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.
Richard

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