They can occur in this order or in some other order, and the patient may move in between stages as she moves towards acceptance. Acceptance is always the last stage of this grieving process.

Upon Diagnosis

These stages are typically triggered when the patient receives her diagnosis.

Initially the patient may experience DENIAL. In this stage the cancer patient does not believe the diagnosis and may go “doctor shopping” or forget about it altogether. Either response is damaging because precious time is lost for treatment.

When a newly diagnosed patient is referred to Dr. Sheila for therapy she often spends the bulk of the work with them removing this denial. This is done mostly by addressing her fears about cancer and making sure she has as much information as possible - making her an “informed consumer” so to speak.

The second stage is ANGER. Here the patient is aware of her diagnosis and is very angry about it. Actually anger is often a good thing. Handled correctly it can be used to inspire the patient to action and can get her to aggressively treat her disease.

The third stage is known as BARGAINING. Here the patient makes a bargain with “God” or the doctor or anyone else who will listen. “If you cure me I’ll never … again.” This is a valiant act to gain some control over a situation where the patient feels she has none.

The fourth stage is DEPRESSION. This is when the reality of the diagnosis sinks in and the person experiences the sadness that the cancer diagnosis elicits. If not dealt with, this depression can seriously undermine the patient’s prognosis.

A lot of the therapeutic work Dr. Sheila does is in helping to manage the cancer patient’s depression. Characteristic of depression is a sense of helplessness and despair. You can imagine how much the patient is experiencing these feelings at this point in her disease. She is at a very high risk of sinking into a suicidal depression if not handled correctly.

But it is not just the risk of suicide that threatens the patient at this stage of the process. A negative attitude can also be very destructive. There is little debate these days about the mind-body connection. A positive mind often brings about miraculous results while a negative mind may lead to disastrous consequences. Psychologically speaking, the key is to work with the patient’s thoughts to help her build a steady diet of positive life–affirming thoughts and to decrease and possibly eliminate the negative self-destructive ones.

The last stage in this grieving process is ACCEPTANCE. Here the patient understands her diagnosis, is aware of it complications, and is willing to deal with it. It is very important from a psychological standpoint to get a cancer patient to this stage because here she is the most cooperative with treatment.

During Treatment

Treatment brings with it its own set of psychological issues. Among the most common are:

• Compliance;

  • Fears about the effects of treatment, such as:

  • Pain;

  • Hair loss;

  • Changes lifestyle;

  • Changes in appearance; etc.

• Loss of control over one’s life.

Compliance means getting a person to take her medication, to go to treatment sessions, etc. Lack of compliance is usually a psychological issue reflecting a form of denial. If a person is not complaint with her course of treatment it is necessary to go back to the stages of grief and work through them again to get rid of the denial.

If her reason for not complying is something else it is usually fear also called ANXIETY. Where depression is the primary psychological condition seen in newly diagnosed patients, ANXIETY is the emotion that presents itself most often during treatment.

Anxiety is fear of the future. A person creates anxiety by the thoughts she tells herself about what will or will not happen at some later time. Anticipating the worst at these times generates the most anxiety. Like working with depression, managing the patient’s thoughts is the key to dealing with her anxiety.

LOSS OF CONTROL over one’s life is an especially difficult issue for many people. This is particularly true of the person who until now had been achieving her life’s goals and ambitions. Helping the patient find something over which she has control helps to modulate this issue. For example, focusing on what she can do to help herself such as taking her medication on time, showing up for appointments, meditating, doing guided visualizations, etc.

Each of these issues needs to be dealt with on a patient-by-patient basis because of the uniqueness of each patient and the course of her disease. Generally speaking, the psychological well being of the patient prior to her diagnosis plays an important part in how well she copes (or doesn’t cope) with treatment complications. Usually, the more psychologically sound a person is the easier time she will have dealing with these issues.

Often putting a patient into a group therapy setting to deal with treatment issues is an effective approach. Hearing how someone else handles the course of his/her own treatment can benefit the patient immensely.

After Surviving

One would think that surviving cancer would be the end of the journey for the patient but sometimes it is just the beginning. Surviving cancer brings along its own host of psychological issues, including

• Will my remission/cure last?

• Will I get it again?

• Survivor’s guilt.

The first two issues reflect anxiety, a very common experience for the cancer patient. As stated above, anxiety is fear for the future so it is important at this juncture for the patient to be taught to stay present focused and to concentrate on those proactive things she can do to remain healthy - good diet, exercise, positive outlook, medication etc.

The third issue, SURVIVOR’S GUILT, is a more difficult issue to address and usually requires psychological counseling. Survivor’s guilt occurs when the patient feels bad for not dying when others before her have. This is especially challenging when those that died first were close relatives or friends and if they died of the same form of cancer.

The survivor’s guilt usually takes one of two forms:

• She should have died too;

• It’s not okay for her to continue to live.

Generally speaking, GUILT means that the patient believes that she did something “wrong.” From a therapeutic stance that is the first line of attack. The patient needs to learn that by surviving cancer the patient did nothing wrong.

Secondly, she needs to learn that it is okay to live. The risk here isn’t so much that the survivor will commit suicide. More likely she will “under live,” meaning that she will stop living life to its fullest and will just go through the motions. Making it okay to thrive is the therapeutic issue.

Issues When Loved Ones Have Cancer

 The cancer patient isn’t the only person suffering through this diagnosis. The patient’s loved ones are also bearing a strenuous psychological burden. Often they are the ones who present for counseling. If they aren’t they should be. Psychotherapy is crucial for the patient’s family as much as it is for the patient herself.

When a person shows up for therapy because they have a loved one suffering with cancer, her most common presenting problems are:

• Fear she will lose this person.

• Fear of the unknown.

• Fear of her own mortality.

• Stress of dealing with the patient and her medical and psychological needs.

• Stress from lack of sleep caused by anxiety

• Stress from working overtime either at home to manage the household or at work to pay medical bills

• Guilt that she is not sick (a form of survivor’s guilt)

• Guilt of possibly outliving her child (if the parent of the patient)

These issues are real and need attention. Too often the focus is only on the patient. When that happens the entire family suffers. Each person is affected by the cancer and each needs his or her own care.

Issues If A Loved One Dies Of Cancer

If the cancer patient dies, the survivors suffer enormously. They need to go through the stages of grief as set forth above. They also need to address issues of survivor’s guilt if present. Lastly, they need to be helped to move on.

Typically, grief counseling is offered in the form of a support group for the bereaved.

Bereavement is a short-term experience of grief. If the grief last beyond a specific period of time (typically two months) the survivor may be slipping into a depression and more serious intervention is necessary.

Treatment Options

They most common psychological treatment options for the patient and/or her loved ones are:

• Individual psychotherapy: for intense one-on-one treatment of all issues

• Group psychotherapy: for 6 to 10 unrelated people to discuss their issues

• Family therapy: for parents, children and other effected relatives

• Couples therapy: for husband and wives

• Hypnotherapy: for relaxation and guided imagery work

In addition, psychotropic medication may be appropriate. A psychiatrist familiar with use of these medications during cancer treatment should be consulted.

No matter which form of treatment she uses, Dr. Sheila keeps strictly to the ethical guidelines of her profession. These include keeping all information in total confidence.

Go to the Services page for a brief overview of other services she offers.