Ask Richard: Needing Secular Counseling After a Mastectomy July 13, 2009

Ask Richard: Needing Secular Counseling After a Mastectomy

Mr. Wade,

This may be an ordinary complaint from a non-believer, but every time I have had to stay in hospital for more than an hour, a “patient advocate” comes into my room and wants to pray with or for me, or leaves me with some sweet religious phrase or blessing in addition to asking me if there is anything I need. Some of these patient advocates wear crucifixes and I “believe” that a crucifix is a symbol of torture which I prefer not to see just before I have any medical procedure for which I will be unconscious. I guess they don’t read the pre admittance paper work I signed where I have marked “NONE” on religious preference.

So, when I was waiting in my hospital room to be taken to surgery for my mastectomy, a patient advocate came in where I was talking to my husband and son and barged into a most personal moment in my life. A significant body part was to be removed from my chest and I was going through some emotional grief of my own with my family. Then I had to interrupt my private moment to be polite and deal with someone who was sure I needed the help of a supernatural source for my comfort. All I needed that day was my family and a competent surgeon.

I am very tolerant of religious people because I was born, raised and have lived most of my life in the Bible Belt and understand the social and familial bonds associated with deep seated religious beliefs. Everybody feels comfortable if everyone is on the same chapter and verse in the family bible. Even when I lived in Lancaster/Palmdale, CA, I encountered a religious “patient advocate” when I had my appendix taken out.

Now that I want to see a “humanist” counselor to talk about life after my mastectomy, I don’t know how to find one in a state where there is a church on every corner. Maybe there should be an online e-counselor for those of us who need a professional not a confessional. Got any suggestions?

An e-patient looking for an e-counselor…

Dear e-patient,

I am very glad that you are interested in getting counseling following your mastectomy. It is not just the loss of a body part. For most women, it is an assault on their femininity, their sexuality, their self confidence and their relationship with their partner. Far too many women go through this trauma and then try to adjust, cope, or “deal with it” all on their own, pretending that they are “fine” and swallowing all of their grief. This can lead to depression, to tension-related illnesses, and to very degraded relationships with their loved ones, especially their sexual partners. Their husbands or partners have their own difficult feelings about it all, but, wanting to be supportive, and seeing their wives being “just fine,” they also swallow their feelings, and the communications spiral down into a suppressed charade where everyone is showing a false front. Then the unexpressed grief and pain, which don’t magically go away, may leak out as anger over unrelated things, and the relationships deteriorate.

Counseling can prevent this and can even strengthen and improve your bond with your loved ones.

Finding appropriate counseling can be a challenge in some parts of the country, especially rural areas, but your persistence will probably pay off. Here are some basic steps to take:

  1. First, see if your health insurance covers counseling or psychotherapy, and if so, to what extent. There may be limits on the number of sessions and the amount that the insurance will pay. There may be specific provisions for post-mastectomy patients, but if not, your need is very legitimate, and is worth whatever it takes to get your need fulfilled. If your insurance will not cover it, don’t give up, just look for less expensive resources. A counselor who doesn’t cost much is not necessarily a bad one, just as a very expensive counselor is not necessarily a good one.
  2. Find a referral to an appropriate therapist starting with the easiest sources first. Start with your surgeon and your family doctor. Ask them if they can refer you to a counselor who is experienced with post-mastectomy issues. Don’t be shy about specifying that you want regular, secular, humanistic counseling, rather than any kind of pastoral counseling. See yourself as the customer, rather than a helpless sick person. You have every right to be picky about what you want. Even in places where there are “churches on every corner,” competent, well-trained secular therapists do exist. If your doctors cannot provide such referrals, then possibly ask the hospital social worker for referrals. Even though the patient advocates there seem to be mostly religious, the social workers may have the information you need. Again, assertively stipulate the kind of counseling you want, and what you don’t want. If that resource fails, ask trusted friends and after that, use the phone book or the internet.
  3. For this issue, I recommend finding a face-to-face counselor rather than an online counselor. The emotional power behind this loss can be enormous, and the therapist can much more easily read your emotional cues and respond to your needs if you are there in the room.
  4. When you first call a therapist, be a savvy consumer and have all your questions written down in front of you. Ask about their license to practice counseling. They should have professional licenses granted by your state which require advanced degrees in counseling psychology and several years of supervised intern experience. These licenses include Marriage and Family Therapist, Licensed Clinical Social Worker, Licensed Professional Counselor, Licensed Psychological Associate and Clinical Psychologist. If you need a cheaper therapist, an intern can do a good job counseling you, while getting supervision about your case from one of these licensed therapists. They each have their own emphasis, but their training qualifies them to provide basic emotional support and relationship guidance. If you can, obtain any fliers, literature or online information they have about their services. That might help you to see what kind of counseling they provide, i.e. secular instead of pastoral.
  5. It is essential, essential, essential that your husband participate in the counseling sessions. He is very much affected by this, but he may think that he has no right to express his feelings when he’s supposed to only be supportive of you. The therapist can referee your communication together, giving permission to say what’s weighing on your hearts. Rather than just having your marriage survive this, your relationship can end up being stronger, closer and more nurturing than before. It usually takes a few sessions to establish a trusting, comfortable rapport between the two of you and the therapist. Your mutual interaction is a skill that all three of you are learning. The more frank and straight forward you can be about how you feel toward your therapist, the sooner you can “get down to brass tacks” and start the healing.
  6. One more valuable resource that you could use in addition to counseling is a mastectomy support group. The internet can help you to find one, either with actual meetings or online forums. The dialogue with others who share your experiences can be very encouraging and validating. They usually welcome the spouses as well as the women.

I hope you find what you need to continue your healing, both inside and out. I admire your willingness and wisdom to seek counseling, given the foolish, ignorant attitudes that many people have toward psychotherapy. There is no reason for anyone to feel embarrassed or ashamed about giving themselves the best care and the most thorough recovery. You deserve it.

You may send your questions for Richard to AskRichard.

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  • lynn

    Wow, e-patient is so…patient! I’d start throwing things at the “patient advocates” after a while and screaming at them to quit pushing their beliefs on me: “Take your god and shove it!” or some such.

  • zoo

    Find a referral to an appropriate therapist starting with the easiest sources first. Start with your surgeon and your family doctor. Ask them if they can refer you to a counselor who is experienced with post-mastectomy issues. Don’t be shy about specifying that you want regular, secular, humanistic counseling, rather than any kind of pastoral counseling.

    If you go this route be VERY specific about what you’re looking for. I didn’t think about this and I’m kind of shy about speaking up anyway so I was sent by my Christian doctor’s office to a Christian psychiatrist who of course recommended a Christian counselor, who of course assumed I’m a Christian and geared many of her questions toward that (I’m most definitely not mad at God, please quit asking).

    I found the therapist I’m seeing (in person) now online through a psychology magazine’s listing service ( They list a lot of things like which types of therapy they use, what issues they specialize in, if they specialize in a specific religion or sex, and usually you can contact them by email to see if they might be a good fit. Definitely ask anything of anyone you’re recommended you need to know before you commit. Hopefully you’ll be spared the false starts so many people have had -_-.

  • CatBallou

    Wow, Richard. You start off your advice with a laundry list of the misery that “most” women experience. Are you trying to make her feel worse? What if she’s not experiencing those particular problems? She already knows that she wants counseling, so what’s the point of highlighting all the things that could be happening to her? I find that strangely unempathetic.
    When I’m dealing with a crisis, I certainly don’t want someone to tell me in detail just how bad it could get!

  • lizzyshoe

    @CatBallou, Richard may have been explaining to readers who haven’t had the experience of going through a mastectomy or knowing someone who has had one. And him going through what he believes she is feeling is not a way of making her miserable, but of showing understanding. I don’t think he meant to hurt her by trying to validate her feelings.

  • mkb


    If you want to e-mail with another humanist who has recently had a mastectomy (in addition to, not as a substitute for, working with a counselor) you can e-mail me at

  • Richard Wade

    Hi CatBallou,
    Your concern for e-patient is very caring, and I am sure that she will not feel worse for what I have described. If she is not having some or any of those problems, then my mentioning them will not be putting them into her head. If they don’t apply to her, she will dismiss them. If she is having some of them, she is probably already at least partially aware of them, and she will probably be encouraged that there is hope for her. Also, becoming more fully aware of those problems is the beginning of her therapeutic process.

    Counseling usually does not immediately make one feel better. It takes some time. One first has to face challenges straight on, see them clearly, make decisions about what to do, take action, practice new behaviors, see new results, practice even better behaviors, get even better results, and then they will begin to feel better. But feeling better is not the primary goal. Living in ways that work better for all concerned is the primary goal.

    Keep in mind that an open letter of advice like this is addressed not only to the person who asked for advice, but also to any other reader who may have similar concerns. Perhaps they have other challenges or crises that might be helped by counseling, but they are not yet over the first hurdle that e-patient has already passed: accepting the idea that counseling might help, and that it is not a shameful thing. My remarks are intended to encourage them as well; to warn them of what I’ve seen happen when people stuff their pain deep down inside, and to hearten them to give themselves every opportunity to have healthy and fully expressing lifestyles and relationships.

  • Jenelle

    In the last year or so, I have spent a lot of time in the hospital in Canada (a total of more than 3 months). I always list my religious preference as “non-religious” and, while I see the chaplain, priest and other relgious volunteers visiting patients, they never say a word to me.

  • If you’re in the UK contact RELATE. It’s a government sponsored organization that ill provide a counsellor who will work on a psychodynamic or behavioral basis with no inappropriate input from the therapist!

  • I am not sure I agree with the statement that it is “essential” that her husband go with her to counsling. I agree that he will be affected by this, but I also think that there would be benefits to her having some solo time with the therapist. After all, it is her body, separate from her husband’s.

    If I were in her situation, I’d prefer to have both individual and combined therapy, I think.

    Assuming she cannot heal as well with some private therapy in addition to couple’s therapy seems a little sexist. She is the one who had the mastectomy, and I think she is the one who should receive the bulk of attention.

    Just a thought.

  • Richard,

    I had the same response as CatBallou to the litany of possible responses to a mastectomy, and I hope you’re right that e-patient is not bothered by it. I’m not a woman, but I cringed a little when I read it.

    That having been said, I enjoyed your article. I couldn’t find a platitude in the whole thing.

    I can’t find more information on you. Can you post a link so we can see more about your background? You seem well-informed on a number of varying issues.

    And to e-patient: I admire your generosity in dealing with the patient advocate. Thanks for opening up about your own battles.

  • Erp

    Aside from the counseling advice, I would report the experience with the patient advocate back to the hospital. Their job is to help the patient not hurt them. If they are barging in on a conversation between a patient and family or offering prayer (especially to patients who have not described themselves as Christian and not straight off the bat even for those), that implies insufficient or bad training.

    Doing a quick google search seems to indicate that the term ‘patient advocate’ covers a wide range of roles. However, I could not find a code of ethics for the type you seem to have encountered. In fact for some it might almost be an end run around a chaplaincy program (and hospital chaplains generally subscribe to a code of ethics that prohibits offering prayers to ‘nones’).

  • Richard Wade

    You are right that a combination of couple’s sessions and individual sessions would be the best, and that would even include individual sessions for the husband. I should have made that clear. I say that it is essential for the husband to be involved because e-patient spends far more time with him than her therapist, and even though she might make excellent changes within herself, her communication patterns with her husband might not automatically improve without guidance and encouragement. A newly healing individual living in a family system that still operates in old patterns will have a difficult time maintaining her progress.

    Portland ME Skept,
    You can find a bit about me on the “About the Contributors” button at the top of the page, just above Hemant’s handsome face, or you can click here. Thank you for your input and encouragement. I consider very seriously what people share in their comments.

  • CatBallou

    I appreciate your response, Richard, but I still don’t agree with you. You didn’t say “some women experience some of these problems,” you said “for most women, it is an assault on [list].”
    I recognize that you’re the counselor, but from personal experience, when I have a crisis or problem of some sort and people project their imagined responses onto me, it is not helpful. If I tell someone about a problem and that person says “Wow, you must be devastated” (or lonely, miserable, etc.), or “I’d be scared” (etc.), it makes me rethink my own reactions and wonder whether I’m failing to recognize the severity of my problem. I still think it’s better to let the person describe their own responses, rather than listing possibilities or “normal” responses.
    And although you may be addressing a wider audience, this woman was asking a very specific question about counseling resources, not about coping with a mastectomy.
    Now when I write in with a question, I’m going to have to change my alias!

  • Richard Wade

    CatBallou, at this point I can only shrug my shoulders. I said “most” because that is the truth of my own experience. Most of the women whom I have counseled about this and similar issues were faced with those challenges, and most of the women who were counseled by my colleagues were too. There are exceptions, and I hope that e-patient is one of them, but I’ll risk saying the unnecessary warning over ignoring the elephant in the room, which is the most common mistake. Saying what might be a complication does not make it become real in the person if it is not in them to begin with, and not saying it does not make it go away if it is indeed, there.

    I take your view with great import, however, and I agree that asking open-ended questions like “How do you feel about this?” is preferable to listing feelings to which the person might say yes or no. This is not a therapy session however, this is a discussion about therapy. If, for the sake of encouraging her to follow through, and others to take her first step, I have been too blunt or insensitive to e-patient, then I apologize to her. Only she can know her feelings.

    I view people as much more than insoluble, sovereign individuals. They are also very much the ongoing process and product of all their relationships, especially those with their loved ones. People are not like pebbles, with no way in. They are more like sponges that soak up much of whatever is in those with whom they live. I have seen too many individuals keep their therapy private, and then go right back to their old behaviors and self images because they are living with others who, not understanding their interconnectedness and having no other model to go by, keep responding in the old ways.

    If you write in with a question of your own, I will be honored, and I will respond to you with my most circumspect and sensitive effort.

  • CybrgnX

    Although I was raised VERY catholic and LOVED my catholic Mom a lot. I have no patience with them. Praying is a cope out of a cope-out. They can’t help so we can continue wasting our time not helping even more!! Just asking how they can help in any small way is better then praying!!!

    If some fool tried to pray for me, I would tell them that they can pray only if their prayers will return my ‘whatever’ to full health or they can say the lords prayer for me after they have shoved their head up their ass first!!!!
    Of course it would be said with polite respect with a smile ;-).

  • Robert

    Richard, I want to say I was touched by your very thoughtful reply and advice. You took a good deal of time and covered all the issues in a very clear and even handed way. I was impressed. Well done. I suspect you have more empathy in your little finger than I have in my whole body!! Robert.

  • Richard,

    I wanted to say thanks for your appreciation of my feedback in your first response. I hope it did not come off as hostile; it wasn’t meant that way.

    Your second response, however, I think was meant to be addressed to CatBallou. 🙂

  • I must say that I would not have been so forgiving. If the “patient advocate” cannot respect your beliefs, then why should you respect theirs? Tell them to take their silly superstitious garbage with them as they leave the room. I guess no one is more anti-smoking than an ex-smoker?

  • Richard Wade

    Oops. Yes, I was responding to CatBallou. I have fixed that in my comment above. Your comment did not sound hostile at all, nor do Catballou’s. I value people’s feedback and their opinions. They often persuade me to think differently, especially when they are offered in a positive spirit.

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