ed. by Sandra Haber
Foreword to the U.K. Edition
Heather Goodare
When I was diagnosed with breast cancer ten years ago I would have given a great deal for a psychotherapist or counsellor who knew something about my disease, who could have listened to me, supported me, helped me to work through my anxieties about treatment, heard and valued my story, and helped my partner and family. There was no one I could turn to locally, but eventually I found what I needed at the Bristol Cancer Help Centre. I was so struck by the importance of what I learned there that on my recovery I decided that I would train as a counsellor so as to be able to offer others what had been denied to me. This resulted in a complete career change, from that of publisher's editor to that of professional counsellor.Heather GoodareI thought it was important to undergo a 'mainstream' training in counselling, and I found a postgraduate diploma course at a local university that seemed to fit the bill. I duly qualified and started work privately, taking a range of clients but specializing in voluntary work with people suffering from cancer. I soon found that in this work there were special problems for which my personal experience had prepared me but which were not allowed for in my training. I found I needed, sometimes, to be more 'active' as a therapist, at times even acting as a patient advocate, that it seemed more appropriate to give rather more inormation than in my other work, that even with early-stage patients the possibility of death seemed to concentrate the mind wonderfully, and that when a person was approaching death the traditional 50-minute sessions, at my house, had to become shorter home visits, when the patient felt up to it. Together with my supervisor, we struggled to devise a flexible way of working that respected the context and sometimes 'broke the rules'.
During this period it would have been most helpful to have had this manual to guide me, to give me new ideas, to reassure me that I was on the right lines. Its surefootedness stems, I think, from the fact that a major contributor to the project was a psychologist, Michele Siegal, who herself suffered from breast cancer. Sadly, Dr. Siegel died before the book was published.
This book is both rich in ideas and extremely practical. It comes at a time when at last the psychosocial needs of cancer patients are being acknowledged in the British National Health Service. The recommendations of the Calman/Hine 'Expert Advisory Group' in their 1995 report A Policy Framework for Commissionng Cacner Services and also the NHS Executive's Guidance for Purchasers of breast cancer services, Improving Outcomes in Breast Cancer (1996), are clear about the importance of access for patients to counselling and psychological help. There is also emphasis on multidisciplinary teamwork and the role of the clinical psychologist in the team.
It is important to stress that breast care nurses, though they may (indeed should) have communication and counselling skills, have rarely undergone a full counselling training, and do not normally have time to offer counselling to patients. At the same time, psychiatric referral is only occasionally appropriate for cancer patients, even though they may well go through periods of anxiety and/or depression (which may be treatment related). Moreover, the crisis of cancer is often the presenting problem which brings to the sureface other underlying issues, needing skilled help to resolve. Sometimes cancer gives people the excuse to give priority to their own needs for the first time in their lives. Breast cancer in particular may make or break relationships with significant others. At these times the help offered by the psychologist or counsellor can be invaluable, and should be seen by patients as a right, forming part of the overall treatment programme, not seen as something with a stigma attached to it, only to be provided when the patient collapses in tears.
Very little in this book is peculiar to the American scene and does not apply to Britain: certain very minor adjustments have been made to the text to conform with British practice. In certain respects American and British practices are now converging: for instance, the Americans are now having second thoughts about offering frequent routine mammograms to women in their 40s, and the British are looking at the possibility of more frequent screening for women over 50. Oestrogen-receptor tests, taken for granted in America but until now not done routinely in Britain are (from 1996) recommended by the NHS Executive as a guide to hormone treatment. And most importantly, British women are now becoming more assertive, like their American sisters, in wishing to be fully involved in informed decision making.
In Britain the importance of psychosocial care in oncology has been recognized by the settingup of the now flourishing British Psychosocial Oncology Society, and by the newly founded National Association of Cancer Counsellors. Members of these two organisations, as well as psychiatrists, clinical psychologists, and counsellors new to oncology, will find this book very valuable. It will also be found helpful to breast care nurses and Macmillan nurses, who are often the first workers to identify those patients who need more specialist psychosocial care than they are able to offer themselves.
Heather Goodare is a counsellor in private practice in West Sussex, specializing in work with cancer patients and their families. She is also the editor of fighting spirit and has contributed to this site a report on the July 1997 World Conference on Breast Cancer held in Ontario Canada.
About these pages: Contact Nina Pope- UKBCA@somewhere.org.uk