On the last track we discussed the first three common reactions loved ones have to the news of cancer. They were shock, anger, and fear.
On this track we will continue our discussion of the eleven common reactions. This track will examine insurmountable burdens, loss of control, grief and guilt. As you listen to this track, evaluate your client. Might the techniques on this track benefit your client as an intervention to his or her reaction to a loved one’s cancer?
11 Common Family Member Reactions (#4- #7)
Reaction # 4 - Burdens are Insurmountable
Fourth, the loved ones of a cancer patient may begin to feel that burdens are insurmountable. This can be a common reaction because the client is having numerous additional responsibilities added to an already busy life. At first, the client tackles them by charging ahead, taking on new chores as well as the old ones. The client handles each and every burden himself. Then, at some point, clients like Ned become exhausted and overwhelmed.
Ned stated, "I’m losing my patience. There’s just to much to handle. If someone asks me to do one more thing, I’ll die!" To help Ned understand that on his own his burdens may be insurmountable, I stated, "You can’t handle all of this yourself, nor should you be expected to. Such expectations will inevitably go unfulfilled, and berating or blaming yourself will lessen your ability to meet any of your responsibilities."
Reaction # 5 - Loss of Control
In addition to shock, anger, fear, and burdens are insurmountable, a fifth common reaction is loss of control. Ned stated, "And then there are days when I feel like someone dropped me down a forty story elevator shaft and said, ‘there might be a trampoline at the bottom.’ I just don’t know what to expect." Family members and other loved ones have an especially difficult time dealing with the cancer because they feel as though they have lost control. Ned stated, "I can’t fix it. I don’t know what’s going on unless I can talk to the doctor. I just feel powerless."
Technique: Gaining Control
I gave Ned some cognitive strategies he could use to gain control.
I stated, "First, talk about the illness. It’s cancer, so call it cancer." As you know, clients cannot make life normal again by trying to hide what is wrong.
Second, I discussed acceptance with Ned. How might your client accept death as a part of life? Ned chose acceptance by thinking of everything he needed to be changed to make him happy.
Ned then went through his list item by item and asked himself if he could let go of each need or the demand to change it. Ned stated, "I guess there are a lot of these that I can let go of immediately. But how can I be happy while Theresa has cancer?"
How might you have responded to Ned? I stated, "With something like cancer that you have trouble accepting, write down the reasons you can’t accept it." For example, Ned wrote ‘It’s unfair.’ I continued by stating, "Look at each reason and say out loud that you choose to accept it. Eventually, your objections will begin to disappear." Ned stated, "I accept that Theresa’s cancer is unfair and wrong."
Reaction # 6 - Grief
In addition to insurmountable burdens and the loss of control, another common reaction is grief. Clearly, at some point, clients will experience grief. Ned stated, "I grieve for what we’ve lost and what we might later lose." Throughout the stages of Theresa’s cancer, Ned experienced several losses. Ned’s dreams, finances, roles, and relationships as he knew them were altered forever. Grief is clearly the natural way to respond to loss. I explained to Ned that suppressing or denying grief is not only abnormal, but would also have a detrimental effect on his well being. Think of your Ned. What methods do you use to help your clients deal with grief?
Reaction # 7 - Guilt
Next, let’s talk about guilt. Ned felt guilt because he believed he could do more for Theresa than what he had been doing. As you know, guilt occurs in retrospect when a client thinks he should have done something differently or not done anything at all. By not meeting his own expectations, Ned felt guilty. I asked Ned, "How can you expect to perform perfectly in a role that depletes your energy and is unpredictable from day to day?" Clearly, guilt is a vicious cycle. Once guilty feelings set in, clients like Ned may go in circles, never feeling as though he has done enough to make up for whatever he thought he did wrong.
4-Step Technique: Moving Beyond Guilty Feelings
To help Ned who felt unrealistic guilt over his wife’s cancer, I implemented the "Moving Beyond Guilty Feelings" technique.
The first step in this technique is to identify as many guilty feelings as possible. I asked Ned to make a list of all the "if" statements he could think of. As you know, "If " statements are part of the vocabulary of many grief clients. Ned’s "if’ statements included "If only I had enforced a better diet." "If only I had stopped smoking." "Maybe if I hadn’t focused on work so much Theresa could have focused on more on her health."
The second step is to analyze the "if" statements with the client for content. Some questions I asked Ned were, "Is this statement realistic or unrealistic?", "Could anyone else have done what you wish you had done?", and "Do you believe the statement to be true?" Ned’s answers indicated he was beginning to dispute his unrealistic guilty feelings.
The third step in the "Moving Beyond Guilty Feelings" technique is to prompt the client to dispute any unrealistic guilt. With Ned, the second and third steps ran together as his answers to my questions were elaborate. You may find, as I did with Ned, that as the client identifies and lists guilty feelings, he or she may begin to analyze and dispute those feelings naturally.
The fourth step is to ask the client to write down new feelings to replace the guilty feelings. For example, Ned wrote, ‘Theresa knows I care for her very much. I only did the things I thought I was supposed to be doing."
Think of your Ned. How can the moving beyond guilty feelings technique benefit your client?
On this track we continued our discussion of the eleven common reactions. This track will examine insurmountable burdens, loss of control, grief and guilt.
On the next track we will finish our discussion of the eleven common reactions to cancer with 4 final reactions. They are a reevaluation of beliefs, the desire to bargain, anxiety, and hope.
Peer-Reviewed Journal Article References:
Dunn, M. J., Rodriguez, E. M., Barnwell, A. S., Grossenbacher, J. C., Vannatta, K., Gerhardt, C. A., & Compas, B. E. (2012). Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis. Health Psychology, 31(2), 176–185.
Infurna, F. J., Gerstorf, D., & Ram, N. (2013). The nature and correlates of
change in depressive symptoms with cancer diagnosis: Reaction and adaptation. Psychology and Aging, 28(2), 386–401.
Sohl, S. J., Levine, B., Case, L. D., Danhauer, S. C., & Avis, N. E. (2014). Trajectories of illness intrusiveness domains following a diagnosis of breast cancer. Health Psychology, 33(3), 232–241.
Online Continuing Education QUESTION 2
What are 4 common reactions to cancer?
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