Sunday, May 22, 2022

by Jennifer Finch, LPC, SEP

This past January (2022) I went in for a routine mammogram. The results came back, and I was recalled like Honda floor mats to go back in for a duplicate mammo. This wasn’t the first time I had been called back so I didn’t bother with worry or anxiety. I chalked it up to technical or technician errors. Blurry images, wrong angles, thumbs in the way, bad lighting, illegible doctor notes. Whatever.

On my second go I felt confident “they” got it right this time. Only to get a phone call a week later sans results. Only an order to have to go in again. Isn’t this like double jeopardy or something? What could this mean? Three times was a first for me. Worry set in. But not too much, I wouldn’t allow it. “We don’t know anything yet,” I convinced myself. On my thrice mammo appointment, we are now into February btw, my husband offered to go with me. I denied his request and said, “I’ll be fine. It’s just across the street at the Health Park. They are only going to take some more images, and then I’ll be home. We can grab lunch after.”

I was wrong. They put me in the pink robe, asked the routine questions: “no deodorant, perfumes, lotions, or sprays” I remarked without being questioned. They squeezed my boobs into the compressor once again, and I went to get dressed. “Don’t get dressed right away,” the technician stated. Gulp. My throat constricted a tiny bit.

Okay, now worry set way in. I waited. And waited. In a tiny room, in a pink half-robe. Then more pictures. Different angles. Different marks for my feet to line up with on the floor. Different boob and body contortions around the hard, clear, plastic box. Arms up. Arms down. Turn sideways. Arch. Slightly. Not too much. A little more. Now I was exasperated. A little perturbed even at the lack of bed-side manner and man-handling from the sturdy female tech. I became an object. With organs and sacks and fluid. Being shoved around, pinched, pulled, and squished. Treated as if my breasts were the crème filling of an Oreo cookie. What was happening? I was winging it with a façade of exterior toughness because the technician knew adamantly, nada. Despite being close to tears.

I went to get dressed. Finally. It was allowed. Pink robe tossed in the dirty hamper bin. Lunch. I’m hungry. I called my husband to let him know I’m on my way back home, when a new nurse with a warmth and a smile arrived asking me to come with her down to the BIG office. What’s in the BIG office? What do you mean the BIG office? Total freak-out. Which to me looks silent, but with really, big, saucer eyes. I kept my husband on speaker phone, and I could hear him slightly, “What’s going on? Do I need to come over there? Jenny, what’s happening?” I couldn’t answer. There wasn’t time for him to get here, the nurse and I were already walking. My arms were stiff at my sides, not walking with me, and my husband was yelling up from the phone. Inaudible.

The hallway seemed twice, maybe even four times the length it was. A time-warp discrepancy of my mind-body to my reality.

My life was changing forever in this moment. Lunch was cancelled. In fact, “Cancel Culture” brought new meaning. Everything was cancelled for me. Upcoming concerts, travel plans, basically anything that I was meeting with enthusiasm in my life, was now off the books, indefinitely. It’s like I went through a scanner and I came out on the island of misfit toys.

I met with the sweet nurse who managed to get my body down the long (only it’s short in reality) corridor, and to the radiologist. I didn’t hear much, but thankfully my husband was still on speaker phone. The information wasn’t wholly lost, as my husband is an astute navigator of the medical arena.

I am certain they shouldn’t have let me drive home alone after that meeting, but you know….healthcare. Maybe it should be called, “healthcarelessness,” or “healthneglect.”

A routine mammogram caught my breast cancer early. I was lucky. But lucky doesn’t mean easy. This was possibly the hardest thing I have had to contend with in this life. The next few months were packed with phone calls to family and friends, cancelling everything, covering my caseload, and making sure my clients had good continuity of care, attending almost daily doctors’ appointments, seeing specialists, getting poked, pinched, prodded, scanned, making impossible decisions, doctor shopping and interviewing, endless google searches and research reading, battling my mind, sitting in blissed-out states, etc. It was frantic and I was riddled with anxiety.

I settled with a decision and opted for a double mastectomy with DIEP-flap reconstruction. It was the hardest and most complicated surgery of all the options presented, but also the most promising as far as long-term outcomes for me and what I wanted. Now it was head down, in the game, steering a clear path with fierce focus and intention. I’ve got a whole lot of living yet to do.

Today I sit 6 weeks out post-surgery. It hasn’t been a breeze. I am wrestling with my impatience. It’s like catching a “River Monster.” Some days are good and a lot of them are hard; hard! I am learning recovery isn’t linear. Complications arise occasionally, like splitting stiches. And cinematic meltdowns come and go. I welcome these massive waves of tantrums because I tend to sleep like a baby afterwards.

My arms still work like a T-Rex with very limited, insufficient movement. I walk slow and hunched over like a story-book grandma, or as my 17-year-old son said, “you look like the average high school teenager with bad posture.” Nerve pain extends armpit to armpit. And pain brain has set in where I cannot seem to remember a thing. Healing will come. Albeit slowly. I am hopeful. And, in this clear moment, I have beaten cancer! Last night I made my debut back to live music and went to see Dave Matthews Band with my family. It was difficult, but I was present. Dave graciously even sported my whole family with handicap passes so I could sit in awesome seats and still see the show above the standing crowd. We had police and staff escort us in and we had a private exit to eliminate festival pushing at the gates when the show ended. I even had three of my very own private bodyguards to keep people from bumping into me (see my two sons and loving husband in picture).

Why do I put all my HIPAA protected data and private personal experience out here? Because this whole experience has changed me. I have let it change me. I am still grappling with what the entirety of lessons are, but I have vowed to let it change me and let it strengthen my purpose of helping others. There is one main reason why I am choosing to share this information today in this post. (Other reasons are sparking rapidly and you can be informed of some of them at the end of this article.)

The prevailing intention is to tackle a long-standing question of ethics in my field as a psychotherapist. Do I disclose to my clients I have cancer?

One of the many questions that haunted me during my time of mayhem and stillness was if I should let my clients know that I have been diagnosed with breast cancer. I meditated, looked under every rock, shook the magic 8-ball, pulled daily tarot, asked every close friend, colleague, and family member, and spent time with my personal therapist to discuss all outcomes of this either/or scenario. When I typed it into Google, every single possible answer came up.

Most followed the archaic ethics code of counseling which adhere to a “No-Sharing” policy. Yet, the therapists who decided not to tell their clients unanimously reported that it hindered their care and the therapeutic relationships negatively. Clients know and feel intuitively when something is off or hidden. This is not shocking news, as good therapists train clients to be great detectors in their own lives and in their own relationships. To feel if things pass their sniff test and to respond truly with their embodied voice is like witnessing them discover they have a superpower. Therapy is an intentionally safe space and secrets large as this tamper with that sacred space. And, let’s get real, clients eventually notice when your hair is missing from chemo and you start showing up in a wig.

Self-disclosure – what to share about yourself with a client and how - is a big topic of debate and always has been. The old school mindset is to share as little as possible, “avoid distracting the client from their work.” Others outside of this antiquated Freudian guideline believe that appropriate self-disclosure can strengthen the professional relationship. Some great therapists are natural storytellers and actually heal others through the sharing of human stories, including their own.

Some common ground between these two opposing sides, is to not share anything you haven’t fully worked through. An example would be to share that you went through a divorce and made it to a happy successful and balanced outcome, vs. you are on your way to your attorney’s office angry and pissed-off right after the session. You will have to decide where you stand on this issue of: to share or not to share.

As a young naïve practitioner, I tended to follow all the general bygone guidelines and kept my side of the street clean and non-disclosed. In hindsight I am not sure this relic rigidity was the best in all cases. It tends to take the human out of the equation. And many of my let-down clients just needed hope through a shared and common humanity. Above all we are entering into a relational field. Even Freud missed the boat on this major aspect that his energy and arrogance filled the room, and this alone impacted the relationship and imprinted in the client.

Over the years I have disclosed more and more. Believing ultimately in “humans helping humans” as my compassionate philosophy. In my classes and teaching you will experience my personal stories the most, but now I even find myself sharing, in appropriate doses, in my one-on-ones demonstrating personal experience is pertinent to the healing atmosphere. Any 12-step based recovery group member will verify that it was hearing other people’s shares that made the most impact in their own recovery. So why isn’t this permitted in the privacy and security of a therapeutic office?

Conclusively, it is up to a therapist to determine if they can bring enough stability and ventral vagal to a session. If your personal stories when shared teeter you on the brink of triggers or angry overtones, then you should refrain in telling them. If your story is abundant in gory detail and fresh trauma, you should refrain in telling it. If your story will destabilize the relational field, you should refrain in telling it. Overall, if a therapist cannot remain stabilized and regulated during a session, then they need to cancel and reschedule. This is on them and not the client. And if this tends to happen often, they should consider a sabbatical, upping their own treatment and self-care protocols, or perhaps even considering finding a new profession or work in a different aspect of the wide field of therapy and healing.

There is nothing worse, and ethically harmful, then having a therapist who is more dysregulated, or overwhelmed than the client. Once I had a therapist who had chronic back pain and she would have to regularly get down on the floor and lie down to stretch out and roll around during our session. This seems blatantly unacceptable to me now. When you know better, you do better and now I know I should have walked out. Also, I have heard too many stories from friends who say they have been to therapists who only seem to want to talk about themselves and will chew up the session minutes doing so. Sigh. These are rare and extreme examples of an abuse of disclosure without boundaries. Severely lacking in professionalism.

Now that I have been diagnosed with cancer and been through this very impactful experience, my mindset shifts even more towards self-disclosure, but maintaining good boundaries is a prerequisite. If I don’t tell them I have cancer, how will I notify my clients that I will be out for 6 or more weeks on medical leave and shut down their questions? Impossible without it sounding like bullshit.

After a long contemplative study in quiet reflection, weighing in the opinions and exhausted conversations with my think-tank of supportive friends and colleagues, I ultimately decided to tell my clients, (and all of you readers) that I had cancer. Not only because the level of deception and deep fakery to cover this up goes against the core of my ethical values; but having gone through this, I hope to help people better and somehow, differently. I am opening the door to have an authentic conversation about therapists as humans.

Having cancer was painful enough, but now trying to hide the fact that I went through something like this seems too hard to manage a pretend world with a pretend story. I read stories from therapists who chose to tell their clients, and some regretted it. Stating their clients left the practice, or it complicated the clients own care-taking and fawning injuries where they wanted to engage in role reversal and care for the therapist. For me, role reversal is easy to curb, by simply naming it, and then opening the dialogue in a natural more inquisitive manner. I welcome questions and I can reassure anyone that I will not answer anything I truly feel uncomfortable with. Is this awkward? Not at all, it feels human and that human connection, often through our pain, but also through our shared experiences that are positive, is what develops strong relationships. Does this distract from my clients’ therapeutic needs? Maybe, we shall see. I hope clients speak up about it so we can either work through it or get them to a more fitting care provider. It is my job to take care of my clients. But of course, disclosing cancer can be a bomb of such magnitude that it sucks all the air out of the room. I understand this whole-heartedly, so of course, it will impact everyone differently and some have the absolute right to choose to go to a different therapist if they believe this gained knowledge of my cancer affects their care in any unhelpful way.

My stance is that we tend to heal better together, through shared experiences and stories, not in isolation. And this collective common humanity includes therapists. Therapists are human too. We have human bodies that get struck with illnesses and diseases just like every being born in a human life does. I have no intentions to lean on my clients for care, I have my own strong, iron-clad support system for that. What I do hope is that this disclosure serves as a source of inspiration. That we can be vulnerable and strong and confident all at the same time.

I work with my clients on being more vulnerable in secure relationships, and tougher in life, so if I can’t exemplify the same thing then I’m sending the wrong message. Here is what I mean by that: Vulnerability without strength and confidence to end your own suffering is left like an undressed, open wound expecting others to save you. I have written about this in other posts, when we are too vulnerable and bleed it out into the atmosphere making others want to dodge it. However, vulnerability paired with strength and confidence is a success story worth sharing. It sounds like “I got through this and let me show you how.” Or, “I’m getting through this and here is where I am so far, where are you? And what have you learned?” Do you hear the toughness meeting the life circumstance? The confidence? Also, the vulnerability and humanness? When vulnerability couples with confidence it is not a dump onto someone else to fix you. There is ownership in our own healing, but also a seeking for help and a collaboration of efforts. There is a strategy of healing. How far we get is up to us, but we get there by listening to others. This is collaboration as a collective unity at its finest.

My hope by sharing this is that I can turn around now and put my hand on the shoulder of the next woman who must endure the long hallway and then drive home alone, having heard nothing in the very important meeting that determined the fate of the rest of her life.

Hiding this experience isn’t going to protect clients, in fact, hiding this builds callousness. As someone who teaches compassion and self-compassion to others, pretending I’m indifferent to my own suffering and becoming hard-hearted through attempts to keep this private goes against what I am working towards.

Sharing appropriate human experiences of suffering and overcoming this suffering, can radically redefine what professionalism and appropriate self-disclosure means in the therapeutic field. I know it did for me. Turns out it was a good choice. At least so far.

Now that I have disclosed this experience, I hope to share more posts from my new perspective as a patient and tackle my concern about our current healthcare systems. I also hope to begin some somatic-based group therapy cultivated to help breast cancer patients and to help fill in the psychological aspects of care that are still largely missing in our medical treatment protocols. If such a group interests you, please reach out.

Also, I would like to close by publicly thanking my cancer care team, because I wouldn’t have made it this far without you. You know who you are. Colleagues, friends, family members, doctors, neighbors, spiritual guides, and healing vibers. Your texts, flowers, prayers, meditations, sun-salutations, candle lightings, crystal holdings, months and months of ready-made dinners, cards, blankets, puzzles, medical advice and knowledge, personal and meaningful artwork, back and foot rubs, phone calls, and adjacent cries have all helped me heal. I cannot thank my circle with words, it wouldn’t be enough. From my heart to yours, I am grateful and feel loved and foundationally supported. You have carried me when I couldn’t walk, and I have made it to the other side of this with more strength, courage, and wisdom that I hope to share like ripples in a pond. It wouldn’t have been possible to get here on my own. I would indeed still be stuck in that long hallway. Thank you with love and light to all that showed up in seen and unseen ways. I am overwhelmed with gratitude and love. To feel intensely and fiercely loved, this I suppose is one of the perks of having had cancer.:)

Why I Chose To Tell My Clients I Have Breast Cancer

We Can Stop Sugar Coating It

The Three Hindrances of Love