Cancer is a major crisis for even the strongest of families. Many parents find it helpful to seek out sensitive, objective mental health professionals to explore the difficult feelings—fear, anger, depression, anxiety, resentment, guilt—that cancer brings up. Individual and family counseling can help address shifting responsibilities within the family, explore methods to improve communication, and help find ways to channel strong feelings in a healthy way.

Family dynamics undergo profound changes when a child is diagnosed with cancer. 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.

Choosing to get therapy isn’t easy. And going to a psychologist isn’t easy. The only way to really work through the emotional pain is to look closely at it. Sometimes they ask hard questions. But it has been very beneficial for me. The best part about therapy is the person you are talking to is impartial. She isn’t related to you, doesn’t go to church with you, doesn’t live with you, and has no connection to you or your situation. A totally unbiased perspective can be helpful when it feels like you are at the bottom of the pit, with no handholds, no ladder, but a shovel right beside you to help you dig deeper. If you decide to begin therapy, do your research. I called and asked for references from a cancer helpline and the social worker at the clinic. Then I talked to a couple of therapists before I decided which one to go with. She was willing to work with me on a payment schedule.

One of the first questions that arises is, “Who should we talk to?” There are many individuals in the cancer community who can make referrals and valuable recommendations, such as other parents who have sought counseling, your pediatrician, and a local or hospital social worker. You can ask these people for a short list of mental health professionals who have experience working with the issues your family 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.

The whole treatment experience put an enormous strain on our marriage. My wife has always been easy to excite, whereas I’ve always been very laid-back. There were moments when I was afraid that it would completely fall apart. Counseling really helped. We managed to survive, and I think in many ways, it has even brought us closer together.

In making your decision, it helps to understand the various types of mental health professionals and their different levels of education and licensure. 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 laypeople or clergy have received 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 and may have additional training in mental health. These three types of specialists are the only mental health professionals who can prescribe medications. In addition, some registered nurses (RNs) obtain postgraduate training in psychotherapy, but they cannot prescribe medications.
• 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 licensure initials usually follow those that indicate an academic degree (e.g., PhD). Most states require licensure or certification 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). Another way to find a suitable counselor is to contact the American Association for Marriage and Family Therapy at (703) 838-9808 or online at www.aamft.org. This national professional organization of licensed/certified marriage and family therapists represents more than 50,000 therapists in the United States and Canada.

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

Counseling helps, preferably from someone who regularly deals with parents of seriously ill children. This therapy is almost always short—although there may be some pre-cancer problems complicating the cancer issues that need to be hammered out.

Antidepressants definitely have a role in the “so your child has cancer” coping strategy. They cannot make the diagnosis go away. They can improve concentration, energy, sleep, appetite, and the ability to get pleasure in life, and hope for the future—all of which you, your child with cancer, your spouse, and your other kids need you to have! They are not a magic bullet. They take two to eight weeks to work, and you may need to change once before you get the right medication, but it can make all the difference.

Also, nurture yourself. Take bubble baths. Buy flowers. Let people pamper you. Say yes when people offer to help. Redefine normal so things can be good again. Make time for yourself. Spend time with your spouse (even an hour to walk and talk and hold hands). Find time for your non-cancer kids, reveling in their accomplishments. Celebrate what is good about your life.

Pick out things that you feel are important to keep up with and do them. (For me it was laundry.) Ignore things that don’t matter for the time being. (For me it was tidy rooms and cooking.) Make peace with your decisions and follow them.

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:

• Are you accepting new clients?
• What are your fees? Do you take insurance? Do you accept my insurance? Do you bill the insurance company directly?
• 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 talking with 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.

I called several therapists out of desperation about my daughter’s withdrawal and violent tantrums. I made appointments with two. The first I just didn’t feel comfortable with at all, but the second felt like an old friend after one hour. I have been to see her dozens of times over the years, and she has always helped me. I wasn’t interested in theory; I wanted practical suggestions about how to deal with the behavior problems. My 8-year-old daughter asked why I was going to see the therapist, and I said that Hilda was a doctor, but instead of taking care of my body, she helped care for my feelings.

• • • • •

We went into family therapy because every member of my family experienced misdirected anger. When they were angry, they aimed it at me—the nice person who took care of them and loved them no matter what. But I was dissolving. I needed to learn to say “ouch,” and they needed to learn other ways to handle their angry feelings.

If your child is going to go to a therapist, he needs to be prepared, just as he would be for any appointment. Following are several parents’ suggestions about how to prepare your child:

• If you are bringing your child in for therapy, explain why you think talking to an objective person might benefit him.

In the beginning of treatment, my son had terrible problems with going to sleep and then having nightmares, primarily about snakes. We took him to a counselor, who worked with him for several weeks and completely resolved the problem. The counselor had him befriend the snake, talk to it, and explain that it was keeping him awake. He would tell the snake, “I want you to stop bothering me because I need to go to sleep.” The snake never returned.

• Older children should be involved in the process of choosing a counselor. Younger children’s likes and dislikes should be respected. If your 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.

David had a very difficult time dealing with his brother’s cancer. Realizing that we were unable to provide him with the help he needed, we sought professional help for him. I think the reason he feels so comfortable with his therapist is that he is aware of the rules of confidentiality. After his sessions, I’ll always ask him how it went. Sometimes he’ll just grin and say it was fine, and other times he might share a little of his conversation with me. I never push or question him about it. If it is something he needs to discuss, I wait until he decides to broach the subject.

• 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. This allows you to both take care of yourself and be a good role model for your children.

Other types of therapy used to help children with cancer, or their siblings, include music therapy (www.musictherapy.org), art therapy (www.arttherapy.org), and dance/movement therapy (www.adta.org).