How can a cancer survivor benefit from counseling?
Survivors are often faced with many different emotions and life changes during their survivorship journey. Although the emotional challenges of cancer survivorship can have a negative effect and lasting impact on a person's overall well-being, it is possible to counterbalance those effects and improve one’s overall well-being through counseling and positive coping. Working through emotional challenges is sometimes easier with the help of a professional counselor. A counselor will listen to you and help you understand the emotions that you’re feeling during your survivorship journey and will teach you how to effectively cope with those feelings.

Cancer, and the effects that come along with it, can create unique challenges for survivors and their loved ones. Some survivors may begin to wonder how to cope with challenges such as physical and emotional changes or concerns about practical issues, while others may just want to discuss their concerns with someone who is outside their circle of family and friends. There is not a specific point in time during the survivorship journey when survivors begin to encounter their own unique challenges. Sometimes, it’s at the time of diagnoses or during treatment, while other times the full impact of survivorship may not be felt until after treatment has been completed. Because each survivor and their experience are unique, the type of counseling, and the time at which they may need to receive it, will vary from one survivor to the next.

Sometimes, people dealing with cancer may feel that they do not have the time, money, energy, or need for counseling. Some survivors may even have concerns that seeing a counselor means that they are weak, mentally ill, or a failure at solving their own problems. However, talking with a counselor does not mean something is wrong with you or that you are a failure. Instead, talking with a counselor is often a sign that you are willing to take care of yourself and find healthy ways to respond to challenging situations. Talking about concerns, no matter how big or small, can help you cope with them more quickly and more effectively. Counseling can help survivors prevent, minimize, and respond in healthy ways to the expected and unexpected stressors that may occur during the experience of cancer survivorship

The following are just a few examples of concerns that could be addressed during your counseling sessions:

• Finding meaning in your illness
• Coping with your diagnosis
• Challenges managing symptoms such as physical and emotional pain
• Difficulty making decisions about treatment, work or home life
• Helping others to understand and adjust
• Communicating with a health care provider, family member or employer
• Financial issues
• Relationship changes
• Longstanding problems unrelated to cancer

Is there a difference between counseling and therapy?

The terms "counseling" and "therapy" have different meanings, but are often used to describe the same activity. Both counseling and therapy involve talking with a trained professional, many of which are licensed by the state in which they work.

• Counseling is the process by which a counselor helps an individual understand and solve problems in order to help him or her cope with mental or emotional stressors. For example, counseling generally works to find solutions to specific immediate problems such as learning how to positively communicate in relationships with others.

• Therapy usually involves talking about your situation in order to gain more understanding about issues such as mood, feelings, behavior and ways of thinking. For example, therapy can help you learn how to find meaning in your cancer and your survivorship journey.

What types of counseling services are available?

Counseling is a service in which you receive guidance with emotional and practical concerns by talking with a knowledgeable and trained professional. The goal of counseling is to learn how to relieve and manage distress about any concern.

Although counseling may be provided in a variety of settings, The Cope Well Foundation currently offers the following counseling types:

• Individual Counseling is when you talk and share information privately, one-on-one with a counselor and usually takes place in a more private and formal setting. Individual counseling can be useful for those who want support but who are uncomfortable talking in groups.
• Group Support Meetings are when a group of individuals come together for similar reasons and may focus on one general topic such as cancer survivorship. Support groups are not always led by a trained counselor and usually take place in an informal setting. Members of the group often organize and lead the group as a way to connect with and learn from others who are managing similar challenges.

What types of counseling professionals are available?

Many different professionals offer counseling services. Some of them may refer to themselves as "psychotherapists," "therapists," "counselors," or "mental health specialists." Although at The Cope Well Foundation we refer to our trained professionals by using the general term counselors, professionals who are trained and licensed in most states to provide counseling services can be referred to as any one of the following:

If you are interested in working with a counselor, you may consider asking your health care team for recommendations. Many hospitals and clinics include social workers or other mental health specialists as part of their team, and sometimes offer select services without an extra fee. If your hospital or clinic cannot help you, you may also be referred to a private counselor in your community or to a local family service or nonprofit cancer organization such as The Cope Well Foundation.

You may also ask others for counselor referrals. Support groups are a good place to get referrals for counselors from other survivors. Some cancer organizations and counseling associations may also provide referrals and information about counselors in your area. If possible, ask for several referrals so you can interview the counselors and find the one who best meets your needs.

Regardless of where you find your counselor, look for a counselor who is experienced with cancer survivorship issues. If possible interview a few counselors before you choose one. Let the counselor know what you want to talk about and then ask if he or she can help you with those issues. If the counselor is not knowledgeable about your areas of concern, ask if you can be referred to someone who has this knowledge and experience.

What type of questions should I ask when selecting a counselor?

Whether you decide to pursue an individual counseling session or a group counseling session, be sure to interview your counselor and ask questions before your counseling session to help ensure that you will feel comfortable once you finally meet. You are making an investment of time, energy, and money when you see a counselor, so it’s okay to talk to a prospective counselor before scheduling an appointment to make sure that the counselor will be a good fit for you. Also, be sure to choose a counselor who you can get to easily and who has hours that work for your schedule. If counseling isn't convenient for you, it will be harder to go consistently. Below are a few questions or topics that you may consider addressing when selecting a counselor:

• Are you licensed by the state?
• Are you trained or specialized in any particular areas?
• Do you have experience working with cancer survivors?
• Do you have experience with my particular kind of cancer?
• What do you understand about the emotional response to this illness?
• What types of counseling methods do you use?
• How do you define successful treatment?
• How long have you been in practice?
• How much do you charge per session?
• Do you have reduced fees available?
• What insurances do you take?
• How often would you suggest that we meet?
• How soon can we meet?
• What are your hours of business?
• In cases of emergency, do you have an ‘on-call’ system?
• Do you have a cancellation policy?
• Are references available?
• Is the counselor male or female, and do you have a preference?

Working through problems may bring up a variety of emotions. It often requires a shift in how you think about situations. The counselor's job is to guide you through this process. The counseling process may take time, but it is likely to require much less time than if you had tried to do the work by yourself. You will find that the benefits are well worth the effort.

How much does counseling typically cost?

Although select counseling services are free through The Cope Well Foundation, counseling fees can be expensive and may vary from one counselor to the next. Therefore, it is important to ask about the cost when you initially speak with a counselor. You should also ask if any free or low-cost services are offered through that counselor. The information below is to be used only as a guideline.

Assistance with costs for counseling services may come from sources such as the following:

• Many hospitals, clinics and nonprofit cancer organizations such as The Cope Well Foundation, provide social work or counseling services without a fee because they are considered to be an important part of the comprehensive services of the cancer program.
• Health insurance policies with mental health coverage usually pay for a specific number of sessions per year with a licensed mental health specialist if the counseling is aimed at a specific problem such as depression or anxiety. The number of covered sessions is determined by the insurance policy and usually ranges from 6 to 20 sessions. Sometimes a co-payment is charged to the patient.
• Some mental health clinics and private counselors offer a "sliding fee scale," meaning you can ask for a reduced fee if you have limited financial resources.
• A private or group counseling session that is not covered by insurance may charge out-of-pocket fees ranging from roughly $40 to $120 per session, depending on the counselor’s credentials and local rates.
• A few organizations offer free limited counseling services over the telephone.

What type of concerns should I address when meeting with my counselor?

Regardless of the concerns that you want to address when meeting with your counselor, remember that a counselor will not solve your problems for you. However, he or she should be able to provide a safe and non-judgmentalenvironment where you can talk about your concerns. Your counselor should be able to guide you through a process of learning and finding solutions and ways to deal with challenges. The general goal for all counselors is toprovide support and guidance as you discover ways to understand and respond to your concerns, therefore you should decide ahead of time what you would like your counselor to help you with.

Because each cancer survivor will have their own unique set of concerns that they will want to address with their counselor, below are just a few examples that you may want to consider addressing when meeting with your counselor:

• What type of counseling will be most effective for me?
• How often should I go to counseling?
• How has my life changed since my diagnoses?
• How have those changes affected my life?
• How have my emotions and attitude changed throughout my survivorship journey?
• How have the physical effects of my cancer effected my emotions?
• How do I talk to my family about my fatigue?
• How can my family and friends help me through my survivorship journey?
• Why do I have a problem opening up to those close to me?
• Why don’t I let others help me with my concerns?
• Why have my partner and I not been very close since my diagnoses?
• How has treatment affected me and those around me?
• What activities can help me feel my best emotionally?

Addressing these types of concerns and working through your problems may bring up a variety of emotions, and it often requires a shift in how you think about situations. Again, your counselor's job is to guide you through the counseling process, which may take time, but it is likely to require much less time than if you had tried to do the work by yourself. If you take the time to be prepared and consider your needs before meeting with your counselor, you may find that the results of your counseling session may be more effective.

How do I know if my counselor is a good match for my needs?

In an individual counseling session, not every counselor is a good match. Even if a counselor has expert credentials, his or her personality or counseling approach may not fit your individual needs. Sometimes counselors and their clients have very different personalities and views on life. If you do not feel comfortable discussing your survivorship with your counselor, that might be a good sign that the counselor may not be a good fit for you, and it may be best to find another counselor. Some people are more comfortable finding support through a faith-based relationship with a spiritual leader such as a rabbi, pastor, priest or hospital chaplain. This may be a relationship that existed before the diagnosis or one that begins after. Although some may not have formal counseling licenses, they may still be experienced enough to provide support in matters that are of concern to you, and you may be most comfortable opening up to these individuals.

In a group counseling session, it is possible that the counselor may seem to be the right fit for you, but the group itself is not a good fit. If this happens, talk with the counselor to see if another group exists or if individual counseling might be more helpful.

Below are a few examples of questions that you should ask yourself to decide if the counseling relationship is working for you:

• Are you making progress and getting the help you need?
• Are you comfortable sharing your thoughts and feelings with your counselor?
• Are you able to tell your counselor when you are uncomfortable or unsure about the counseling relationship?
• Does your counselor respond in a positive manner when you talk about your concerns?
• Are you comfortable in your overall counseling environment?

If you cannot comfortably talk with your counselor about your feelings, or if the counselor's responses to your questions are not helpful, you may want to find another counselor. Regardless of why you may or may not feel comfortable with your chosen counselor, finding the right counselor and getting the help you need is the ultimate goal, so select your counselor carefully.

In Closing

You do not need to have a major crisis or concern in order to talk with a counselor. Counseling can help to make decisions, build self-esteem, and deal with stress. Even if you only have concerns about general daily challenges, you can benefit from talking with a counselor by clarifying and prioritizing needs or finding answers to a problem. Counseling is a healthy choice for people from any background or experience. When you want to findways to manage and understand your concerns, counseling can help.

As you continue your counseling, there should be an on-going evaluation of your counseling sessions. You can accomplish this by talking to your counselor about your progress. You have a right to ask questions and to receiveanswers to them.

You, the client, are always in charge of your counseling process, and you have the right to refuse what your counselor is offering you if you’re not satisfied. You have the right to change counselors and the type of counseling that you’re receiving.

(Sexual conduct and/or contact between therapist and client is NEVER acceptable conduct. Outside relationships such as business, friendship and socializing with your therapist are also not recommended because they create barriers to the therapeutic process.)

Works Cited

Institute of Medicine, National Research Counsel. Meeting psychosocial needs of women with breast cancer. Washington, D.C.: National Academies Press, 2004. Holland, Jimmie, ed. Psycho-Oncology. New York: Oxford University Press, 1998.