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Cancer Support Ideas and Programs
by Pat Fobair, LCSW, MPH, Marty Marder and Sheila Slattery

What About A Cancer Support Group
Resilience, A Patient's Perspective
Assertive Communication

What About A Cancer Support Group?
Pat Fobair, LCSW, MPH
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Question: "Am I the right kind of person to be in a group? I've never done this kind of thing before."

Answer: People have said to me that they have a need to feel less isolated and more understood since their diagnosis for cancer. "When I joined the support group I realized I was not alone", Charles said. "I needed time to talk with others about what I had just been through. I thought I was healthy and then this thing came along! I felt wounded, and nobody else seemed to get it!" Another group member, Shelia, said "It felt so good to let my feelings out. They seemed to register with others in the group."

Having cancer feels like a life threat. Loss of control may subside when treatment begins, but many of us need to talk about what has happened in order to feel okay about ourselves. We find that we benefit from sharing our experience with others. It normalizes our thoughts about ourselves when we find understanding in others responses.

As a long time group leader working with those diagnosed with cancer, I was also diagnosed with a breast cancer in 1999. I found that talking with others in group helped me acknowledge my negative feeling and encouraged my efforts toward active coping. My usual wish to minimize or awfulize my experience, was kept in check.

Many topics come up in support groups: the impact of the diagnosis, one's sense of loss or grief, overwhelming emotional reactions, physical losses, communication problems, and the reactions of others. Many people notice a change in their values and a new sense of meaning in life

The Supportive Care for Cancer Patients program in the Complementary Medicine clinic at Stanford University Hospital and Clinics is sponsoring a support group on Thursday mornings at 10 to 11:30AM. The group is held at 1101 Welch Rd., Bld. A, Suite 6. It is open to all cancer patients. The leaders are Pat Fobair, LCSW, MPH and Bita Nouriani, MCFC intern. For more information call, 650-297-5566 and ask for Holly Gautier RN, or call her direct at 650-723-2268.

There are additional groups at Stanford University Hospital and Clinics. There are groups for breast, ovarian, leukemia and lymphoma patients. There are groups for younger patients, and one for older patients. An open house, or drop-in group for spouses and family members is being initiated in February, 2001 in collaboration with Cancer Supportive Care. For more information call Susan Weisberg, 650-725-2765 or Pat Fobair, 650-723-7881.

We look forward to answering more of your questions.
Pat Fobair, LCSW, MPH

Resilience, A Patient's Perspective
Marty Marder, Pat Fobair and Sheila Slattery
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As Survivor's of cancer, each of us has a story to tell about finding our own personal Resilience. We look upon,'resilience', as our ability to recover from the shock or depressive feelings we have had after our diagnosis and treatment for cancer. Being resilient means allowing the elastic component of us to spring back. Our need is to resume our original shape after having stretched ourselves to take in the requirements of cancer treatment.

Marty Marder, "Everybody brings their own resilience to the problems of life. Each of us bring who we are, our best, "resilience", to meet the challenges of life. One of the big questions is - How do we handle a problem we didn't want? - It's how we hold it that seems to count. Can we see our recovery or recurrence issues as a challenge, a problem to be solved, even though it is a problem we didn't want?"

"How do I go on to live my life? What do we do with our situation?" Choosing among the options available gives me some measure of control. We have some say in the matter of what is happening to us.

What are the things that we can do that encourage our resilience?

  1. Learning about treatment.
  2. Choosing among the treatment options.
  3. Who might help? You are not alone!
  4. Social factors can contribute to longer life.
  5. Exercise.
  6. Keeping a positive outlook might help.
  7. There are always questions to be answered. If I die, do I say, I "failed?" No
  8. Quality of life is in the Moment. Quality of life takes place every day.

One resistance to finding our resilience is that as patients we sometimes blame ourselves for having cancer. When the issue of blame comes up, Sheila Slattery thinks of, The dog theory! "We don't blame our pets, when they get cancer. Why do we blame ourselves?". Cancer happens in plants as well as mammals, like dogs, and cats. Isn't it funny that we find it so easy to blame ourselves for our cancer?

Sheila went through a shift in perspective about her career and self-image after treatment for breast cancer. "I learned that my sense of being is not dependent on what I do. And I learned the essential value of doing nothing!" Some of the mental and emotional tasks that helped me make this shift in perspective were:

  1. Letting go of parts of my self-image that didn't fit anymore.
  2. Letting go of illusions I had about health, and my sense of control.
  3. Coping with the fear of learning how to die! By working with hospice patients, Sheila found that she was able to explore what she was most afraid of.

Pat Fobair writes that her lessons in resilience included finding ways of looking after herself. "What was going to help me get through treatment. The answer included finding nourishing food, paying more attention to my comforts at home from pillows, music, reading, and videos. I felt like my job was to work on myself."

I allowed myself more space to feel my negative feelings, to be more spontaneous, enjoy the moment. Today I find myself paying more attention to friendships, diet and exercise.

What about you? Any thoughts you"d like to share about what helps you stay resilient?

Marty Marder, Sheila Slattery and Pat Fobair recently shared their perspectives on finding resilience at the Cancer Supportive Care Program Wednesday lecture series.

Assertive Communication*
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Assertive communication involves addressing a message that expresses your feelings, thoughts and concerns in a direct and honest manner that is respectful to the other person.

It is a learned ability that we are always working to improve. Our thoughts and feelings can influence our communication. After a cancer diagnosis, many of us found we had a greater personal need to be direct in our communication. Here are some notes from the work of Christy Telch and others, which may be helpful.

Eight Steps To Communicate Assertively

  1. Identifying and clarifying our thoughts and feelings is a first step in finding a way to be clear in what we say. For example, feeling left out can lead to angry feelings and harsh responses. Once I'e discovered that my feelings were hurt, that I felt left out, it is easier for me to say, "I felt left out of the fun. Next time I would like to go with you too".
  2. Watch out for roadblocks in communication. The way we say it can determine how the other person will hear it. Roadblocks to our hearing or understanding might include: You statements, like "You make me mad." Other roadblocks include using nonverbal messages like the silent treatment, not listening, or clock watching. A third set of roadblocks include name-calling, being judgmental, "that was inconsiderate of you." or making hostile or aggressive remarks.
  3. There are, Better Way of Saying It! Ways of being more effective in communication include: Making I statements, like "I feel disappointed or angry." Providing positive nonverbal messages like eye contact, listening, nodding agreement. Remaining calm. Using nonjudgmental statements of feelings like, "I felt like my feelings were not considered."
  4. Be Specific - Concrete messages like "Could you help me with this task," turn out to be easier on others than "I need some help."
  5. Be Calm and Objective - When I'm defensive, i.e. "you never say anything nice", triggers a defensive response. Saying, "I like it when you compliment me," might elicit something warmer.
  6. Begin Positively - How we begin our message has a significant impact on whether or not the rest of the message is heard and how it is interpreted. "I liked it when you helped me with that project last week. Would you be willing to help me again?
  7. Provide a Solution - When we provide a solution or alternative along with a problem or a complaint, it leaves our friends feeling less confused or uncertain.
  8. Communication Tips to Keep in Mind - Choose your time to be more direct. Timing can be everything. It's hard to enjoy effective communication when we are feeling hurt or angry. Letting go of blame or the desire to hurt also helps in good communication. If at first we don't succeed, Be persistent. Keep trying!

( *Content revised from the work of Christy Telch, Ph.D in collaboration with Frank E. Stockdale, MD, PhD, Jill Lehman, LCSW, and Isabel Walker, LCSW in Medical Oncology at Stanford University Hospital, and the American Cancer Society, 1983. Additional thoughts contributed by Pat Fobair, LCSW, MPH.)

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