy suggest that these conversations provide a chance to discover one’s own meaning from the cancer experience, learn tools for promoting personal resilience, and find ways to navigate with grace the ‘new normal’ that is the future.

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