A diagnosis of cancer can bring up many emotions and cause stress, anxiety, or depression for both patients and their families. In this podcast, we’ll discuss how seeing a Licensed Marriage and Family Therapist can help a person with cancer, how to find a marriage and family therapist, and what to expect from your visits.
ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology known as ASCO, the world's leading professional organization for doctors that care for people with cancer.
A diagnosis of cancer can bring up many emotions and cause stress, anxiety, or depression for both patients and their families. In today's podcast, we'll discuss how seeing a Licensed Marriage and Family Therapist can help a person with cancer, how to find a therapist, and what to expect from your visits. This podcast will be led by June Foss, who is a counselor at Novant Health Derrick L. Davis Cancer Center in North Carolina and Cheyenne Corbett, who is director of the Duke Cancer Patient Support Program. ASCO would like to thank Ms. Foss and Ms. Corbett for discussing this topic.
June Foss: Hello. My name is June Foss and I'm the oncology counselor at Novant Health Derrick L. Davis Cancer Center in Winston-Salem. I'm a licensed marriage and family therapist. I'm joined today by Cheyenne.
Cheyenne Corbett: Hi. I'm Cheyenne Corbett. I'm with the Duke Cancer Institute. I'm a family therapist by training and I also lead the supportive care services here at the Duke Cancer Institute. Today, we're talking about marriage and family therapy in cancer care settings. I have some questions here that I'm going to ask of June and both she and I are going to then talk about our responses to them. June, when should a patient work with a marriage and family therapist?
June Foss: I think first it's important to understand that marriage and family therapists are licensed mental health practitioners with a master's or doctoral degree and a minimum of two years of supervised clinical experience. We are trained as family focused psychotherapists and mental health generalists and are one of the five core mental health professionals along with psychiatrists, psychologists, social workers, and psychiatric nurses. We are trained to diagnose and treat mental health and substance abuse problems. A patient could work with a marriage and family therapist any time they're dealing with mental or emotional health issues. This might include anxiety, depression, grief, family issues, end of life issues, et cetera. I can always meet with a person and determine if the issue they're dealing with is one that I can help them with. But if not, I'm a good starting point for them at least. If they present with an issue that's out of my area of expertise, I would just try to refer them to someone who specializes in that particular area.
Cheyenne Corbett: Yes, we also do something very similar. Our therapists work with patients actually at any point in time in their cancer experience. At any time, at suspicion of a cancer diagnosis or post-diagnosis, during treatment, after treatment, survivorship phase, as well as end of life issues, our therapists are trained to work with people throughout or at any point really in their cancer experience. We know that cancer can be very distressing and things occur for patients during their experience and their family members, so we're able to help respond to issues that arise during those cancer experiences, but we're also able to help them manage things that are exacerbated by the cancer experience. June, at your center, from your experience, would one be recommended to a family therapist by their healthcare team or is there something that patients or family members need to do in order to initiate being referred to a family therapist?
June Foss: Right. Well, not all settings have marriage and family therapists just as not all settings have a psychiatrist or social workers. Like in my setting, I'm the only counselor here and I just happen to be an MFT. Of course, that makes the referral to an MFT easy. But if a person knows that they specifically want to work with an MFT and there's not one on the healthcare team, they could certainly ask if one is known in the community. If not, or instead of that, they can actually look for available MFTs on the AAMFT website under therapistlocator.net and this will give them the listing of available MFTs in their area.
Cheyenne Corbett: I know at our setting, we have a team of six marriage and family therapists who practice both inpatient and outpatient. The medical team works very closely with our therapists and can make referrals to them. They can do this. We screen our patients for distress, as many folks do at other cancer centers. Depending on the issues that the patient and families are experiencing that are distressing, the medical team members - the nurses, the physicians, the PA's - everyone has been trained in order to how to connect patients to our family therapist and for what reasons you would refer to a family therapist. We're able to connect people that way.
Of course, it also depends on if an issue has been disclosed to the medical team members by the patient and family. If the patient and family disclose a concern, the medical team members can refer. But if for some reason the patient and family is not comfortable disclosing to their medical team, sometimes we won't get direct referrals, self-referrals from patients and family members about issues that they're struggling with that they want to talk to somebody about, so we connect them that way. Then we've also used for community providers the same therapist locator on the AMFT website in order to connect people with family therapists in their areas too.
June Foss: I get a lot of referrals from the distress screening, but that's not usually as-- it's a lot of false positives. The referrals I tend to get more are from the nurse navigators or the mid-levels or the physicians. Typically, after a follow-up conversation to find out, yes, what's concerning for the patient or family member, we can do that too.
Cheyenne Corbett: What are your thoughts about whether somebody should see a marriage and family therapist who specializes in working with people with cancer? Or somebody with a more general family therapy background is also can be helpful.
June Foss: Well again, I think it's important to remember that MFTs are mental health generalists, so we're trying to deal with many issues. If a person happens to find an MFT who specializes in working with people with cancer, that's wonderful. However, if that's not available in the patient's particular area or cancer center, I think they should still feel comfortable seeing an MFT and the training and the skills that they have developed will still serve the patient well. Again, I go back to the AMFT therapist locator, a great resource, again, for them finding MFTs who might list cancer as a specialty. Also, they can check their insurance company listings of the in-network providers and often there's a listing of what areas those providers specialized in.
Cheyenne Corbett: As the field of family therapy has advanced over the years, there's developed this sub-specialty. Did you all know of MFT that is medical family therapy?
June Foss: Yeah.
Cheyenne Corbett: It's marriage and family therapists who received additional training and at some school certification or specialization in medical family therapy that specifically provides them with more education and experience in terms of helping patients and family members cope with the impact of illness on their lives. These are folks who've also had that additional set of training and who are experienced, typically, working in healthcare settings or understand that collaboration that happens between therapists and the medical team members for somebody who is coping with cancer that that's a really critical part of the therapy.
Because oftentimes, therapists who are practicing in the community aren't necessarily collaborating as closely with the team members in the local cancer centers. Those people with the medical family therapy background have some specific training in how to do that. Of course, other family therapists are able to do it as well, but people who have that medical family therapy training background have experience doing that and they orient their practice around that collaborative approach.
June Foss: Right, right.
Cheyenne Corbett: What should your patients and family members expect from their first visit with you?
June Foss: First visits with me are usually a time for getting to know the patient. If they bring a family member with them, it's a time for getting to know them. It's also a time for doing an assessment to see what's really happening, what are the struggles, and what is the patient's history in terms of emotional and/or mental health, what medications they're on, et cetera. During that first visit, I want to get a good overall picture of the patient and not only what issues they're bringing to the session, but also what their history has been and what their goals are.
Cheyenne Corbett: Yeah, I know it's really helpful for our therapists is really getting a sense of that, because they often get a referral from the medical team with information either based on the distress screening or based on their conversation with the patient. But having that chance to be able to talk to the patient and family about what their experiences are and getting to know them, getting to know what their concerns are from their perspective, it's a really important step and also having conversations around what are their goals, what do they want to see different. Because sometimes, that's the same as what the medical team referred them for or even what a family member wants to see and sometimes it's different, so we always try and make sure they we're getting a sense of not only what they were referred for, but also what they want to see different and then try to work towards that.
Because I know, your role is probably very similar, there's a lot of communication back and forth between the patient, the family members, you, the medical team members. There's a lot of communication and everybody has got ideas of what could be different or what patients need some assistance with or what could be changed. But I think it's really a critical role for the MFT to be able to really talk to the patient and family members and get their specific perspective and a better understanding of what they want to see different. Because sometimes they're struggling with things that are different than what we're aware of or sometimes, the things that we think they're struggling with, they're actually not really a challenge for them and they identify other issues that are of more concern to them that they want to work on.
June Foss: Yeah, that is so true.
Cheyenne Corbett: As you start to work with a patient or family, what are some typical goals for either this type of therapy or your work with families facing cancer?
June Foss: The goals are, I would say, as varied as the patients are really. For example, I might be meeting with a patient whose primary struggle at this particular time is cancer brain. They're struggling to think clearly, to be organized, to accomplish the tasks that they used to accomplish easily but are now finding very difficult to get through. We'll talk about those specific areas and help them come up with a game plan for how to better manage their life in terms of meeting those particular needs. A lot of the patients I deal with are struggling with the cognitive distortions or the twisted thinking that the things like all-or-nothing thinking or black-and-white thinking. Things like, "Well, because I lost my hair, I'm never going to be pretty again or my husband will never be attracted to me."
We try to just really help them understand that those may not be rational thoughts, and how to identify, then how to correct those ways of thinking because those are thoughts that get them into trouble. Some patients are dealing with PTSD brought on by the various treatments they may have had or even the anticipation of the treatment. Some patients I've dealt with have had been having bad dreams. We try to talk about the dream and process how they interpret the dream and come up with ways for them to counteract what they're dreaming so that they have a better outcome. Those are just some of the examples of the things of course. Some patients, I should say, could be dealing with some fear, end of life issues, that kind of thing. I try to just make this be a place where patients can bring whatever they need to bring in a place where it's safe to be totally honest and deal with whatever problems they're struggling with. The goals would revolve around all of those kinds of issues.
Cheyenne Corbett: I think it's important, we see so many people with challenges that they're facing throughout their cancer experience. Sometimes when people are referred to a family therapist, they're interpreting that something is wrong with them or that there's some sort of problem. Or like the typical referred to a therapist or psychiatrist, somebody thinks that their doctor then thinks they're crazy and that's why they're referring. But really, with the fact that we have family therapists in cancer centers now, the fact that psycho-social and spiritual concerns are really embraced in the oncology community now is really helping to normalize the fact that when somebody is going through something as major as a cancer diagnosis in treatment, that experiencing challenges along the way is totally normal.
Being able to have resources to be able to help attend to those challenges and help be able to prevent them or help make them better once they start to occur, I think is really important. As we go along through our therapy with our clients, it's really important for us to really emphasize that, that a lot of the challenges that people are facing are normal responses to what they're going through. While it might be different than a lot of the people that are around them in their family community or work community, that really amongst other people facing cancer that what the challenges that they're facing are actually quite normal. The changes can vary in terms of the impact on them and their family or the intensity. It's just being able to provide that personalized therapy experience to really be able to find out how much of a problem it is for the patient, what particular things are an issue, and really work with people. I know our goal is to help resolve those challenges to the satisfaction of the client.
Sometimes, that might be slightly different than a medical team, so we work with the medical team and communicate around that too. But I think some of the most common things that we see, like you mentioned, are things like marital conflicts or the self and body image issues that you referred to. Our family therapists do a lot of work with clients around sexual health and intimacy related issues. A lot of what we're seeing now actually for our patients is we have a lot of younger patients with young children. Our family therapists with their training and background is really a great fit for that because they can help these parents talk about parenting with cancer and they can really help the families cope with the changes that they're going through or the challenges that they're facing and be able to work with the kids around communication or the impact on the kids too.
I think it's been a unique skill set that lends itself really well to working in this environment and knowing that a cancer diagnosis really does have a systemic impact on not only the patient and their physical body, but their emotions like you mentioned earlier or their family and for us to be able to pay attention to all those different ways that they might potentially impact the family. I think seeing a family therapist can be really helpful because they can help pay attention to those different things is basically what I'm trying to say. I think it's nice too because we have—our therapists sometimes meet with people one time. Sometimes they meet with people for several sessions.
Our goal is to be more brief oriented and not necessarily for somebody to stay in therapy for a long period of time. We want to help people be able to either develop or remember the skills that they had to help deal with the challenges that they're facing so that they are not reliant on the family therapist or other mental health professional going forward in the future, that they remember those skills or redevelop them and can use them as they keep going through their cancer experience. Do you have any suggestions for patients or family members who are reluctant about seeking therapy or attending therapy or maybe have family members who are reluctant to participate in therapy?
June Foss: I just would encourage them to at least try it. I think if we can get them in the door and we can help them see what it would be like. A lot of people have never done any kind of counseling or therapy and so they have no clue and they have a lot of fears about what it might be like or being judged or that kind of thing. I just try to encourage people. Just come once and let's just sit down and talk, and we can even talk about what those fears are that are making them reluctant about coming. Usually, if we can get them to come one time, they will realize it's not as scary as they thought it might have been. In fact, a lot of times, some people once they come and then they'll say, "Oh, I feel so much better." That's always really encouraging them to have a patient or family member that has been really reluctant to finally come and then leave expressing the help and the relief that they feel.
Cheyenne Corbett: Well, and we see other patients share with other patients and family members that they meet about if they've participated in either a group led by a family therapist or sessions with a family therapist, how helpful that has been for them in terms of communicating within their family or being able to talk about an issue that they were facing, that they didn't really have anybody else to talk to about. Our therapists and most therapists would be flexible enough to, like you said, be able to address those concerns, but also be able to really focus on the goals of each person in the room. Then I think that's, again, one of the things that family therapists have that specialty in doing is that there's not necessarily one person's perspective in the room.
We're really inviting everybody's perspective into the room. What you see maybe—I would sort of joke about what you see on TV and in movies, everybody is blaming one person in the room. When somebody is going to therapy, that's really not what it's about and it's really about tapping into those resources and strengths of the people in the room and also getting everybody's perspective so that therapists will really be working to make sure that that happens. That's one of the things that I think has been helpful for us is that our therapists convey that to people, that they're really looking to get everybody's perspective. Sometimes, it's helping to encourage somebody to come visit. It might be that they provide a very supportive role on helping somebody else who's experiencing some challenges.
I think always getting that referral to a therapist for a lot of people that can be a little concerning. I think that's why for our setting, it's really become something that's so normal in terms of a referral for somebody to help that our medical team members really relay that experiencing challenges throughout cancer experience is very normal and we have these team members who are trained to help our patients and their family members through this experience and really help connect. There are patients and family members who asked. When they have their physician or their nurse or other members of their medical team saying, "Hey, this is really helpful service. It's really helped a lot of my other patients." I think that can be very helpful as well, very powerful. You find that in your practice as well?
June Foss: I do. Actually, I think that's one of the most important things, is for the other members of the healthcare team to try to normalize the process of getting help from the therapist and just to encourage them. That this is something that will be helpful to you, that will be beneficial. I think that can also—even if they are frightened, or fearful, or hesitant, they trust the healthcare provider. They will often come and say, "Well, I'm coming because the doctor said I needed to come." Then once they're in the session, then they realized the benefit of this can be for them.
Cheyenne Corbett: Right. Yeah. Our patients have really talked about how helpful it's been for them. Like I said, sometimes, they have one conversation with the therapist, sometimes they have multiple conversations and that's really driven by the therapist and the client. But the fact that the services are available to them and that they're helpful, something that we try to continue to make sure—we continue to do here at the Cancer Institute—make sure that these services are made a priority and that they are available to all our patients and family members. We actually, our patient population, many people who come here are local, but we also have people that come from a distance. We're constantly connecting with marriage and family therapists in our patient’s home communities and really establishing them with that because we think it's a very helpful resource for the families that we serve.
June Foss: Right, right.
Cheyenne Corbett: Well, it's been great talking to you today, June, about marriage and family therapy in cancer care.
June Foss: It has been, this has been really nice to have this conversation and to see how we are doing some things similarly and some things are a little different in their settings. But that the role of marriage and family therapist is consistent in terms of what we can offer to our patients.
ASCO: Thank you Ms. Foss and Ms. Corbette. More information on the role of marriage and family therapist in cancer care can be found at www.cancer.net.
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