How to find a cancer therapist

Managing cancer can be too hard to do alone. Many people find that their friends and families, in spite of their loving support and best intentions, can’t handle the ongoing worries and conversations. Especially once treatment is over, many people expect you to be over it. They want to move on with their lives and think you should be able to do the same. We know it isn’t so easy. In my long experience, many people find the emotional challenges ever harder during the early months of returning health. Others are overwhelmed sooner, during treatment, and realize it could be helpful to talk with someone.

How do you know if it would help you to talk with someone about your worries and feelings? A simple answer is that, if you are wondering about this, it likely would be a good idea. If you find that your sadness or anxiety or generally blue mood are interfering with your quality of life, it can help to work with the right therapist. If you are having trouble sleeping, are often short-tempered or impatient, or if you are ruminating about a possible recurrence or worsening cancer, talking with the right person will help. If you and your spouse or partner are struggling, it might be wise for the two of you to go together to a therapist. It is not a sign of weak character or mental illness or inability to manage stress to make this choice. In fact, it is likely quite the opposite, and an indication of strength and thoughtfulness to reach out for help. Some of my patients come to me because their families or close friends have been urging them to do so, but most come because they want to feel better and hope for some strategies to manage the stresses of cancer.

There is no right or wrong time to begin this work. Some people reach out immediately after diagnosis while others wait until treatment is done. Some people come a year or two later when their life routines have normalized, but they are recognizing the changes in themselves and feeling uncertain how to best proceed. During active cancer treatment, the months of chemotherapy and/or radiation, it can seem too much to add one more appointment to an already crowded calendar. Many people are so focused on just getting through the days that they push aside their feelings and worry and attend only to what is immediately necessary. Then, after the final infusion or radiation appointment, all those feelings come flooding in, and it is a good time to focus on them to move toward a healthy recovery.

Here are some things to consider if you are looking for a therapist with skills in psycho-oncology:

1. There are many psychotherapists who are excellent clinicians, but who have little experience with oncology issues. You would need to spend some of your precious time and money educating them about your diagnosis and treatment, and they won’t have a broader perspective of other peoples’ reactions and coping strategies. When you make an initial inquiry, always ask about their experience with other cancer patients.
2. Geography matters. If you are only going once or twice to meet with someone, it may not matter if they are quite inconvenient. Even if you go weekly or biweekly for some time, you may choose a particular person and be willing to make the longer drive. But think about it.
3. Ask about insurance. Clinicians who work at hospitals or cancer centers or other community practices are likely to accept most insurances. Clinicians in private practice often do not. While this may seem very off-putting, it is usually worth a conversation. Accepting insurance may put restrictions on your treatment, and insurance companies have the right to request information about you. Paying privately avoids these problems. Many therapists have sliding scales and are able to work out a fee that seems fair to you both.
4. Assuming competence, chemistry is most important. You and your therapist have to like each other. This is a sensitive topic in my professional world, but I strongly believe it is true. A therapeutic relationship is a powerful and strong one, and, like all other human relationships, it matters a lot that you basically like each other. This does not mean that you want to be close friends; that would be impossible and unprofessional. It does mean that you have to feel comfortable and trusting.
5. How do you locate the right person? You can begin by asking your doctors or nurses for a referral to an oncology social worker at your treatment center. If you would prefer to have this part of your care somewhere else, an oncology social worker can recommend experienced therapists in the community. Ask your cancer buddies; they may have found someone whom they like. You can contact the Association of Oncology Social Work (AOSW) for a list of certified oncology social workers in your area. In Massachusetts, you can contact the National Association of Social Work (NASW) for a referral through their referral center. Other states likely have a similar service.
6. At BIDMC, we have a wonderful group of oncology social workers who can be helpful. They can either meet with you at BIDMC downtown or at the Needham Cancer Center or refer you to someone good near home. Learn more about BIDMC's oncology social workers here. https://www.bidmc.org/centers-and-departments/social-work/clinical-services/hematology-and-oncology