The Role of Pastoral Care and Counselling in addressing the Emotional and Spiritual needs of the Cancer Patients

Introduction

Cancer is a terminal disease that threatens human life. People living with cancer undergo a time of emotional and spiritual deprivation in addition to their physical pain. When people are diagnosed with cancer they go through a painful process of shock, denial, anger, guilt and depression. They often ask, “What did I do wrong?” or “Why me?” Some patients even question “where is God?” Most patients wonder whether they did something wrong to develop cancer in them. They even think they are being punished for something they didn’t do in the past. Myths and misconceptions are also common among the cancer survivors that cause anxiety and worry in them. Therefore, the pastoral care givers and counselors role becomes significant in alleviating the emotional and spiritual pain of the cancer patients, improving their quality of life. 

What is Cancer?

Cancer is defined as the unwanted growth of cells in any part of the body. It is a disease where cells grow out of control and invade, erode and destroy normal tissues in the body. Cancer is basically a disease that involves abnormal growth of cells that have the potential to spread in different parts of the body. The disease may be curable if detected in early stages. Normal cells in the body grow, divide into new cells, and then die, but cancer cells do not die when they have been damaged. Instead they continue to grow, replicating the damage and sometimes invading other parts of the body. Typically, these cells grow together into a tumor, but some cancers affect blood cells instead and circulate through the bloodstream.

Causes of Cancer

Although sometimes cancer has no discernible cause, it is classified under two broad categories; known as 1) Environmental factors and 2) Genetic factors.

Genetic predisposition and environmental factors together play an important role. Genetic constitution of the body is something that cannot be dealt with but controlling the external environmental factors is in one’s hands.

Symptoms of Cancer

• The formation of lumps
• Prolonged cough
• Abnormal bleeding
• Excessive weight loss
• Changes in the bowel movement and so on

Types of Cancer

Cancer can occur anywhere in the body. Broadly, cancers are classified as either SOLID (breast, lung, or prostate cancers) or LIQUID (blood cancers). While there are more than 100 types of cancers that can affect the human body here is a look at the some of the most common types: 

Lung Cancer: This type of cancer occurs in the cells inside the lining of the lungs. Some of the common symptoms of lung cancer include coughing up blood, breathlessness, chest pain and weight loss.

Breast Cancer: This type of cancer is most common in women. Early signs of this type of cancer include a lump in the breast, dimpling of skin, liquid discharge from the nipples and change in the breast shape.

Skin Cancer: Skin cancer is one of the most common types of cancers. It affects more than a million people every year. It can form in the skin cells in any body part. It is mainly caused due to overexposure to sun. 

Melanoma: This is another kind of skin cancer that forms in the skin’s melanocyte cells. It leads to the production of brown pigment melanin and is said to be the most dangerous types of skin cancer.

Prostate Cancer: This mostly occurs in men over the age of 50 years. It develops in the tissues inside the prostate gland. This gland forms a part of the male reproductive system. 

Kidney Cancer: Also known as renal cancer, it forms in the ducts of the kidney. Two common types of kidney cancer are Renal Cell Carcinoma (RCC) and Transitional Cell Carcinoma (TCC).

Colorectal Cancer: Colon and Rectal cancers have also seen a rise. Colon is part of the large intestine and helps in digestion while rectum is found at the end of the large intestine.

Bladder Cancer: The cancer cells that develop within the bladder tissue result in bladder cancer. Lower back pain, pain in urination and blood in urine are some of the symptoms of bladder cancer.

Leukemia: This type usually forms inside the bone marrow or tissues that are a part of the blood cells and is referred to as blood cancer.

Non-Hodgkin Lymphoma: This includes different types of cancers involving white blood cells. It usually causes lymph nodes, weight loss and fever. It can occur in different parts of the body.

Stages of Cancer

There are four stages of cancer. If detected at an early stage, it can be cured with the help of surgery and medication however when detected at a later stage it usually becomes serious for the patient. Here is a detailed look at the four stages of cancer:

Stage 1: In stage one, the cancer is small and is still contained within the organ it sprung up in.

Stage 2: The size of the tumour is larger in this stage, however it hasn’t yet begun to spread in the surrounding tissues. At times stage 2 of cancer also means that the cancer cells have gone further and spread in the lymph nodes near the tumour.

Stage 3: The tumour is much larger in this stage and it may have begun spreading in the surrounding tissues. Cancer cells also spread in the lymph nodes in the area in this stage.

Stage 4: In this stage, the cancer has spread to other organs. It is also referred to as secondary or metastatic cancer. 

Treatment  

Different types of cancer cells respond to treatment differently, which means that treating cancer often requires multiple approaches to treatment. Cancer treatment might include surgery, radiation therapy, chemotherapy, and other methods.

The Bible and Physical Illness 

The Bible gives no support to those Christians who proclaim that sick people are always out of God’s will or lacking in faith. God has never promised to heal all of our diseases in this life, and it is both incorrect and cruel to teach that instant and lasting health always will come to those whose faith is strong. Sickness raises difficult and crucial questions about suffering. In his classic little volume on pain, C.S. Lewis summarized two basic questions that face any one who suffers: If God is good, why does he permit suffering? If God is all-powerful, why doesn’t he stop suffering? It seems probable that our finite human minds will never completely comprehend the reasons for suffering.

• Sickness is a part of living: at times everybody gets sick
• Care, compassion and healing are important
• Sickness, sin and faith are not necessarily related
• Sickness raises important questions about suffering

The psychological and Spiritual implications of Sickness are caused by the following:

Sickness involves much more than physical malfunctioning and recovery. Any illness can bring a variety of psychological and spiritual reactions that concern physicians, family members, and non-medical professionals such as counselors. Many of these psychological-spiritual influences can complicate or accentuate the physical illness and delay or prevent recovery. Some of them are listed below.

• Stress and helplessness
• Guilt and self-criticism
• Fear and depression
• The experience of pain
• Family influences and so on

For a person who is fighting with cancer, it is not uncommon to experience psychological distress and spiritual deprivation. They go through enormous pain and grief in different stages. According to Elizabeth Kubler Ross (On Death and Dying, 1969) the terminal ill patients go through five stages of dealing with death, known as five stages of grief.

1. Denial

• State of shock and denial
• No not me! It’s all a mistake. I don’t believe it; this can’t be happening.
• I don't want to think about it.
• A sense of unreality

2. Anger

• Why me? What did I do to deserve this? Why not somebody else?
• It can be towards themselves, family and friends.
• This anger is the manifestation of the pain or loss

3. Bargaining

• Mainly with God
• I promise I’ll do anything to be cured.
• I will change my life, my personality, I will be good.
• It is often accompanied by guilt.

4. Depression

• After loss depression is a perfectly normal emotional response.
• I feel so low and discouraged.
• Nothing matters, nothing will help, what’s the use?
• Withdraw from normal activities

5. Acceptance

• Okay, this is the way it is.
• Now let’s get the show on the road and do something about it.

 

The Role of Pastoral Care and Counselling in addressing the Emotional and Spiritual needs of the Cancer Patients:

Emotional and spiritual care is normal and necessary as it is an integral part of cancer care. Whether they are coping with the diagnosis, the challenges of treatment or continued worrying about a recurrence, the cancer patients need emotional and spiritual support to handle their situation. Addressing psychological well-being can help the patient feel more relaxed and be in control, cope better during treatment, overcome anxiety and depression and enjoy life. Appropriate pastoral care and counselling skills/functions may be helpful in working with the cancer patients. 

The Role of Pastoral Care

To care for other persons is an intrinsic quality of being human. What makes some caring “pastoral”? Pastoral caring is distinguished by the identity of the caregiver, the context in which the care is given, the ethic by which the care is governed, and the goal toward which the care is directed.

Rodney Hunter affirms that pastoral care is concerned with discovering how to care for others in their concrete contingencies and problems so as to stimulate or enable their life of faith and their practical knowledge of God. The following pastoral qualities may be helpful in caring the cancer patients.

1.   Visits

Frequent visits may help the cancer patients to enhance their quality of life but need to be sensitive to their physical condition, so that visits may not be too long and also not too rushed.

2.   Presence

Most of the cancer patients feel isolated and secluded. The physical presence of the pastoral care giver may enable the patients to connect to the outer world.

3.  Interaction

There are some patients who long to tell their stories but sometimes they may not get chance to do so. The Pastoral care giver’s interaction with cancer patients may enable them to talk and get emotional relief.

4.  Self-awareness

The primary concern of the pastoral care giver is to make the patient be aware of the things around him or her. This gives them space to realize their self-worth and dignity. 

5.  Touch

Studies proved that through physical touch the patients gain enormous strength. This needs to be done appropriately. It will be good if patient takes the lead in shaking hands or other physical contact.

6.  Spiritual-awareness

The pastoral care giver can help the patients to bring them into God-conscious who is the source of all        healing. Many cancer patients whom I visited were angry with God, but yet they were in need of prayer. This can be done based on the patient’s willingness and interest.

    

7. Prayer

Prayer is a resource to connect to God for healing. All the patients may not be aware of this fact at the same time we are not sure whether all the patients be healed physically thorough our prayers but still prayer has got its own value at the bed side.

8. Song/Music

 Singing with music with the patients may enable them to feel more relaxed and they may even join the singing group in clapping sometimes which would eventually change their mood to positive state. 

9. Scripture

Reading the scripture verses for the cancer patients may bring comfort and consolation ar the word of God has power to change situations.

10.  Eucharist

Some patients/family members may wish to have the Holy Communion. The bed side Communion is a part of a therapeutic healing. This may lead the patient to confess and get forgiveness from God. This would enable patients to gain spiritual strength and solace. 

The Role of Pastoral Counselling

The American Association of Pastoral Counsellors (AAPC), the first association of Pastoral counselling in the world (1963), describes Pastoral counselling as the “exploration, clarification and guidance of human life, both individual and corporate, at the experiential and behavioural levels through a theological perspective”.

Pastoral counselling aims to find a new level of self-identity and maturity by deepening its theological roots, broadening its methodology and discovering its unique contribution to the helping of troubled humanity. In counselling the sick, often it will be necessary to go to them.The importance of counselor is warmth, empathy, genuineness,the value of listening patiently and gently encouraging sick people or  their families to talk about their fears, anxieties, anger, future, and  trying to understand them with compassion, without being gushy or demeaning. The following counselling skills may be helpful while addressing the emotional or psychological needs of the cancer patients.

1.      Rapport building

By visiting patients the counselor can build a rapport (professional relationship). This would help in creating trust and confidentiality. The cancer patients may not be willing to share their stories at the first visit. When they gain confidence they begin to talk. Hence rapport building plays a crucial role.

2. Attentive listening

The cancer patients tell their stories; comprising of multiple issues sometimes. Attentive listening helps the counselor to respond appropriately.

3. Empathetic understanding

Empathy is putting ourselves into the shoes of others feelings and emotions. For a counselor it is important to empathize with the patients in their struggle for life, trying to understand the content and meaning. 

4. Responding to Content and meaning

The patients may share many things but it is the duty of the counselor to pick up the content and its meaning and respond creatively.

5. Facilitating Catharsis

While interacting with the patients, the counselor enables them to vent out the feelings of the patients which is known as Catharsis. The cancer patients feel relaxed when they are allowed to pour out their feelings.

6. Acknowledging and Addressing the feelings

It is important that the counselor accepts the feelings expressed by the patient and also address them, enabling the patient to feel comfortable.

7. Identifying core issues

The patient may start telling multiple issues but it is the responsibility of the counselor to be specific and concrete in enabling the patients to deal with their issues.

8. Being non-judgmental

This means the counselors should not take sides. Being neutral without judging the patient is necessary as it helps the counselor to avoid prejudice and evaluation. 

9. Avoid giving a false hope

It is good to instill hope in the cancer patient for extending the quality of life but at the same time counselor must be careful not giving false hope to the patients. 

10. Appreciating Patients

It is always good to appreciate patients for their self confidence, ability to cope and their self worth. Genuine appreciation may bring positive effects on the patients.

Counselling application to the Cancer Patients 

1. Supportive Counselling

• Supportive counselling is providing mainly emotional support to the patients.
• Trying to identify their feelings about the disease, treatment and inner fears.
• Help them to overcome the feeling by providing them the necessary support.

2. Educative Counselling

• Often mental states such as fear, anxiety, anger, confusion and repression are due to lack of information about the disease.
• A well informed patient usually does better in many ways than an uninformed patient.
• The patient can feel he/she is in control and make wise decisions if he/she knows the facts and can compare the options.
• The better the patient understands the therapy- what its goals are, what the side effects may be, and the less threatening it will seem.  

3. Reconstructive Counselling

• It is mainly working on deep personality changes that occur due to the disease. 
• Help the patient and family members to accept the reality. If the client has any hard feelings with their family members or friends facilitate to reconcile with them. 
• Unfinished work, last wishes can be asked and can be discussed with family members.Follow up can be done based on the results or requirements.

Conclusion

Cancer has become much more treatable in recent years due to new advances in medicine that often lead to earlier detection and more effective options for treatment. However, a diagnosis of cancer is still likely to be frightening, and it often brings up a wide range of difficult emotions and may significantly impact many areas of a person's life. Thus, the pastoral care and counselling plays a vital role in helping the cancer patients to alleviate their emotional and spiritual pain, and improve their quality of life. Therefore, being with the patient, trying to understand their world and responding to them with care is essential for the pastoral care givers and counselors.