If you’ve been diagnosed with cancer, you will interact with a number of different members of the health care team at various times during treatment. When you walk into a doctor’s office, hospital, or cancer center, you may encounter nurses, physician assistants, social workers, doctors—the list goes on. In this series, we talk with some of these health care professionals to learn more about their jobs and the role they play in providing high-quality cancer care.
A cancer diagnosis often triggers difficult emotions and makes communication difficult, both for the person with cancer and for those closest to him or her. Sometimes, the complex feelings and lifestyle changes caused by cancer and its treatment become overwhelming. Counseling is designed to help people respond to these challenges and the associated emotions in healthy ways.
To learn how licensed marriage and family therapists help people with cancer and their loved ones, I talked with June C. Foss, LMFT, a counselor at Novant Health Derrick L. Davis Cancer Center in North Carolina, and Cheyenne Corbett, PhD, LMFT, Director of the Duke Cancer Patient Support Program.
Q: How would you describe the role of marriage and family therapists in the cancer care team?
Cheyenne Corbett (CC): Marriage and family therapists (MFTs) are a rare breed in cancer care settings. However, their skill set lends itself perfectly to working within this environment. At the Duke Cancer Institute, we have a team of medical family therapists, who are MFTs specialized in working with illness. These MFTs are trained to work in partnership with the medical team, the patient, the family, and members of their larger system, as appropriate. In this role, MFTs work with patients and families to help them manage the impact of illness on their lives and relationships. To do this, they ask their clients what is distressing them and what they want to be different. Using this information, they can work together to create the desired change.
June Foss (JF): My role on the cancer care team is helping patients and their families deal with the emotional impact cancer has on their daily lives. This means being available to respond to requests from others on the care team to see patients and their families. I might be called on to meet with a patient at any time during the continuum of treatment, whether it is just after diagnosis, during treatment, as a follow-up to a significant level of distress on their Distress Screening, or even after treatment has finished. I work with new patients, survivors, family members, and members of the care team as needed to offer assistance. I normally see patients in the outpatient setting, but on occasion I am called to the inpatient setting to offer supportive counseling.
Q: What are some of the most important things you do for patients on a daily basis?
JF: As the MFT and the only clinical counselor for the team, probably the most important thing I do for patients on a daily basis is to listen to their story. This might include hearing about their struggles with anxiety, depression, "cancer brain", difficult treatment decisions, etc. Then when they are ready, I offer ways to help them navigate the emotional roller coaster that most people with cancer experience.
CC: At Duke, our MFTs work with patients and their families to address many kinds of stressors and concerns, including marital conflict, end-of-life issues, self- and body-image issues, sexual health and intimacy concerns, and issues related to parenting with cancer. One of the most important things our therapists do is listen. While this may sound like a cliché, I don’t mean listening passively like therapists in movies, but rather actively listening and being curious to get to know the patient and/or family member(s), their concerns and challenges, and their strengths and resources.
Q: What is important for people to know about MFTs and psychosocial care?
CC: Psychosocial-spiritual care is a critical component of oncology services. Often, people think that being referred to or seeking MFT services means that there is something “wrong” with them, but this is not what marriage and family therapy is about. Our approach looks at problems within a relational context, not as problems that lie within the person. We look at risks and challenges, as well as strengths and resources, to assist patients and families in managing the particular issues they are facing. Our goal is to help resolve challenges using brief approaches, so typically people only need one or a few conversations. Again, given all that patients and their family members face, we want to help resolve or prevent problems in a timely manner, so people do not have to endure prolonged distress and can better manage the impact of cancer as they go through the experience.
JF: I think it is important for people to know that MFTs provide psychosocial (emotional, social, and practical) care through the lens of family systems. Family systems include biological families, work families, faith families, etc., and MFTs work with individuals from this perspective. So, even if the extended family is not part of the counseling process, they are still part of the work that takes place with a patient. For example, if I am meeting with a woman who has had breast cancer, we may be talking about how she can communicate her needs to her partner, how to maintain discipline in the home even though she is having treatment, how to manage the worry about a recurrence, what to share with co-workers when she returns to work, or how to use her faith to help her through hard times. MFTs are uniquely trained to view people through this holistic perspective and are comfortable including others in the counseling process as needed or desired by the patient.
Q: How did you end up working in oncology?
JF: I have been practicing as a licensed marriage and family therapist since 2002, but I have only been working in oncology for about 10 months, so I am still adjusting to my role in this setting. I wasn’t specifically looking for work in oncology but was looking for a new opportunity to use my skills and training as a MFT when I learned about the opportunity at Novant Health Derrick L. Davis Cancer Center. My own experience with cancer started when I was a little girl and my mother was diagnosed with cancer. She is a survivor, but that experience was very significant in my life story. In more recent years, my father and other family members have had cancer. So I actually have a personal history with cancer that combined with my credentials as a MFT seemed to have led me to this field of work.
CC: When I learned about MFT in undergrad, it was a short paragraph in one of my counseling texts in a psychology class. It made so much sense to me and really aligned with how I saw the world, much more so than any of the mental health fields. So, I focused all my efforts on learning more about MFT and then pursuing my education in this field. That training intersected with my personal experiences to lead me to work in oncology. I have significant cancer history in my family, and through all of it (until this became my profession), we had little to no psychosocial support. I decided to use my training to help other families facing cancer and can’t imagine myself working in another setting.
Q: What is the most rewarding part of your job?
CC: There are so many rewarding aspects of my job. As an administrator, knowing that I can help support my team to do this important work is rewarding. I want to help reduce as many barriers as possible in this complex health care environment so my team of therapists can focus solely on addressing the needs of their clients. Also, so often in mental health care or medical care, people are told what is okay or not okay, what their experience “should” be, what is normal or abnormal, that as a MFT, being able to partner with people to help create meaningful change from their perspectives is so important to me. To see clients make these meaningful changes, and to see the strength of those we serve, is rewarding in and of itself.
JF: There are many rewarding areas in my work here at the cancer center. One area I really appreciate is seeing the wonderful care and concern extended to our patients by the staff. I get calls from doctors, nurses, physician assistants, nurse navigators, the dietician, genetic counselor, chaplain, and even administrative folks who recognize a need and are concerned about a patient’s emotional state. There is much love and care extended in this place, and I am so grateful to be surrounded by people who care and are willing to take action to get appropriate help for a patient. Another rewarding part of my job is the privilege of sitting with patients and their families and witnessing such amazing attitudes and strength. I am constantly reminded of the gift of each day and am grateful for the patients who are willing to trust me with their stories and their struggles.
Q: What is the most common relationship issue that people living with cancer face?
JF: One of the most common relationship issues I see working with people with cancer is difficulty with communication, especially worrying about who, what, and how to tell about their diagnosis and how to manage life both now and in the future. Finding the “new normal” as a family seems to be an ongoing challenge for many people diagnosed with cancer.
CC: The cancer experience can vary so greatly by type of cancer, stage of disease at time of detection, the type of treatment(s) used on the cancer, the patient’s and family’s history, and the patient’s and family’s situation at the time of care. Given that, there are common relationship issues we see, and we then partner with our clients to understand the issues as they are experiencing them. Some of these issues may arise for patients and families during their experience with cancer, or they may have been challenges prior to the diagnosis and be exacerbated by the cancer and its treatment. Much of the time, the issues are related to communication: with loved ones, their friends, their colleagues, or their medical caregivers.
While the emotional, practical, social, and spiritual impact of cancer is often in the form of distress, many people are positively affected by cancer. As patients and/or family members experience this positive influence on their lives, it is often something they talk with our therapists about to make sense of for themselves.
Q: What is the best thing a person can do to deal with the challenges cancer causes in relationships?
JF: Communicate, communicate, and communicate!!! I can’t say it enough. There are so many things that cancer patients need to communicate to their loved ones. These range from sharing the diagnosis, what the treatment will look like, specifics about how the treatment is affecting them, where they need help, where/when they need privacy, financial decisions, end-of-life planning and decision making, etc. This is one time that people need to really have those hard conversations and find ways to manage together. Helping families have these difficult and challenging conversations is one of the ways that I can be useful.
CC: Know that experiencing challenges is normal. These challenges can exist on a spectrum of intensity, and it is important to reach out for help to know that when an issue becomes troublesome. MFTs can help mitigate many issues by working with patients and/or family members to help prevent problems from arising or worsening. Also, people often don’t think to bring up psychosocial-spiritual issues with their medical team because they are focused on their physical care, but it is important to do so. Medical caregivers may not directly address the issue, but they can connect you with psychosocial providers who have expertise in helping with the effects cancer has on marriage/family life. Now, there are even focused accreditation standards for cancer care programs that set this expectation that we ask patients about psychosocial distress and connect them with services, as we know that this distress can lead to increasing challenges, and may interfere with the patients’ and family members’ overall health and wellbeing.
Q: How can patients access MFT services during or after cancer treatment?
CC: Some centers, like the Duke Cancer Institute, offer MFT services onsite for patients and families during or after cancer treatment. If your treatment center does not, MFTs can be found in most communities. If possible, look for a MFT with a medical family therapy background that is experienced in helping families facing illness. Any member of your care team can connect you with MFT services onsite or in the community.
JF: I would suggest that you first ask if this service is available at your cancer treatment location. If there is a counselor or psychologist on staff, you might make an appointment to talk or meet with that person to find out if they are trained in couple or family therapy. If they aren’t, ask for a referral to someone in your community. Another way to find a marriage and family therapist in your community is to look on the American Association for Marriage and Family Therapy (AAMFT) website. AAMFT has an online tool to find clinicians by location, www.therapistlocator.net. Insurance companies also know the specialties of their in-network providers and can usually give you names of MFTs that might be covered under your medical insurance.
June and Cheyenne talk more about the role of marriage and family therapists in oncology in the following podcast. A transcript of this podcast is also available.