Casebook of a Cancer Therapist: Relationship

Abstract

If you are a clinician who treats cancer patients, I hope you agree that many of them would benefit from talking with a professional about adjustment to their illness. If you are interested in helping cancer patients adjust or in referring them for help, you may wonder what the rules are that govern this transaction. The therapist needs a model to guide his or her work with the cancer patient. While my model has been cognitive therapy, any framework agreeable to the therapist and patient is acceptable. Much (but not all) of the work with this problem will be short term. It can be successfully carried out in a room with a closeable door and 2 (or 3) chairs. The locale can be the therapist's office (by referral) or an outpatient oncology room. If the latter, the appointment can be associated with a medical visit for cancer treatment. The cognitive model will likely focus on the patient's thoughts about cancer: its prognosis, its treatment, or its course. Changes in routine related to illness or treatment may be approached by defining a new life stage with the patient. Constant prediction about the future is discouraged in favor of a focus on the present. How to communicate about cancer with one's spouse or children is a common issue to consider. Therapy may involve helping the patient to rework his or her concept of self-worth. Issues of control, acceptance, and maintenance of life activities are commonly discussed. The hallmark of any successful psychotherapy is often the establishment of a working relationship between therapist and patient. At times, the process of engagement (forming the relationship) may be treatment's biggest challenge. This was the situation I encountered with Ms A.