Life Changing Events

So often in life it seems that we make plans and begin to move forward, but something happens and these plans go awry. 

Life Happens!

About a week after my last entry, my personal world was turned upside-down.  My wife was diagnosed with a rare and aggressive form of cancer on a routine medical checkup.  One of the first thoughts that I had concerned my clinical practice: what do I do with this?  A bit of explanation may shed a bit more light.

I sometimes refer to myself as a 'dinosaur' as far as practicing psychiatry, due to my background and training as a psychodynamic or psychoanalytic psychotherapist.  This approach has the therapist as a sort of 'blank screen' or 'cardboard cutout' of a human being with little personal detail provided.  The theory is that the patient will "fill in the blanks" with his or her own ideas, fantasies, and projections.  Although there is certainly much to support this approach, over the years I realized that many of the people whom I worked with had experienced a great deal of what I call 'relational deprivation and injury' prior to reaching adulthood.  It became clear that part of the healing process occurred in the context of a real relationship with the therapist.  Actually, that occurs in ALL therapy.  Even Freud was more of a real figure to his patients than is often presented.

So allowing "more of me" into the session has been a part of treatment for years, but how much?  Differentiating between 'being real' and bringing one's own issues into the therapy is something one must be vigilant about.  A few months ago this became an entirely different undertaking.

In therapeutic work, my own emotional reactions to what is occurring in the session can tell a lot.  For example, if I am suddenly having a strong urge to cry at a time when there is nothing going on in me to trigger such a reaction, a bit of internal reflection will usually point out that I am reacting unconsciously to something the patient is feeling, even though he or she may not even be talking about something sad.  I have joked that it is like Mr Spock doing the Vulcan mind meld from across the room.  For the therapist, knowing one's own issues and current emotional state is vital to being able to assess what is going on in the session.  Dealing with my wife's illness was clearly going to impact this balance.

This Must Have Happened to Someone Else Before

My first thought was that there have obviously been many psychiatrists and psychotherapists who have had a spouse with cancer.  What did they do with it?  How did it impact their work?  Unfortunately, I couldn't find anything about this.  I thought I had remembered a paper or two in the past concerning the issue of cancer in the therapist's spouse, but nothing seemed to turn up.  If anyone reading this happens to have any references, please let me know!

How Much to Share?

When I decided that this was going to have an impact on me significant enough to 'leak' over into my clinical work, there was no question that I would share...but how much?  This point is important because my bringing a personal issue into a patient's therapy MUST not become a resistance or distraction to working on the patient's issues.  Being overly vague or evasive could easily become even more of a distraction as the patient inwardly is trying to 'fill in the blanks' and/or outwardly seeking more information.  But too much information obviously carries its own problems.

Another element somewhat unique to my practice is that I am a committed (although highly imperfect) follower of Christ.  Many of my patients are as well.  One of the greatest obligations AND privileges that God gives His people is to pray for one another.  There was no question in my mind that both my wife and I needed prayer from our brothers and sisters in Christ.  As my wife chose to tell our Sunday school class about her cancer, we realized that word would spread.  So after she gave me her permission, I decided to tell some of my patients specific information about her condition.  We have also discussed my writing about this here, and she has been agreeable.  So now I begin.

Cancer

My wife was diagnosed with a poorly differentiated vaginal adenocarcinoma in June, 2011.  Primary vaginal cancers are very rare, and adenocarcinoma (a cancer originating in glandular cells in the lining of the vagina) is only 10-15%.  Her cancer appears to be a 'clear cell' type, which was seen in 1 in 1000 female children born to mothers given DES during pregnancy.  DES was used from the 1940's until 1971 in women who were at high risk of miscarriage.  The drug was taken off the market when girls in their teens and twenties began to manifest clear cell carcinoma.  We don't know if my wife was exposed or not, and appearance in a woman in her 50's would be extremely rare.  But that is what she has.

We learned one month ago that it had spread into both of her lungs.  She had external beam radiation + chemo for six weeks during the summer, then had radiation implant treatment (brachytherapy) in September.  The primary lesion showed some response, but she has now begun an aggressive regimen of Taxol combined with cis-platin due to the pulmonary metastases.  As this cancer is so rare, there really is no research nor established protocols to determine the best approach.  She had her second round yesterday (it is given every three weeks), and after another couple of rounds, she will undergo scans to assess whether or not it is working on her particular cancer.

I will close for now, but will resume writing about both these issues as well as other topics.  Thanks for reading.