Why Working With Cancer Patients Is Not Depressing

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"Isn't it depressing?" is the first question I'm asked, which tells me many people don't understand just how clarifying and transformative the cancer experience can be. Having worked with cancer for 20 years and having had it myself, I understand what everyone else does--that cancer is shocking, harrowing, painful and sometimes fatal. But there is much more to the story, and as a psychotherapist, I am on the front line watching lives open, deepen and heal, regardless whether patients live or die.

The story begins with a person in a sea of turmoil, stripped of safety and familiarity, searching for bearings and hope. There is an immediacy in the room-no time for disguises, formalities, superfluous concerns. Meeting someone in this raw state, I find myself alert, mobilizing the best in me to help. The room is filled with both the preciousness of life and the inevitability that we all will die. The conversations vacillate between both realms. The presenting concerns are urgent and important: How can I protect my kids? How do I stop the terror at night? How do I know if I'm choosing the best course of treatment? What if I don't make it?

As humans we are conditioned to avoid the unpleasant, and we often don't change and grow until we have to. This makes therapy with clients "not-in-crisis" move more slowly. Not so with cancer patients, who are bombarded with physical and emotional pain and discomfort, and for whom the veil between life and death has been lifted. Cancer forces accelerated growth and change, much of it dreaded and unwelcome at first.

Cancer patients bring to therapy topics of great importance; big picture topics; matters of the soul. What aspects of my life are no longer important? Where do I want to put my energy? Which relationships and projects are most meaningful to me? What legacy do I want to leave my children if I die or even if I don't? Physical and emotional pain affords them the possibility of cultivating courage and strength beyond what they have known. Fatigue affords them the chance to slow down and notice their environment in new ways as well as to discern where they will put their limited energy. Fear of dying affords them a reason to clarify priorities and to bring to life parts of themselves which have been asleep.

In 1996, one of my first clients was "Mark," a 23-year-old police officer with stage IV lung cancer. He was a "tough guy." A month before he died he was bed-ridden, struggling to breathe, and I visited him at his home. He wanted to talk about a squirrel who had been hanging out by his window. With tears in his eyes, he told me how amazing this creature was and how much time he spent watching it. He told me that before his diagnosis he never would have recognized the beauty of a squirrel. This was not sadness, but access to his deep love for life. I am not exaggerating when I say he was feeling a kind of rapture, immersed in gratitude. I was so moved, and 20 years later I still feel grateful that he showed me how we can come alive even under the most tragic circumstances.

Like Mark, for many cancer patients there comes a time, whether they live or die, when they find the space to respond to cancer rather than primarily reacting to it; when they have it instead of it having them. What does this mean? It means that though they have faced and may still be facing fear and pain and grief, they have stayed open to life itself, and to the difficult path life has given them. It is this staying open, leaning in, saying yes to overwhelming difficulty, not every day, but overall, which is the recipe for extraordinary transformation. It's the most beautiful process I've seen in people. And gifts to people who brave this journey are precious: Clarity of priorities, deeper compassion, stronger connection. Not too depressing, huh?

People without cancer or impending death have recognized the power of crisis as transformative. Stephen Levine wrote the book A Year to Live, which offers people a chance to intentionally and systematically treat the year ahead as if it's their last. My supervisor in 1996 ran a group based on this concept and made massive changes to her life. By the end of the year she was glowing, clear, grounded, present in a way she had never been before. A year later she died in a car accident while traveling, and though she was only 60, I somehow felt a sense of peace about it; she was living her best life with two feet in. In another example, the owner of a popular yoga studio owns a casket and lies in it each day to remind himself, viscerally, of the preciousness of life. The bottom line is, it is harder to find the best of life's treasures without the intrusion of a terrible crisis.

Working with cancer patients is piercing, engaging, meaningful, transcendent, but not depressing.

Pamela Cordano, MFT is a California-based psychotherapist who specializes in illness and grief. For twenty years she has worked with individuals, couples, families and groups using a relational and somatic approach. Inspired by Viktor Frankl, she is passionate about the power of identifying and embodying what is meaningful, which allows for increased vitality and new possibilities. She leads a weekly Meaning Group in her private practice and teaches MeaningWork Workshops to groups and professionals both locally and internationally.

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