'I tried to stay upbeat for everybody, I kind of lost myself': How counselling helps with healing

The previous January, her GP had prescribed tablets for IBS and recommended she keep a food diary. With no improvement, Lambe — an admin worker in further education — returned to her GP in late February and was referred for a colonoscopy.

“By the end of May, I’d heard nothing. I’d had a couple of bad days. I was tired, irritable. I woke up one morning and said, ‘Right, I’m going to the hospital.’ To be honest, I was also getting a bit nervous with summer coming — how was I going to wear a white jumpsuit with all this going on?”

Arriving in the hospital just days before the June bank holiday, Lambe had a blood test and CT scan. “They thought maybe I had a kidney stone.”

But within 48 hours further tests confirmed a tumour blocking her bowel. “It was localised, but advanced. I had to have a stoma. The ball started rolling then about next steps and procedures.”

Seven weeks of radiation and 16 weeks of chemo, finishing in March 2024, were followed by surgery in April to remove the tumour, some of her bowel, and her ovaries and uterus — radiation had caused damage to these and there was scar tissue.

In the high-dependency unit for five days, Lambe was home after two weeks. However, she did not feel “in a good place” mentally. “I was cancer-free, the tumour was gone, I was supposed to be jumping up and down, but it didn’t hit me like that. I was very emotional.

“I think I didn’t deal with the diagnosis when it first happened. I tried to stay upbeat for everybody, I kind of lost myself. From diagnosis to surgery, every day was, ‘Right, I just need to get through this’ — recover after getting the stoma, get over radiation, prepare for chemo, prepare for surgery. And after surgery, there was nothing left. I had to deal with everything I hadn’t been dealing with.

“When you’re lying in bed post-surgery and you can’t move — and you have to keep motivated — that can be hard. Things that used to motivate you, you can’t do anymore: Go on a night-out with friends, to the gym, or on holidays. 

"I also found the stoma really hard to accept,” recalls Lambe, who had the stoma reversal procedure last September. 

Throughout this journey, “many questions came and went. Like: is it my time? Did I make the right choices in life? Will I be remembered? Will my best friend find a new best friend?” 

While she had huge support from friends — one male friend is now her partner — and family (“My brother Colm was a rock), as well as her workplace, Lambe, “in a very low place” post-surgery, was referred to the Mater Public’s psycho-oncology department and saw a psychiatrist and psychologist.

“I learned how to deal with my emotions, to have compassion for myself, to accept I’ve been through so much that I’m allowed to get angry, to get sad.”

Through the psycho-oncology department, Lambe participated in an eight-week mindfulness group. “I do it myself now at home. It’s just about being in the moment.”

Today, she’s feeling good. “My body is getting back to normal — it might take another few months. Post-surgery, I was straight in to menopause. I’m on HRT patches and, touch wood, I haven’t been too bad.”

Prior to cancer, Lambe says she would probably have “fobbed off” the idea of counselling. “I’d highly recommend it now. Because with cancer, it’s not only the body — the head also needs looking after.”

Dealing with distress

Dr Helen Greally is ex-clinical lead for psycho-oncology at the National Cancer Control Programme (NCCP) and is director of support services at Galway-based charity Cancer Care West. 

She says psycho-oncology was first named at New York’s Memorial Sloan-Kettering Cancer Center in the 1970s, where Dr Jimmie Holland saw the need to treat the emotional trauma experienced by cancer patients and their families.

Holland became the founder of psycho-oncology, conducting some of the first research on cancer’s psychological impact on individuals and families — she also looked at how psychological and behavioural factors affect cancer risk and survival.

Greally says that cancer causes distress to almost everybody who has been diagnosed. “About 45% to 55% of people suffer significant distress. People are often quite scared — is the cancer treatable? Is it curable? There are different phases to adjusting.”

Psycho-oncology, she says, is about helping people navigate the cancer journey from diagnosis through treatment to post-treatment and right to the end, whether cure, survivorship and living well with cancer or, for some, palliative care. 

“Psycho-oncology is overarching, covering all these phases,” explains Greally, adding that “huge amounts of research” underpin how psycho-oncology supports people through cancer.

“We know it works,” she says, pointing to a meta-analysis of 91 studies that found psychological therapy reduces physical healthcare costs by an average of 20%. And a 2014 study found that “where data is available” on the cost of psychological treatment and physical healthcare, the savings exceed costs.

Greally points to Australia and particularly Canada as having very good psycho-oncology services, but says Ireland is also “well represented”, due to recent investment. 

“The NCCP has been tasked with implementing recommendations in the current National Cancer Strategy (2017-2026), which includes recommendations for psycho-oncology,” Greally says. 

“And in the last six years, multi-disciplinary psycho-oncology teams have been established at Ireland’s eight cancer centres.”

Gamut of emotions

Dr Sinéad Lynch, counselling psychologist at the Mater Public’s psycho-oncology department, says distress is the term psycho-oncologists use to describe the whole gamut of emotions patients can feel at diagnosis and right through their cancer experience, whether shock, anger, fear or sadness. 

“Distress can be spiritual, existential — fear of death, it could be social or financial. The word 'distress’ reduces stigma — the person’s suffering because they’ve a cancer diagnosis.

“And in [cancer healthcare] it’s now advised to measure distress as ‘the sixth vital sign’, along with blood pressure, temperature, and so on — the whole patient is being treated.”

Lynch studied psychology at University College Dublin and then worked in television — she became a daytime producer on RTÉ — but after her mother was diagnosed with breast cancer — dying four years later, when Lynch was 30 — she reached a turning point. “Though I really loved the creativity of TV, I wanted to find a new path, a bigger meaning.”

A master’s in psychotherapy at Dublin City University was followed by a doctorate in counselling psychology at Trinity College Dublin. Lynch knew she wanted to work in psycho-oncology.

The Mater Public’s psycho-oncology department is an acute service and follows the NCCP’s tiered model, where patient distress is matched to expertise.

“Very acute and severe distress requires psychology or psychiatry,” she says.

“It’s when someone gets to more acute distress, with maybe a history of depression and anxiety, or they’ve very acute anxiety that’s causing panic where they’re not able to engage with treatment. 

"They might be stuck in shock, sadness, heightened anxiety, that’s filling every day, every thought and feeling.

“Or perhaps they’ve multiple factors making it very difficult. Perhaps they need a social worker to support with children or finances. Maybe they have psychosis caused by steroids and so need psychiatric input.”

Lynch says this level of distress is not in the same realm as a cancer patient who bursts in to tears during a chemo session — they are having a bad day, had little sleep the night before, but generally are coping quite well and have a lot of family and friends as support. 

She says this person might benefit from help from a Daffodil Centre or ARC Cancer Support Centre.

Whereas, the person who says, ‘I’m not sleeping at all, the steroids are affecting my mood, I’m worried about my job continuing to pay me, I’ve no-one at home to support me’, has a number of stressors and is a candidate for the psycho-oncology service.

When faced with cancer, people feel so many emotions, Lynch says. “There’s no set pattern. Naturally, there’s shock and fear at diagnosis, but some have been suffering for a while, trying to find answers. Diagnosis can come as a relief — now there’s a plan, they feel vindicated, though a lot of anger can also come up.”

After the initial shock, people often adjust when they know their treatment plan. “Anxiety can shoot back up a week before chemo — we often get referrals then. Cancer shakes the foundations — where everything had felt certain, it now feels uncertain, the patient feels out of control.

“And all the different time points can bring different uncertainties. When chemo ends, the person may feel, ‘I’m on my own now’ — they’ve got used to being scaffolded, monitored every week. And ‘scanxiety’ is a known phenomenon — coming up to their scan, people can become very anxious.”

Lynch hopes her patients will feel supported by the psycho-oncology service, not feel so alone. 

“I hope they can take away some coping skills, tools, and insight about themselves. I’d love for them to feel they’ve gained something they can take with them, either in living with cancer or recovering from it.”

While much has been done, Lynch would like to see more team members who could offer group interventions to patients with a wide range of issues, such as those coping with physical adjustment to a stoma, or suffering body image issues post-surgery.

“They may feel a loss of self-esteem or not feel ‘like myself’. Loss of a body part, such as a breast, or a functioning deficit, such as erectile dysfunction after prostate removal, can cause huge mental anguish. 

"And for many people with a stoma, leakage is a big concern — accidents can lead to shame and embarrassment, so they may not socialise as they once did, [which can] lead to sadness and depression.”

Greally would like to see equity of services for all cancer patients. “We’re very aware there are still a lot of inequities in cancer support among marginalised communities — people with poor socio-economic status, older people, immigrant populations, those with intellectual disabilities.

“There should be equity and inclusion in cancer services.”

Support services

• Psycho-oncology services developed with HSE and Department of Health investment – within Ireland’s eight cancer centres, multidisciplinary teams have been established to deal with psychological distress. Teams comprise psychiatry, psychology, social work and nursing.
• Community cancer support centres have been established under the National Cancer Care Programme. Dr Helen Greally, ex-clinical lead for psycho-oncology at NCCP, explains that these have been tasked with supporting people with cancer in the community – patients and families.

They offer three key supports:

• Information and advice about how to manage and live with cancer
• Psychological counselling and therapy
• Range of survivorship programmes to help people live with cancer

“For example, they might help people take up physical exercise, manage stress or fatigue, or live with the fear of uncertainty,” explains Greally.

Much supportive care is offered by charities and voluntary services:

Irish Cancer Society’s Daffodil Centres (https://www.cancer.ie/daffodil-centres): Staffed by specialist nurses and trained volunteers, they provide information and support to anyone affected by cancer.

ARC Cancer Support (https://www.arccancersupport.ie/): The charity provides psychological, emotional, practical and educational support to people with cancer and those who care for them.

Online course

Lynch runs the Comfort Group as part of the psycho-oncology service. The group started as an Irish Cancer Society-funded research trial. 

This compared group-based compassion-focused therapy techniques, along with breathing pattern retraining, with treatment-as-usual on the psychological functioning of patients diagnosed with cancer. 

“The six-week online course showed successful clinical reductions in distress in cancer patients,” says Lynch. 

www.mater.ie/services/psychology/wellbeing-centre/.

Spot the symptoms 

• Changes in bowel habits — diarrhoea, runny bowel movements, constipation, needing to poo more or less often than usual.
• Blood in your poo, which may look red or black.
• Abdominal issues — cramps, general abdominal pain, bloating that doesn’t go away.
• Weight loss when you’re not trying to lose weight.
• Tiredness and lack of energy when you’ve had enough rest.
• Any unusual change you know isn’t right for you.
• If you experience one or more of these symptoms, you should make an appointment to see your GP.

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