Family Work in Oncology: Trusting the Narrative

The author describes her work with a dying patient, work that extends from the patient to his wife and adult offspring, and has transformative benefits for the family.     

Living with dying and disabilism: death and disabled children

This paper explores the ‘offensive presence’ death has sometimes represented in disability studies. The paper focuses on interviews with three mothers of children with the label of life‐limiting and life‐threatening impairments and positions their experiences within the current policy context for disabled children in England. The narratives are part of a wider on‐going study funded by the Economic and Social Research Council ‘Does Every Child Matter, post‐Blair? The interconnections of disabled childhoods’ (RES‐062‐23‐1138). Findings include: (i) families experience social isolation and poverty; (ii) support from services is lacking and/or inappropriate; (iii) families worry about the future and the (physical, social and emotional) costs of care. The paper concludes by suggesting that social oppression theories of disability have much to offer in terms of challenging the disadvantage disabled children and their families’ experience during life and in death.     

Balancing Hope and Hopelessness in Family Therapy for People Affected by Cancer

This paper discusses how the concepts of hope and hopelessness can affect therapeutic interventions when working with people affected by cancer. The concepts of hope and hopelessness are considered within the therapeutic relationship and the biomedical model. This explores whether there is a difference between hope and denial and considers how culture, religion, and spirituality influence an individual's interpretation of hope. For some people living with a cancer diagnosis, the word ‘hope’ can become a burden. They can feel a pressure to present as strong, positive, and hopeful in the face of extremely confronting situations. Therapists need to give patients time and space to explore their feelings of hopelessness without rushing them to a place of hope for which they are not ready. Case examples are provided and the author reflects upon her own family therapy practice working in an acute health care facility. This stresses the importance of critical reflection, supervision, and peer support.     

When Death Becomes the end of an Analytic Treatment: Necessary Parameters

This paper is based on a social worker psychoanalysts work with an analysand, who during the course of an analysis, was diagnosed with advanced and inoperable lung cancer. The paper explores: changes in the analytic frame; countertransference responses; and how the analyst worked with her patient until the very end. Working with the dying patient may offer perspective on how we think about and approach the termination phase in other psychoanalytic work as well.     

Behavioral economics of death and dying decisions: Both rational and irrational approaches

A decision to accept death and forego life-extending medical procedures can be both rational and irrational. This article reviews perspectives on death from the viewpoint of behavioral economics, which relies on psychology as the basis of decision-making in this regard. According to behavioral economics, both the benefits of living and the costs of death should be emphasized so that a person who is thinking about suicide reconsiders that option and, hopefully, changes his or her mind and tries to safeguard life and avoid life-threatening risks. One way to make dying decisions more rational is to write out a living will or advance directives to help doctors understand a patients’ intentions with regard to decisions about dying should they become unable to articulate that intention at some later, critical, life-or-death situation. Living wills and advance directives can therefore reduce the chances of mercy killing or euthanasia, especially in the context of a developing country, especially when life-extending technologies are limited.     

In life and in death: the story of people living with metastatic cancer

ABSTRACT

Advances in the treatment of metastatic cancers such as melanoma enable patients to live for many years. However, melanoma patients are under constant threat of a recurrence or a new growth, are under intensive follow-up, and must avoid exposure to the sun. These factors engender anxiety, a constant fear of recurrence, and a reduction in routine activity, thus requiring patients to develop mechanisms for coping simultaneously with the illness and the threat of death. This study uses content analysis of the documentation of a support group for metastatic melanoma patients to examine how they cope with both. The findings suggest that they are able to cope with both simultaneously. However, perhaps because they recognise their total lack of control over the illness, they exercise control in how they cope with death. The findings suggest that support groups like the one documented in this article could serve as sheltered and effective therapeutic spaces for coping with the threat of death.     

In the Shadow of Death: Relational Paradigms in Clinical Supervision

The process of clinical supervision is a complex undertaking that is influenced by multiple factors, including the personalities and characteristics of the supervisory dyad, developmental considerations, social attitudes, ecological factors and the parallel process. The supervisory interchange becomes even more difficult and complex when it occurs in the context of HIV and AIDS related practice, which introduces the reality of untimely death accompanied by grief and loss. In this paper, I will review the literature in regards to developmental aspects of the supervisory relationship, transference and countertransference paradigms and the parallel process. These particular issues will be framed within a relational perspective and the ways it shapes the supervisory process. The focus of this paper will be clinical work with clients diagnosed with HIV and AIDS and the impact of death and dying on the supervisory paradigm. The literature review will be elaborated on through a clinical vignette followed by an extended discussion.     

Cancer as a Life Transition: A Relational Approach to Cancer Wellness in Women

Receiving a diagnosis of cancer is a traumatic event and changes one's life forever. The period of initial diagnosis and treatment is indeed a life transition, regardless of the prognosis. It precipitates a change in self-perception, physically, emotionally, and interpersonally. It changes how a woman sees herself, her family, and her world. Simultaneously the woman is confronted with many decisions to make regarding treatment options and the management of personal, familial, and work related responsibilities. People have the opportunity to reflect on old decisions and to make new decisions. Inevitably one is confronted by mortality. The management of this illness is done in the context of a complex network of relationships with family, friends, coworkers, doctors, other medical personnel, and clergy. Often it is the clinical social worker who is in the position of facilitating access to and participation in resources for care. Many women join healing communities or wellness centers to find a model of care and achieve a state of well-being that utilizes and encourages the support of these relationships. Understanding the importance and impact of these relationships can help clinical social workers facilitate cancer wellness in their clients and advocate better on their behalf. The intent of this paper is to understand the concept of cancer wellness as a relational approach and to promote its place in integrative clinical social work practice.     

Augmenting Bowen Family of Origin Work: Using the Genogram and Therapeutic Art‐based Activity

This article explores the use of creative artistic activity and metaphor to augment Bowen family of origin work. It draws on the case study of a couple engaging in premarital counselling to illustrate several ways that art making can be used to enhance Bowen systemic processes. It illustrates the value of collaborative genograms and related creative products to offer a supplementary voice for salient, verbally inexpressible content while supporting clients in externalising and processing difficult emotions with reduced reactivity.     

Tuning and Practicing the Therapeutic Instrument: The Therapist's Life Experience

This article views the therapeutic use of self broadly as if through a wide-angle lens focusing on the therapist within his or her surroundings. These contextual features can be seen as projections of the therapist's self and therefore useable in treatment. Through an interest in alternative brain functions due to her own struggles with a neurological illness, the author arrived at the idea of utilizing her personal interests which naturally come into the milieu as therapeutic vehicles. Personal interests that are compatible with the patient's character offer alternative modes for experiencing, expressing and regulating affect states. These interests in the expressive arts together with the person of the therapist constitute a medium for rotating attention around unfamiliar parts of the mental landscape. Disavowed or dissociated affects can be unearthed, made conscious, put into language, and treated. This idea in practice nests neatly within recent thinking in psychoanalysis, neuroscience, and the philosophy of science. When language alone is not enough to move the therapeutic process forward, other working knowledge in the therapist's life can be brought to bear as a powerful evocative force for therapeutic change.     

Systemic Therapeutic Approaches with Sexual Minorities and Their Families

Abstract

GLBTQ families encompass very diverse forms, all of which are interwoven with other differences such as class, race, ethnicity, religious and spiritual beliefs. This article will familiarize the reader with some challenges faced by families of sexual minorities and how different family therapy approaches might be applied. Training issues for therapists are identified and future areas for development are discussed.     

On the Receiving End: Women,Caring, and Breast Cancer

Gendered definitions of care influence breast cancer survivors’ coping strategies, sense of entitlement to care, and ultimately their capacity to receive care. Using qualitative data from 60 intensive interviews, this study examines how gendered definitions of care influence women’s experiences as care-receivers. Findings indicate that negotiating gender boundaries to care for the self is both empowering and stigmatizing. Women with breast cancer are required to break gender norms that stress compliance, nurturing, and putting the needs of others first to prioritize their own needs for care. Concurrently, they take on additional nurturing roles to provide support to other women with breast cancer, relinquishing to some degree the individualistic approach to life they found necessary to cope with their illness in the first place.

Missing Michael White: Understanding His Influence in One Person's Life and Work

This is a personal reflection that describes and seeks to understand the significance of Michael White's contribution to my life and work. It offers a personal history of the ways in which these ideas were incorporated over time, and the way in which Michael's teaching made this possible. It looks at how this influence is taken forward and continues to be lived out. It reflects the knowledge and skills, the intentions and the hopes, the purposes and plans held that have been shaped through learning experiences with Michael White and the people and ideas that this introduced me to. The legacy of this learning is a hopefulness for future skill development and teaching, nurtured through these communities of people.     

Trauma and the Clinician: Therapeutic Implications in Clinical Work with Clients

This article explores clinical issues related to self-disclosure to clients following a traumatic event in clinicians' lives. In particular, special attention is paid to the role of self-disclosure in clinical work when clinicians are conflicted about whether or not to share personal information or how to communicate it to clients due to the nature of the trauma. Therapeutic implications, both short and long term, associated with such self-disclosure are discussed.     

Along the Cancer Continuum: Integrating Therapeutic Support and Bereavement Groups for Children and Teens of Terminally Ill Cancer Patients

Family life is altered irrevocably when a young parent is diagnosed with or dies from cancer. This article tracks the genesis and transformation of a comprehensive psychoeducational support and bereavement program for children, adolescents, and parents affected by cancer. From the inception of the program, families with parents in active treatment participated in time-limited support groups. When a parent died, families transitioned out of support and into bereavement groups. As the cancer experience became more chronic, families remained in these respective groups for longer periods of time. This required clinicians to reconsider group structure to avoid the additional losses incurred as newly bereaved families transitioned from one group to another. Restructuring the program allowed participants to remain in familiar environments and to experience greater support and continuity in their care. Children, teens, and parents made clinical gains in communicating their needs and feelings to loved ones. Further, children and teens stayed on track developmentally, academically, and socially. Clinicians structuring these programs must be skilled in working simultaneously in both support and bereavement modalities. Recommendations for self-care and supervision are suggested.     

Grand Slam on Cancer

A winner of 59 Grand Slam championships including a record 9 Wimbledon singles titles, Martina Navratilova is the most successful woman tennis player of the modern era. Martina was inducted into the International Tennis Hall of Fame, named “Tour Player of the Year” seven times by the Women's Tennis Association, declared “Female Athlete of the Year” by the Associated Press, and ranked one of the “Top Forty Athletes of All-Time” by Sports Illustrated. Equally accomplished off the court, Martina is an author, philanthropist, TV commentator, and activist who has dedicated her life to educating people about prejudice and stereotypes. After coming out as a lesbian in 1981, Martina became a tireless advocate of equal rights for lesbian, gay, bisexual, and transgender (LGBT) people, and she has contributed generously to the LGBT community. Martina is the author of seven books, including most recently Shape Your Self: My 6-Step Diet and Fitness Plan to Achieve the Best Shape of your Life, an inspiring guide to healthy living and personal fitness. Martina was diagnosed with breast cancer in 2010.     

Chapter 6: University of Arizona Life & Work Connections

SUMMARY

The concept of integration has emerged in recent years as a strategy considered by providers of employee assistance, wellness and work-life services to meet the changing needs of the organizations they serve. There continues to be much discussion, however, about what exactly integration is, and how to do it. Beginning with a definition of integration, this article seeks to contribute to the discussion by describing the University of Arizona (UA) Life & Work Connections, a program that was conceived from its development to be an integrated service model. The theoretical and philosophical backgrounds of the program are presented and translated into the UA Life & Work Connections model. Advantages of the model and challenges to integration are discussed, and a detailed case study of a critical incident response is presented.     

Working with Stories: Street-Level Bureaucrats and Their Work with Individuals with Psychiatric Disability Exposed to Interpersonal Violence

ABSTRACT

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.     

Live Your Life Out Loud

Susan Love, MD, MBA, has dedicated her professional life to the eradication of breast cancer. Author of the bestselling Dr. Susan Love's Breast Book, Dr. Susan Love's Menopause and Hormone Book, and Live a Little, Susan is Chief Visionary Officer of the Dr. Susan Love Research Foundation where she oversees an active research program centered on breast cancer cause and prevention. Susan co-founded the National Breast Cancer Coalition in the early 1990s, and she served on President Clinton's National Cancer Advisory Board from 1998–2004. Her recent projects include recruiting 377,000 women for the Love Army of Women, an Internet program that partners women and scientists to accelerate breast cancer research; and the online Health of Women Study designed to identify the cause of breast cancer. A recipient of six honorary doctorate degrees, Susan is Clinical Professor of Surgery at the David Geffen School of Medicine at the University of California, Los Angeles. In June of 2012, Susan was diagnosed with acute myelogenous leukemia and was treated with an allogenic stem cell transplant.     

Motives for sharing illness experiences on Twitter: conversations of parents with children diagnosed with cancer

A patient- and family-centred approach in paediatric health care is important because parents are involved in making key decisions about their child’s health care and advocating for the best interest of the child. Parents and family members are increasingly turning to the internet to find and actively share information about their child’s health care. Twitter is one of many online platforms used by parents of children diagnosed with cancer to share information related to their child’s cancer experience. Existing research suggests that there is a need to better understand the motives for using Twitter for sharing content about a child’s cancer experience. Furthermore, there is a lack of theoretical frameworks for characterizing those motives. In this paper, we identify key themes of tweets posted by parents of children diagnosed with cancer and align those themes with motives inspired by the well-studied Everyday Life Information Seeking framework. We propose a new motive in addition to those associated with the framework and suggest that information can be shared for endogenous reasons as well as to meet the needs of others. This paper contributes an increased understanding of motives for sharing information about a child’s cancer journey and extends a theoretical framework for building further knowledge in this area.