How will I know if I need counseling or other support?

When first diagnosed with cancer, most people go through a period of emotional turmoil, which includes feelings of anxiety, sadness, grief, and fear for the future. You may have questions about why this has happened to you; what does your life really mean; what about a higher power; worries about your job, money, insurance; and other practical matters. Over time, as you move through cancer treatment, you begin to figure out how to address these concerns.

If you have close relationships with other family members or friends, they will play a part in helping you cope with cancer and its problems. If things stay unsettled or you find yourself feeling sad much of the time, or if you feel unable to make even small decisions, it may help to talk with a counselor. The normal process is to feel more capable of meeting the challenges of the cancer diagnosis and treatment as you go along. Typically, you will begin to feel you can handle your treatment as well as the issues of other family members. But if you have constant feelings of hopelessness, anxiety, and fear you may need outside help. Trying to tough it out can waste time and energy. Getting the help that you need can put you back on course much more quickly.

Family members have their own issues as a result of your illness. In a marriage or long-term relationship, cancer happens to the couple, not just the patient. Sometimes couples have trouble talking about cancer and its many issues. Often this is because couples tend to protect each other, but in the long run, this can become a communication barrier. Even with the best intentions, each person can feel alone or abandoned instead of supported. Family members are often angry about the cancer. But they find it hard to talk about that to the person with cancer because they do not want to seem to blame the innocent victim. With help, couples learn how to talk about their feelings without hurting each other.

If you seem to be talking about the same issue over and over again, you may be stuck. It might be helpful to talk with a third party to get another view on how you can move forward and support each other.

Single parents or couples with problems that started before the cancer may be even more stressed by the demands of the illness. Single people will need even more support from friends or extended family members. A single parent may want to talk with a cancer counselor or join a support group to meet others who are dealing with the same issues.

With troubled marriages or other relationships, you are often forced to look at and deal with the old problems in order to heal and recover and move on to cope with cancer and its treatment. Dealing with cancer along with a troubled relationship is more stressful than most people can manage alone. Sometimes people worry that relationship problems or unresolved conflict will interfere with their getting well. There is no evidence that stress causes cancer or decreases your response to treatment. But worry and pressure will affect your emotional responses and make life even harder than it has to be.

How will I know if my children need extra help?

Parents are experts when it comes to their children and often can predict how they will react to new and stressful situations. Many times parents can tell how their children are feeling by how they act. When children are upset, they often react with a more dramatic version of how they behave normally. Quiet children may become more withdrawn, loud and active children crank it up a notch, and children with learning problems start doing worse in school. Some kids may have more trouble being apart from a parent. Some begin to have trouble sleeping. Some kids express their emotional stress with physical symptoms like headaches or stomachaches. They may seem tired or sad a lot of the time. Any change in how your child usually behaves may be a red flag that they need some attention.

Young children usually cannot talk easily about their feelings, so their behavior will usually tell you what might be going on. You can learn a lot by watching your child play. Listen to what they say to their dolls, watch what they draw in school, and how they act with their friends. Young children may seem to go backward (regress) instead of forward in learning new tasks. Toilet training may be stalled. Children may be insecure, clingy, or resist your attempts to correct their behavior.

Teens probably won't regress in such dramatic ways, but they may argue more or be more distant as a way of acting out their distress. They may also have trouble in school. Teenagers may have trouble sleeping, or they may seem to sleep all the time. In theory, at least, teens are able to talk about their feelings. Sometimes that is easier said than done. Try introducing a light topic and leading into a more feelings-related topic. A direct question like "You seem worried, what's going on?" may open up the discussion.

Remember that not all problems are related to the cancer, even though there are times it can feel as if cancer has taken over your family's life. But look closely at your child's behavior and think about what else might be going on. Is your child having trouble adjusting to a new teacher? Are they upset about not being invited to a party? Are they struggling for more independence? While cancer in the family can certainly add a lot of stress, there may be other things going on in your child's life that could explain their behavior. You might not know unless you ask.

Try to get your children to tell you what's troubling them, if they can. A simple, "You seem very thoughtful (sad, worried, etc.) these days. Can you tell me why?" may give you new insight to your child's behavior. Check with the school to see if the behavior is also noticed there. Maybe a teacher is incorrectly assuming that because a parent is ill, the child should be treated differently. Often this just makes the child feel more isolated. Check out all of the possibilities before you decide what needs to be done to help your child feel better.

Also remember that a child's personality is an important factor in how they will react to illness in the family. Some children are easy-going and kind of roll with the punches while others tend to make a mountain out of a molehill. Different things work for different children in a family, so think about how you handled each of your kids before cancer was part of your lives. Those same methods will often work again, even though the problems may be different.

It often helps to get as much information as you can about a problem from all possible resources. This means speaking with your child's teacher, guidance counselor, pediatrician, or a counselor or social worker on staff where you are being treated. It's also a good idea to ask your child what you might do to help them feel better. If your child seems distressed and talking about it together doesn't help, the child may need outside help.

Always tell your children that they had nothing to do with causing your illness. As illogical as this idea may seem to adults, experts know from experience with families dealing with cancer that children usually believe, at one time or another that they had something to do with a parent's illness. Also remind them that the focus on the cancer is short term. Life will go back to some kind of routine after treatment is over

Children can become depressed or anxious, just as adults do, though they may not show it in the same ways. For instance, a common sign of depression in a child is a change in behavior, like suddenly getting poor grades in school or losing friends. Most children whose parent has cancer seem able to cope, but there may be times when it gets to be too much. If a child seems to be having trouble, it may mean a more serious problem than a normal, sad response to cancer. Extra help is needed if a child:

• Is unable to handle the feelings of sadness
• Feels sad all the time
• Cannot be comforted
• Admits to thinking of suicide or of hurting herself or himself
• Feels extra irritable
• Becomes very angry very quickly
• Has changing grades
• Withdraws or isolates himself or herself
• Acts very different than usual
• Has appetite changes
• Has low energy
• Shows less interest in activities
• Has trouble concentrating
• Cries a lot
• Has trouble sleeping

When a child shows 1 or 2 of these symptoms, it may help to offer more support. But if the usual methods of handling these problems are not working, or if the problem goes on for more than 1 or 2 weeks, the child may need extra help. (For more serious problems, such as if the child is planning to hurt himself or herself, urgent help is needed.) It may be useful to talk with the child's pediatrician, school counselor, or with the social worker or counseling staff at the hospital where the parent is being treated. Since these experts know how other children have reacted to illness in the family, they may be able to offer a useful way of looking at the problem. They can evaluate the child and make sure that any needed help is given. They can also suggest books, videos, and children's support groups that may help. Rarely, a child may need to see a psychiatrist for medicine or counseling.

Why do some people resist getting help with emotional or family problems?

For many people who are just starting to deal with cancer, merely sorting through the many medical decisions is a huge challenge. They may not have the energy to cope with much more, so emotional issues get pushed aside until later. This makes sense because people can only cope with so much at one time. But there are some basic things that children need to know as soon as a parent learns about the cancer. These include the simple facts about what cancer is, how it is treated, and how it affects the child's life. You need to talk about these things in words that fit the child's age and development. For more information, please see Helping Children When A Family Member Has Cancer: Dealing With Diagnosis and Helping Children When A Family Member Has Cancer: Dealing With Treatment.

One of the issues that comes up when you need support services is how you feel about asking for help. People sometimes think they should know how to handle every problem that arises even though they have never had cancer. Some think asking for help is a sign of weakness. In fact, the opposite is true. Asking for help is a sign of strength. Learning what to expect from yourself and other family members can help you solve problems more quickly. Helping your children cope with your illness will teach them that while we cannot control everything that happens in life, we can control how we choose to deal with problems.

There are other reasons to ask for help. During periods of active treatment, you may feel tired and overwhelmed with physical symptoms. Your family members have their own reactions and worries to deal with, along with helping you with your physical needs. If family problems are worrying you, it may distract you from your recovery. This can make it harder for you to do the things you need to do to get better.

Along with their worries about a sick parent, children are dealing with other concerns and stresses. They must keep up in school, manage relationships with siblings and friends, and do their chores at home. They are also growing and changing daily in how they think about life and themselves. It may seem to be too much for them to deal with your illness. Asking for help and learning how other families deal with these problems can help save your energy and guide your children through a tough time.

The health care team wants to help families enjoy life, even in the face of cancer treatment. It will help if you can make good choices about managing the illness, remain hopeful about the future, and feel some control of the situation. You never want to feel that your whole identity has become wrapped up in being a cancer patient. You always have choices about how to feel and think about the situation. With your help, your children can also learn how to deal with cancer and its treatment, and keep their normal growth and development on track at the same time.

Why do some people need extra help while others don't seem to?

Some people refuse to get professional help for emotional or family problems, no matter what their needs may be. In their eyes it is just not an option. They feel that needing help means that they are weak or that it is a sign they are unstable or even "crazy." The American culture tends to value independence or "pulling yourself up by your bootstraps." Sometimes this attitude may cause more harm than good.

If you try to compare yourself with others, it may seem to you that some people sail through cancer and its treatment without much stress or strain. Keep in mind, though, that you may not know what they are really going through, or even if they got help for their problems. But some people are their own worst critics and have thoughts like, "What's wrong with me?" or "Why am I not tougher?" While we all may have a need to feel independent at times, there are other times in our lives when it is hard to feel tough or to even feel good about anything. It is important to give ourselves permission to need and get help.

A person's ability to handle stress depends on many things. Some of these are related to our genetic make-up and physical factors, like the effects of hormones and medicines on our bodies. Our basic personality doesn't change a great deal as we grow, but it is affected by our life experiences. Other important factors are our relationships with other people, especially our parents and siblings, our unique culture, our education, intelligence, our spiritual path, career success, finances, gender or sexual identity, and our physical and mental health. Human beings are complex and no two people react the same way to life's experiences.

Sometimes knowing more about the cancer and its treatment will help you cope. Think of learning about your illness and your emotional responses as equally important. It is all just part of the package of dealing with your cancer with success. To look at it another way, it's part of your training in completing the cancer marathon. But any champion runner has a team supporting him or her. Struggling alone makes the whole race more difficult and painful than it should be. Give yourself the benefit of other people's experiences and insights so that you can approach your situation with support and hope.