The Benefits of Talking with Others
Why join a support group? Do they exemplify the adage that “misery loves company?” Do cancer patients become more miserable by being exposed to the fears of others with the same illness?
Robert Watts, a football player with Hodgkin’s lymphoma, explained how joining a group of fellow cancer sufferers helped him. “When I was diagnosed, I was a professional athlete,” he recalled. “I was used to putting problems aside. I could not think about injuries when I was playing or I would get injured and instead I would picture myself doing what needed to be done, picture myself winning. That didn’t work when I found I had cancer, although I used it as my model for getting through treatment."
“It was after treatment that problems began. I would find myself getting overwhelmingly anxious, feeling tight in the chest. I remember working out in my gym at home and after fifteen seconds of skipping rope my chest tightened up; my muscles were tight from the radiation and I didn’t know how to deal with that. I was scared I was going to die. But I wasn’t allowed to be scared. It got to where I found myself driving in my car on the Golden Gate Bridge thinking, ‘Well, if death is going to get me, let’s just get it over with. I can’t live with this.’ I needed a checkup from the neck up. I called up my doctor and he said, ‘Get down here.’ Sometime during treatment, someone needs to lead you by the hand and take you to the group. I felt overwhelmed at the thought that I wasn’t the same man I was when I started treatment, that I couldn’t solve things by just working out more. I couldn’t accept being someone who was sick, who faced the risk of dying. Since I have been to the group, I have cried. I feel better because I can accept better who I am now.”
For Robert, his physical strength represented his sense of well-being. It took the experience of feeling the emotional pain caused by the disease in his body before he could reach out to others for help.
Groups provide an opportunity for people to see their own problems as others see them, through the eyes and ears of other group members. This helps them gain a new perspective on their illness and reduces the inappropriate guilt that often besets cancer patients. They learn that many of their problems are due to cancer, rather than personal failings. At other times, group members develop and consolidate their own sense of personal competence in dealing with cancer by helping others who have less experience with it. Groups can also assist in developing a more active coping stance and in finding something to do about even the worst aspects of the illness, such as fears of dying and death. Group discussions of these issues help members to experience shared anxiety and sadness. This can be invaluable to an individual who is about to sink into the despair that loneliness causes. Our 2001 book, Group Therapy for Cancer Patients, provides a detailed description of the methods of leading such groups.
Many patients report a psychic numbing that characterizes their initial response to learning they have cancer. Before patients can speak fully about their grief, they need to talk together, a process characterized by Freud as “remembering, repeating, and working through.” Something therapeutic occurs when you hear your own voice while talking with others about your problems. The experience of a life threat and the need to grieve the loss of one’s health is better handled when shared with others in the same predicament. For example, perhaps you’ve always believed that life should be fair, or that “bad things do not happen to good people.” The discrepancy between this view and your present life situation conjures up many feelings, many of them negative.
When you ask yourself the question, “Why has this happened?” you’re really asking, How could this have happened to me?” There is a human need to find a positive purpose for a negative event. Examining old beliefs can lead to finding meaning in the new situation. Illness threatens our dreams and diminishes our illusion of autonomy and control over life. Cancer threatens the illusion that life is predictable and controllable. Group discussions can lead to the discovery of smaller but potentially controllable new domains. Taking charge of treatment decisions, family relationships, priorities in life, and managing relationships in the group can be a powerful antidote to the helplessness engendered by illness.
Some topics that frequently emerge in support groups are the impact of the cancer diagnosis, the sense of loss and grief, the overwhelming emotional reactions that overcome us from time to time, physical losses, communication problems with family and friends, the reactions of others to us, the changes in our values and goals, and a view of the meaning of life.
The ability to be in touch with one’s feelings is a very important part of dealing effectively with the disease. Robert Watts recalls, “The greatest thing that turned me back toward my feelings is what I learned with the Survivors’ Group. One night when I was feeling bad, a young Latin woman entered the group. She had recently completed her therapy for lymphoma. She cried every time she attempted to talk about her pain. Finally, she spoke about not being able to feel good about anything, about not feeling lovable. For the first time, I heard someone talking about experiencing what I had experienced, and suddenly I realized that I was not the problem, but instead that I had a problem.”
The moments of clarity, identification, and connection that come with discussing deep concerns are part of the emotional healing process that group therapies offer cancer patients, a process that helps patients return to a sense of inner control. Just as illness has biochemical and emotional components, healing requires emotional as well as physical assistance.
Benefits of Group Support
There is growing evidence that educational, supportive, and psychotherapeutic interventions for the medically ill can have a variety of positive effects, including distress reduction, improved coping, enhanced interaction with family and friends, improved interactions with health care professionals, and adherence to treatment. Social support also can be an important factor in mediating individuals’ ability to cope with stress.
Support Groups Are Safe and Inexpensive
Support groups have proved helpful to cancer patients. For example, support groups have been shown to reduce traumatic stress symptoms, reduce other psychological symptoms and distress, improve coping, enhance disease knowledge, improve quality of life, and reduce pain. Such programs have been developed in oncology centers, private practices, and in supportive care programs. Recently, efforts have been made to establish and evaluate chat room programs on the Internet for cancer patients and those with other medical illnesses. While maintaining quality control is a difficulty, electronic support has already opened new worlds of information for patients, and also may provide increasing amounts of emotional, as well as intellectual, support at little or no cost.
Group members often remain in touch with one another for years after their formal participation ends. Typical comments are:
“When I joined the support group, I realized I was not alone.”
“I needed time to talk with others about what I had just been through.”
“I thought I was healthy and then this thing came along! I felt wounded, and nobody else seemed to get it!”
“Sometimes I found that what I said seemed to register with others in the group."
“It felt so good just to get my feelings out in the open.”
Cancer patients benefit from sharing their feelings with others and from finding understanding in their responses and stories about themselves. Having cancer presents an immediate life threat. Treatment offers hope as well as new problems. The life threat may subside with treatment, but many need to talk about it with others in order to reclaim a sense of inner control.
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David Spiegel, M.D.
Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine, where he has been a member of the academic faculty since 1975. More He is Past President of the American College of Psychiatrists, and Past President of the Society for Clinical and Experimental Hypnosis, and a member of the Institute of Medicine of the National Academies. He has published ten books, 368 scientific journal articles, and 156 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. His research has been supported by the National Institute of Mental Health, the National Cancer Institute, the National Institute on Aging, the National Center for Complementary and Alternative Medicine, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, the Dana Foundation for Brain Sciences, and the Nathan S. Cummings Foundation.
Pat Fobair, L.C.S.W., M.P.H.
Pat Fobair is a California licensed clinical social worker who worked in San Francisco Bay area hospitals for over forty years.'. She initiated group therapy support for cancer patients at Mount Zion Hospital in San Francisco, January, 1970, (now part of the University of California in San Francisco). In the 1980's, she started multiple groups for breast, young people, and multiple cancer diagnoses at Stanford University Hospital's, Department of Radiation Oncology, (1980-2003). More With her colleague, Susan Weisberg, LCSW and six patients treated for Hodgkin's disease, Fobair developed the "Surviving!"magazine which featured stories written by patients. They published four times a year, 1983-2003. At the behest of Dr. Ernest H. Rosenbaum, MD, she facilitated in the development of the Supportive Care Program at the center for Integrative Medicine at Stanford Hospital, in 1998-2003, led by David Spiegel MD in the Department of Psychiatry and Behavioral Medicine. From the 1980's through 2003, Fobair was active in psychosocial and medical research on patients' quality of life after treatment for Hodgkin's disease, and breast cancer. Her work has been published in over 40 journal articles and book chapters, 1975-2012, and presented throughout the United States, Europe and Asia. From 2007-2012, Fobair was a CIES Fulbright Specialist on the Social Work list with the United States State Department. During tours in Turkey (2008) and Vietnam (2012), she worked with professional colleague, Grace Mishler, MSW using the Coping Engine teaching tool. It was particularly popular in Vietnam at the University of Social Sciences and Humanities, Vietnam National University, and at the US Consulate in Ho Chi Minh City, where an audience of 250 people did not want the lecture to end until their questions had been answered. Fobair developed a system, the Coping Engine, as part of her work with cancer patients, 1990-2013 at Stanford University Hospital. Initially called, "Coping with Loss of Control" it was used with cancer patients treated in the Department of Radiation Oncology. It evolved into the "Coping Circles" and "Copingengine.com," a web site and tool she continues to assist.