Cancer is a major crisis for even the strongest of families. Many find it helpful to seek out sensitive, objective mental health professionals to explore the difficult feelings— fear, anger, depression, anxiety, resentment, guilt—that cancer arouses.

Family dynamics undergo profound changes when a child is diagnosed with a brain or spinal cord tumor. Seeking professional counseling for ways to adjust and manage is a sign of strength. When a child has cancer, problems may be too complex and family members may be too exhausted to manage on their own. Seeking professional help sends children a message that the parents care about what is happening to them and want to help face it together.

One of the first questions that arises is, “Who should we talk to?” There are numerous individuals in the cancer community who can make referrals and valuable recommendations, including:

• Other parents who have sought counseling
• Pediatricians
• Oncologists
• Nurse practitioners
• Clinic social workers
• School psychologists or counselors
• Health department social workers

You can ask the people listed above for a short list of mental health professionals who have experience working with the issues your family’s is struggling with, for example, traumatized children, marital problems, stress reduction, or family conflicts. Generally, the names of the most well-respected clinicians in the community will appear on several of the lists.

In making your decision, it helps to understand the various types of mental health professionals and their different levels of education and liscensure. The following disciplines train individuals to offer psychological services:

• Psychology (EdD, MA, PhD, PsyD). Marriage and family psychotherapists have either a master’s degree or a doctorate; clinical and research psychologists have a doctorate.
• Social work (MSW, DSW, PhD). Clinical social workers have either a master’s degree or a doctorate in a program with a clinical emphasis.
• Pastoral care (MA, MDiv, DMin, PhD, DDiv). These are laymen or clergy who receive specialized training in counseling.
• Medicine (MD, RN, ARNP, PA). Psychiatrists are medical doctors who completed a residency in psychiatry. Physician assistants and advanced practice nurses have the equivalent of master’s level training in medicine with additional training in mental health. These three specialists are the only mental health professionals who can prescribe medications. In addition, some nurses obtain postgraduate training in psychotherapy.
• Counseling (MA). In most states, individuals must have a master’s degree and a year of internship before they can work as counselors.

You may hear all of the above professionals referred to as “counselors” or “therapists.” The following designations refer to licensure by state professional boards, not academic degrees:

• LCSW (Licensed Clinical Social Worker)
• LSW (Licensed Social Worker)
• LMFCC (Licensed Marriage, Family, Child Counselor)
• LPC (Licensed Professional Counselor)
• LMFT (Licensed Marriage and Family Therapist)

These initials usually follow others that indicate an academic degree (e.g., PhD); if they don’t, inquire about the therapist’s academic training. Most states require licensure or certification in order for professionals to practice independently; unlicensed professionals are allowed to practice only under the supervision of a licensed professional (typically as an “intern” or “assistant” in a clinic or licensed professional’s private practice).

When you are seeking a mental health professional, ask the professional how long she has been in practice. A licensed marriage and family therapist who has been seeing patients for 10 years may be a better clinician for your needs than a licensed psychologist or psychiatrist in his first year of practice.

Another method for finding a suitable counselor is to contact the American Association for Marriage and Family Therapy in Alexandria, VA, at (703) 838-9808, or online at www.aamft.org. This is a national professional organization of licensed/certified marriage and family therapists. It represents more than 50,000 therapists in the United States and Canada, and its membership also includes licensed clinical social workers, pastoral counselors, psychologists, and psychiatrists.

A psychiatrist who is the mother of a child with cancer offers a few thoughts:

To find a therapist, a good first step is to call two or three therapists who appear on several of your lists of recommendations. Following are some suggested questions to ask during your telephone interviews:

• What are your fees? Do you bill the insurance company directly? Do you accept my insurance?
• Are you accepting new clients?
• Do you charge for an initial consultation?
• What training and experience do you have working with ill or traumatized children?
• How many years have you been working with families?
• What is your approach to resolving the problems families develop from trauma? Do you use a brief or long-term approach?
• What evaluation and assessment procedures will be used to define the problem?
• How and when will treatment goals be set?

The next step is to make an appointment with one or two of the therapists you think might best address your needs. Be honest about the fact that you are interviewing several therapists prior to making a decision. The purpose of the introductory meeting is to see whether you feel comfortable with the therapist. After all, credentials do not guarantee that a given therapist is a good fit for you. Compatibility, trust, and a feeling of genuine caring are essential. It is worth the effort to continue your search until you find a good match.

Children need to be prepared for counseling, just as they do for any unknown event. Following are several parents’ suggestions about how to prepare your child:

• Explain who the therapist is and what you hope to accomplish. If you are bringing your child in for therapy, explain why you think talking to an objective person might benefit him.
• Older children should be involved in the process of choosing a counselor. Younger children’s likes and dislikes should be respected. If your young child does not get along well with one counselor, change counselors.
• Make the experience positive (e.g., describe the therapist as “the talking doctor”).
• Reassure young children that the visit is for talking, drawing, or playing games, not for anything that is painful.

• Ask the therapist to explain the rules of confidentiality to both you and your child. Do not quiz your child after a visit to the therapist.

• Make sure your child does not think she is being punished; assure her that therapists help both adults and children understand and deal with feelings.
• Go yourself for individual or family counseling or to support group meetings. You not only will be taking care of yourself, but you will be a good role model for your children.

Some other types of therapy used to help children with cancer or their siblings are music therapy (www.musictherapy.org), art therapy (www.arttherapy.org), and dance therapy (www.adta.org).

In Armfuls of Time, psychologist Barbara Sourkes quotes Jonathan, a boy with cancer, who told her, “Thank you for giving me aliveness.” She discusses the importance of psychotherapy for children with a life-threatening illness: