UNDERSTANDING THE MENTAL CHALLENGES OF CANCER RECOVERY

Through the eyes of an expert

by Tzoumaka Anastasia, Makri Maria

Mental health, constitutes one of the most crucial parts of our well-being, especially when we face important challenges, like cancer. The power of our mind and soul, is often proved to be of equal significance with cancer treatment procedures, affecting the way that we process the illness. The interview we conducted with psychologist, Dr. Ziliaskopoulou, provided us with valuable information about how cancer affects mental health, and how meaningful emotional support can be, during and after cancer treatment.

I: Could you first give us some personal information, for example your name, age and specialty?

Z : “My name is Despoina Ziliaskopoulou, I am 42 years old, and I am a psychologist, with two Master’s degrees, οn clinical and οn health psychology. I also have a PhD related to cancer and the experience of women with mastectomy. I am currently doing a postdoctoral on breast cancer and I have my own private office, where I offer therapy sessions, as a trained psychotherapist on Cognitive Behavioral approach.”

I: How did you decide to become a psychologist, and why did you choose to specialize in this particular field?

Z: “I first learnt about psychology as a profession, when I was in high school and I decided that I wanted to follow this career, knowing that I was interested only in being a psychotherapist and not working in the research field. I think that I made this decision, because I liked very much to analyze people and to try and interpret their behaviors, and also maybe because of some personal issues that I was dealing with. Then, I specialized in the field of health psychology, as I was very interested in serious diseases and health issues in general and also I liked to work with topics that concerned women. Moreover, when I was a child, my grandmother died from breast cancer, so I saw the difficulties of the disease and how this illness was treated as a taboo and that motivated me as well to learn more about health.”

I: In your opinion, what are the three key things you always take in mind when starting a session with a client?

Z: “At first, I believe that the relationship between therapist and client is a very important part in the process, so there has to be trust, for the client to feel safe. Of course, I put as a priority being a good listener and try to understand the person’s perspective of things. Something else that I consider necessary for the sessions, is to learn as much as I can about the client’s past, because the way in which people deal with the illness is shaped to an extent, from their childhood experiences and the ways they used back then to overcome their problems. For example, if a person is used to being very autonomous and doesn’t ask for help generally, it might be a shock to him/her being in that vulnerable position, needing to ask for support from others.”

I: Which therapeutic approach do you consider to be the most appropriate for people with serious illnesses?

Z : “Many studies have shown that CBT is a very effective way to help people with cancer and from my personal experience, I have realized that it can contribute to the improvement of a client. But that is not always the case, as in CBT we focus a lot on a quality we call “fighting spirit” and we try to work with the person’s resilience. That can be a good thing, as it provides clients with more confidence and trust in their abilities, but it could also pressure people to feel that they must always be strong or hide their fear from others. In some cases, it would be beneficial to work with a more psychodynamic approach, especially if the client isn’t ready to accept the situation and there we can just give them time to express their feelings. In addition, I have noticed that many therapists use the existential approach, as it is more directed towards finding a meaning in your life, and this way, it can help clients to get their own answers about why this has happened to them.”

I: Is there a common element or pattern you notice among cancer patients?

Z : “They usually experience a very strong shock, they have difficulties to realize what is happening to them and they tell me that they are frightened. They also focus at first on the most practical medical issues, for example getting a second opinion from a doctor, beginning their treatment and having their check ups done. Another common pattern I personally noticed, is that when they are under chemotherapy, it is difficult for them to focus on our sessions because of their side effects, so during this period we can’t work so much psychotherapeutically, but acting more as a support system. When this procedure is done, they often try to understand what they had done personally to cause the cancer, so they tell me most times that they think they didn’t take good care of themselves and they were pressured by others. Following this realization, they often state that they will try and use this disease as a chance to change important things in their lives.”

I: How do you handle difficult questions from patients who are facing death or are close to it?

Z:“That is a very hard topic, as I believe that death does not come up easily in a conversation and it’s proved by current studies that we want to act as if death isn’t a part of our lives anymore. Death is considered a failure, a difficulty of the doctor to save the patient’s life and also we, as therapists, are also afraid to some extent. As a result, it is vital that we have addressed these issues ourselves first, in order to be able to endure the pain and fear people face. For these reasons, we might not be able here to understand them completely, but we try to listen as best as possible.”

I: What role does the family play in supporting their loved ones and how do you work with them?

Z: “In general, they say that cancer isn’t a personal disease, but a disease of the whole family, because when someone is diagnosed, that affects the lives of all the family members and his/her loved ones. Families can offer great psychological support to the patients, not by trying to reassure them or pressuring them to be strong, but by being there to listen to them and give them space to express their feelings. I don’t typically invite the family members for a session with them, because I prefer to understand what my client has to say about their interactions with their relatives and then give advice about the way that the patient can alter his/her way of reacting towards their family. However, when I feel that the family interferes or pressures excessively, I might speak with them in a session, in order to help both them and my client as well.”

I: From your experience, do you find one-on-one sessions or group therapy to be more effective?

Z: “In my opinion, this decision lies with the client exclusively. Some people may prefer the extra element that group th erapy has to offer, meaning the sharing of their common experiences and feelings. On the other hand, some clients feel better with the one-on-one sessions, because based on my personal experience, they may feel stressed and frightened to see a person in the group that is in a worse condition than them, so this makes them think that they will reach that stage later and they don’t want to have to deal with this stress. There are times, when I propose some cases, where I would think it would be helpful, to attend a group therapy, but I let the clients decide.”

I: What are some common prejudices or misconceptions that people have about cancer patients?

Z: “Sometimes, people have painted that picture in their minds, that cancer patients are unhappy or miserable, but that isn’t true, because it is very natural for them to experience shock and sorrow, especially in the start, but that doesn’t mean that they don’t work with themselves, or that they are unable to feel happy when good things are happening to them. And of course, we have this main stereotype that cancer means death, so when the public comes in contact with cancer patients, they don’t know how to act, they feel awkward, and that can make the patients distance themselves. As far as women with breast cancer are concerned, there is the prejudice that if they have gone through mastectomy, they aren’t feminine enough, and as a result, a lot of women feel pressured to go through a plastic surgery to improve their breast’s appearance, or they are stressed about if men will find them attractive. Lastly, it is very common for people to believe that patients affected by cancer should be some kind of “fighters”. This could lead to individuals hiding their “negative” feelings, such as the fear for their life, and not being able to express themselves in an authentic way.”

I: In your opinion, how much can resilience help patients throughout their journey and in what extent do you think that resilience comes from our personality or by working to develop it as a trait?

Z: “Some people are more resilient than others naturally and that can contribute to a better and quicker adjustment to the situation. However, one of the main goals of therapy sessions is to help develop this character trait, as the techniques we use, encourage the clients to have more confidence in their personal abilities and help them deal with pain and difficult situations more effectively.”

1. Do you believe that financial factors affect whether people begin or continue therapy sessions?

“As far as psychologists in private offices are concerned, we know that the people who reach out to us for therapy sessions, usually can afford it. But, of course, there is an important percentage of patients that don’t have the financial means to begin therapy privately, so their needs are supposed to be covered by the psychologists working in hospitals, or by the associations created for cancer patients, which offer free psychological support to those who need it. However, I think that the services that are being offered aren’t adequate enough to respond to such a big amount of people and this situation is getting worse, as more and more public clinical settings are getting privatized.”

I: Lastly, have you seen therapeutic sessions resulting in improvements both psychologically and physically?

Z: “That depends on the patients. In some cases, we act more supportingly and not so psychotherapeutically. On the other hand, there are some individuals who want to answer some crucial questions about their situation, to find meaning in their lives, or try to get back to their former activities, before the diagnosis. But, all clients see a big difference compared to the mental state they had when they first asked for help.”

I: What do you think about phrases like “they lost/won their battle with cancer”, which are so commonly used?

Z: “These phrases lead to stigmatization and in recent years we try to avoid using them, because they maintain the viewing of cancer as a taboo issue. We can just say, “They died from cancer”. This is the only way to show that cancer isn’t that frightening anymore and it’s also something that happens in life. And of course, phrases like “he gave a hard battle with cancer”, are suggested to be avoided, because we can’t evaluate if someone has fighted or not and also because the outcome depends on many factors, and not only by the patient’s attitude.”

I: Okay, thank you very much for your participation in this interview!

To conclude, mental health plays a key role in the process of recovering from cancer. The assistance which a specialized psychologist and a strong social support can provide, have a direct effect on building resilience and help patients to improve the quality of their lives. Our conversation with the psychologist shed light on the deep, emotional layers of mental well-being, especially in times of personal crisis. What truly resonated was the emphasis on the importance of emotional validation and the healing power of being truly heard. It’s not just about solving problems, but about creating a space where people feel safe to express their vulnerability and fears.