1. Finding Strengths with Your Partner after a Breast Cancer Diagnosis Ali Schaffer, LCSW Manager, Patient and Family-Centered Care Vanderbilt-Ingram Cancer Center

2. Goals Discuss the impact of cancer on relationships Normalize feelings and responses Highlight the good, the bad and the ugly Share tips and tools for couples to navigate relationships and cancer Provide resources Q&A

3. Cancer is happening to both of you. “The unique dynamics that define each couple are in precarious balance during good times and easily upset during crisis.” -Jane Hill, CURE Magazine Cancer is a crisis.

4. Setting the Stage

5. Cancer = Change Social Lifestyle/behaviors Family/friend relationships Spiritual Late effects of treatment Fertility Body Image Self-Esteem Health of Offspring Sexual Health and Intimacy Mental health Dating/relationships Physical well-being Employment Healthcare Financial Insurance Secondary health risks

6. Image from www.leighalake.com

7. Issues to Consider: Survivor Impact of treatment and survivorship on mental health Change in family dynamics, personal relationships Integrating cancer experience into life Coping with treatment-related effects: short-term and long-term Psychological adjustment Mental health issues “Who am I?” Fear of recurrence “I am invincible.” Change in employment? Image from www.youngsurvival.org

8. Issues to Consider: Partner/Caregiver(s) Fear of recurrence Future long-term care needs? At-risk for mental health issues Re-establishing family roles, rules and limits Integrating cancer experience into life Monitoring health and well-being of all family members Financial, employment, insurance-related distress Balancing roles: cheerleader, note taker, errand doer, etc..

9. Issues to consider: Couples “When couples are initially confronted with the cancer diagnosis, they may try to carry on as usual. This is a mistake.” “Conspiracy of Silence” Changes in ability to do “normal” couple activities. Changes in intimacy. Fear(s) of losing partner. Feelings associated with changes in role. Navigating extended family/community/friends Idea--Can you approach this as a “we disease?” Idea--Create a couples journal to document the present, remember what brought you together, and dream about the future.

10. Different Strokes for Different Folks “People cope differently…in life and with cancer.” When under stress, many women tend to want to connect with others and talk about their feelings and fears. Whereas, men tend to process their emotions alone. Therefore, there can be misunderstanding and conflict around what I need vs. what my partner needs and this can create additional challenges.

11. Factors That Impact Coping Previous experience with and/or exposure to cancer and outcomes. Treatment: intensity, duration, short-term and long-term side effects Pre-existing dynamics/patterns/communication in the family Coping with previous life experiences, stress, trauma Prior history of mental health issues Individual perceptions and prejudices about cancer Personal experiences and responses to loss Type of cancer Prognosis Tolerance of physical symptoms

12. "Any catastrophic illness, but cancer especially, forces people to look at and deal with many things they didn't pay attention to before. So take advantage of that and view it as an opportunity to make your relationship stronger.“ -Katherine Puckett, LCSW National director of Mind-Body Medicine at the Cancer Treatment Centers of America

13. Empowering C’s C C

14. COMMUNICATION Discuss ALL of your feelings. Set aside some time to create safe space in which to talk about your feelings and work to understand the other persons’ feelings. Listen with a sense of curiosity, reflecting back what you hear, acknowledge your partner’s feelings and take in what he/she has said before you respond, even if you disagree. Take relaxing breaths. Ask for a time-out. Use “I” statements. Be willing to ask for help. Share expectations of yourself and others. Assumptions can be dangerous. Sometimes you don’t need answers, you just need someone to listen.

15. COMMUNICATION TOPICS Priorities-does anything need to be changed? Meaning of cancer and impact of treatment Intimacy and Sex Needs and Wants Personal/Caregiver/Couple/Family goals Finances Feelings I See You…and I Appreciate… What is Fun? Healthcare Navigation Getting Back Couple Time After Cancer Changes in Roles ??

16. BARRIERS TO COMMUNICATION “We’ve never talked about this before.” “I’m embarrassed.” “I get so emotional/angry/mad/sad when we talk.” “He/She doesn’t want to talk about it.” “It never seems to be the right time.” “I don’t know what to say, or how to start a conversation.” “He/She won’t listen to me.” Many couples can benefit from working with a professional for additional guidance to navigate these common issues related to the unique experience of living with cancer.

17. CREATIVITY Identify new solutions to problems. Safe space to experience emotions. Make time for FUN. Time management. Cancer-free zones. Try new things. Healthy habits.

18. CURIOSITY Consider the ways in which you have grown from this experience. How do you cope? How have others have coped? What’s working? Not working? Identify triggers- fatigue? Chemo? First’s? If possible, anticipate changes- in schedule, roles in/outside of the home, and communicate this information.

19. CONSISTENCY Find ways to regain routine. Schedule regular “together” time. (e.g.-date night, workout time, movie marathons). Communication patterns/methods. Engage in routine self-care.

20. COMMUNITY Who are the people in your neighborhood?

21. CHEESE DIP

22. Post Traumatic Growth Post traumatic growth (PTG) is a construct of positive psychological change that occurs as the result of one’s struggle with a highly with a highly challenging, stressful, and traumatic event. -Calhoun and Tedeschi (2006) Cancer can be an catalyst to positive growth “ Couples face cancer and they share the pain together, but they also have the potential to share in the gain from the trauma.” -Anne Coscarelli, Ph.D. Director, Simms/Mann-UCLA Center for Integrative Oncology

23. Things to Remember… You are on the same team. Listen, don’t try to fix. Communicate. No one is a mind reader. Be honest…even when it is hard & uncomfortable. Self-care is key. It’s the little things-a touch, a smile, a note. Forgive beginner mistakes. You can always try again tomorrow.

24. For additional information: Allison Schaffer, LCSW Manager, Patient and Family-Centered Care Vanderbilt-Ingram Cancer Center (615) 322-9799 allison.schaffer@vanderbilt.edu