Annette smiles wanly when I open the waiting room door, walks slowly into my office, and lowers herself gently into her usual chair.
“Welcome back,” she says with little enthusiasm.
“Thank you,” I reply, surprised by Annette’s distance and reserve. Although this was the Annette who began therapy with me many years ago, our close enduring relationship had allowed her to deal with her childhood sexual abuse and to transform into a warm, open, engaged woman. Now forty-five, she worked as a para-legal and had a full, satisfying life. Although she never married, she had several long-term relationships and a network of close friends. She was usually especially glad to see me after my return from vacation, eager to catch me up on her life.
After a brief silence I ask, “What’s wrong, Annette?”
“I have some really bad news,” she says, her voice barely audible. “I have metastatic colon cancer.”
My eyes widen, tears immediately filling them. “Oh Annette,” I say. “I’m so, so sorry. When did you find out?” I was only gone two weeks I think to myself, aware that I feel guilty I wasn’t here for her.
“Just yesterday. I guess I’m still in shock. I wasn’t feeling well, had some bloating, discomfort. I wasn’t hungry which, as you know, is unusual for me. I thought maybe it was just my usual stomach stuff, but I went to my GI doctor. He examined me and suggested a colonoscopy and a CAT Scan. I was too happy about that. And then the diagnosis, cancer. They want to start chemo. I don’t know. I don’t know what my chances are and if I’m going to die anyway, I’d rather not prolong the agony.”
I’m overwhelmed by sadness, sad for this woman who fought so hard in her therapy to get through the pain of her past, only to now be forced to confront a dire illness and the possibility of death. My own losses flash in front of me as well, my husband to metastatic prostate cancer, numerous friends to pancreatic cancer, liver cancer, breast cancer. The list seems unending.
“I’m sorry, Annette,” I say. “I know I’m not being helpful to you.”
There again is her wan smile. “No, you are. I can see how much you’re affected by my news. That means a lot to me. I know you care for me. I know I’m not just one in a long line of patients.”
“We’ve worked together a time long, Annette. Of course I care about you. And I’ll help you through this however best I can.”
“Will you support whatever decision I make about whether or not to get chemo?”
“I will, but there’s a “but” to that statement. I want you to be sure you’ve explored all your options and know what the doctors think of your chances.”
“I am going to see an oncologist.”
“Good. I’m glad. And I also think you need to give yourself some time. You just found this out yesterday. It’s overwhelming. It’s overwhelming to me, it must be more than overwhelming for you.”
“You’re the first person I told.”
“You didn’t call any of your friends?” I ask, surprised.
“No. I knew I’d see you today. I was afraid if I told anyone I’d totally fall apart. I called in sick to work. I couldn’t bear telling everyone there and I didn’t know if I could fake it. They know I haven’t been feeling well.”
“Do you feel you can tell your friends now?”
“I don’t know. I’ll see.”
“Annette, does this feel like part of the abuse all over again? Like an unwanted, foreign thing invading your body?”
“Oh my God, I hadn’t thought of that! But it’s true. I mean I know it’s not the same thing, but it does kind of feel that way. How did you think of that?”
“I guess because today you’re more like the self I knew when we first started seeing each other – removed, defended, isolating. I know it could be shock, but for you I thought it might be more. And it’s not only the cancer itself, but all the tests you had to take and will continue to have to take. So we’ll need to be sure that your decision about treatment isn’t contaminated by your desire to avoid what might feel like more abuse.”
“You’re right. I wouldn’t want that bastard to destroy me in the end.”
“I wouldn’t want that either. Go see the oncologist, tell some of your friends and hopefully you’ll have time to decide what to do.”
“See you Thursday.”
“See you Thursday,” I repeat, aware of the now increasing importance of time.
Lovely piece of work.... Radical Genuineness, Validation on a deeper level, connecting her past to the present, holding that fine balance of acceptance but also not giving up - supporting change strategies. Good work! I hope your client gets a really good medical outcome. I know she'll be supported well, emotionally and psychologically! :)
Thank you so much for your comment, Hersh.
Interesting that you saw my genuineness as radical. I would hope that by now, there was more genuineness in our field than not.
Thanks again for the positive feedback.
Oh, sorry - a bit jargonny - I work as a DBT therapist, and it's a term borrowed from DBT. I fully agree, "Genuineness" in this context does not need the preface "Radical." :)
Thanks for your clarification, Hersh.
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