Who am I as a Therapist? What did Having Cancer Change?

In the fall of 2018, I began the arduous fight of ridding my body of cancer; a cancer that I knew was not going to ultimately cause my death but might cause some disruptions in the way I live my life. My parts that hold to my “work hard, play hard” lifestyle were pretty confident that aside from some days off following surgery and a few days of fatigue following chemotherapy rounds, nothing major would change; especially my practice. Parts of me were convinced that this could be nobly done without my patients ever knowing that I was undergoing medical interventions. After all, if the venerable Supreme Court Justice Ruth Bader Ginsberg (RBG), a women who is far more senior in age than I, managed to go through treatment for pancreatic cancer and years later colon cancer while never missing a day on the bench, invasive ductile carcinoma wasn’t going to get in the way of my patients and me. Besides, this wasn’t my first rodeo. I beat the same diagnosis 15 years ago with a lumpectomy and radiation with only 2 days out of the office after surgery.

This exorcism began with a 12-hour surgery that entailed bilateral mastectomies with simultaneous DIEP flap reconstruction – which means that the rounded part of my abdomen that several parts of me were always annoyed about and then thrilled for, was available for use and was moved north to become my breasts. The magical brilliance of my surgeons, matched by their unwavering care and compassion, made the healing relatively easy and I was back in the therapist’s chair after a two-week break. However, I’m sure that my countenance was different coming in after the surgery since I moved stiffly and sat more erect as I was corseted for healing purposes. And though I am loath to admit it, my body shape had changed. My parts that did not want to see the physical changes in me were working quite well, quite hard, and continue to do so. And there I sat in my chair as if nothing had changed. But was that true? What would my patients have said if I had the courage to ask them?

Just prior to the surgery a question began to lurk from one of my therapist managing parts: Do I tell my patients now what I am about to undergo? This lead to other questions: Do I have to let my patients know what I am about to undergo? Do all my patients have to know? Can you tell some but not others? What impact will telling them have? It was only after 3 months into treatment that I could form the question, what impact does my not telling them have?

Prior to and during the surgical phase, only one patient knew of my medical situation. This is a patient I saw 3 times a week for complex trauma. Our work hinged on our connection with my being in Self and offering my Self’s strength to hold her as she goes down pathways of her life that she kept closed off for 40 years. There was a bond between us which I felt I would be breaking by withholding the truth, which may be tantamount to lying. However, there was the overwhelming concern of burdening her and interfering with her process on her journey to wellness.

While I feel connected to most of my patients, for those that I see once a week for issues pertaining to loss of a parent, fear of dying and loss of a parent due to cancer, I couldn’t see how telling them would be beneficial. Perhaps I felt that with patients I see more frequently, there would be adequate time to work through all the issues. With the others who have so much to deal with in just one session a week, I was worried that my disclosure would not get adequately processed. Their needs are first and foremost. Besides, if RBG could do this with no one knowing, why couldn’t I?

Then it was on to Round 2 in the fight – chemotherapy, which made Round 1 look easy. Forget about the post-operative pain, the drains, the fatigue, chemotherapy was going to rock my world and change me in ways I never saw coming. It wasn’t as though I was ignorant of what chemotherapy can do in terms of healing while inflicting suffering. I had some friends that had gone through it and knew of a few others’ experiences. I always heard, and was warned by my initial oncologist, Dr. L, that the third day after the treatment, you could feel fatigued. He said you take it easy for the days following and then you should be fine. He said that if you have your treatment towards the end of the week, you should be back in your office by Monday – doable. So I scheduled my chemotherapy treatments such that I could reschedule my Fridays earlier in the week as it’s a light patient load and be back for my heaviest therapy day, Monday.

What was left unsaid was that the fatigue was unlike one ever felt before; a fatigue that sleep does not abate. That “taking it easy” was more about not having the strength to walk, not deciding that walking might be too strenuous. Left out of the description of what to expect was more fully fleshed out by my treating oncologist, Dr. G, who said that it would be expected to need at least 6 days post-treatment until one was more or less upright. This explanation was proffered after my first two chemo rounds. It never occurred to me that on the Monday following a treatment on the previous Wednesday, I’d have to cancel my patients because I clearly was not up to the task of even getting out of my home. When I cancelled my Monday patients, calling to tell them that I wasn’t feeling well, they were all kind and understanding. I felt like I had let them down by not being able to see them and by withholding the truth, which polarized parts thought of as being either protective or lying.

Then came the “hair” thing. Dr. L did me a tremendous favour by telling me that on the 14th day after the first treatment, you will lose your hair. His doing that gave me sufficient time to order a cranial prosthetic, otherwise known as a wig. I believed that if I got a wig that looked the same as the way I wear my hair, no one would be the wiser. I don’t remember ever seeing RBG in a wig or bald, so the right wig would work. Honestly, the anticipation of losing my hair was far worse than when it actually happened. On the 14th day, as per the 11th commandment, my hair fell out. Thankfully my wig was ready, however, it wasn’t styled quite the way I wear my hair. In fact, it looked like a wig an Orthodox woman might wear that did not reflect me.

My first place of business that day was a peer supervision group. The reveal did not go well. No one said anything. The silence was so loud. It wasn’t until the end of the 90 minutes that I could bring the wig into discussion. It appeared as if everyone was trying to make sure that I was okay without asking. It was uncomfortable for me as well as for them. That afternoon I met with my patient that knew of my treatment. She didn’t say anything. I didn’t say anything. We were in disconnect. The following week, after a wig magician transformed the wig into a style far more alive and similar to my appearance, my patient and I were able to discuss my hair loss and its ramifications to some degree. Despite my letting the patient know that she was free to ask any questions at any time, she needed me to bring up the topic. She was afraid that discussing my hair loss would hurt me. In retrospect, I’ve come to realize that I was so disappointed, not by the hair loss, but by the wig initially failing to camouflage the damage, I couldn’t discuss it in those two earlier sessions.

In the months approaching my treatment, I fancied myself that I might buy a few inexpensive wigs, of different colour and style, to wear when I’m out and about not being a therapist. I figured that if I’m going to be bald, I might as well have some fun with it. I knew before becoming a wig wearer, that the wigs were not me and therefore would have names. So I bought a fun curly style I named Grace, as it’s quite reminiscent of Debra Messing’s hairstyle. The work wig was Rosie the Riveter. It was quite clear to me when I put either wig on it’s not me. Even Rosie, the one to look like me, was at best a replication. So who was I? I was Joyce, who presently was bald and preferred wearing caps and scarves rather than either wig. In the first month or so of wearing my wigs, I realized that the wearing of wigs is to minimize the discomfort of others. Caps were more comforting to me.

I brought this line of questioning to my mentor, Dr. M, who provides consultation on several of my cases. Who am I when I am in the Rosie wig? What would it mean to wear the Grace wig to session? What would it mean to simply wear a comfortable cap or scarf? He wisely asked me where is my Self in the session. Does the disguise of the wig get in the way of my Self?

Coincidentally, (although many in our field believe there’s no such thing as coincidence) the evening after my consultation session, I watched the CNN documentary Love, Gilda. Throughout Gilda Radner’s adult life, she kept wondering whether she was herself or playing a character. I think she was perpetually searching for Self. She also pondered when she was in Self for herself and/or how it reflected to her public. Frequently when amongst others, Gilda would wonder if she’s a character to them, to herself or was she ever the True Gilda, perhaps for both herself and her observers. When Gilda lost her hair due to chemotherapy treatments for ovarian cancer, she decided to never wear wigs, as wigs were creating a character and were not she. After watching this moving documentary, I sent this email to Dr. M:

… I think I intuitively had the same thinking as she (Gilda) in that I named my wigs. They are not me. I’m more me in the hats/caps because the true me is now, temporarily, bald. The wigs feel fake and yet I feel that I need to protect my patients from being scared with the truth. Or am I protecting myself? And do patients have the right to all the truth?

These questions don’t have quick easy answers. Who was I protecting? My manager parts are consumed with protecting my patients, making sure that my patients are the pure focus of the session. Yet there are two people in the room and one is undergoing treatment for cancer. And where I believed that some of my patients wouldn’t notice if I came in with a pumpkin on my head, is that a lack of acknowledgement of what I was undergoing, or an indicant of a lack of connection? And on whose part? Theirs? Mine? Both? I think these manager parts may have deluded me to think that it is Self that is determining to keep this truth from my patients. My manager, the therapist police part, continually states: Remember the session is about the patient. Their needs supersede yours. If I tell them, does my issue get in the way of theirs?

In the discussion with Dr. M, I contemplated what would it be like to come into session with the Grace wig; not the other wig that I’m desperately wanting to look like the old me of several months ago and cannot. Nothing could make me look like that as my previously familiar look has changed. That question probably came from a part that was looking to have some fun again. But is the consultation room the place for me to have fun? Yes, when it comes to doing the work with my patients, being in Self and helping them get to where they’re going. But it’s not to be fun solely for my enjoyment. The question could also have come from another part that hurts and mourns for the way I used to look. I say this with other parts knowing that the old Joyce will come back as Joyce 2.0; similar enough but with growth and patina. Meanwhile, there was some homesickness for the person who used to look like me.

And then there’s the question of how much are our patients supposed to know about us. Are they entitled to the whole truth? Some of the truth to some of the patients? I believe that there is merit in knowing that all things do not hold for all people and clinical judgment as to what works for individual patients is paramount. This where the importance of being in consultation cannot be underscored enough.

So, back to would I wear Grace to work. After a lot of contemplation, I came to a place to rest. I was open to additional thinking and discussion amongst my peers to see if I would or should shift off of this spot. First I thought about whether or not I’m in the character of “therapist” when I am working or am I truly all that I am. Well, all my parts come with me wherever I go, but that does not mean that they are on display. For example, I am a dancer but that does not mean that I dance in front of my patients. The dancer part of me is there in tune with how my body reacts and moves based upon what it transpiring in the moment in session.

I dress for work in a certain way that I could wear just about anywhere, but what I can wear just about anywhere doesn’t mean I would dress that way for work. For example, for work, I draw the line at leggings with sweatshirts and miniskirts. I love wearing them but these outfits are clearly not appropriate for conducting therapy. Conducting therapy is not the place to be dressing for fun. I dress in a way that reflects and respects the importance of the work. So why would I wear Grace to work? It would be no different than wearing a miniskirt. A great piece of costume but in the wrong place, and yes, it would be a costume.

So what about the idea of wearing caps or scarves? It would be the truer me, the one who is temporarily bald. It would be more honest. The wig is a disguise. Is not wearing the wig an honesty to be foisted upon my patients? Is it an honesty to be foisted upon me? I knew the truth. I accepted it. The question then became could I be so bold as to bring it into the consultation room. Does it need to be there in such pure form? When I went out to run errands or meet with friends and family, more times than not I was in a cap. So why was this different than when I’m with patients? Aren’t our relationships with our loved ones and friends supposed to be different than the relationships we forge with our patients? Perhaps it is with more formality that we meet with our patients. Perhaps that formality requires a disguise, or a prosthetic, such as a wig. Perhaps we need to portray ourselves as complete, whether or not we truly are. But then, who is ever truly complete? Maybe we need to show our humanity with our flaws, with what is now missing.

There was room for a Goldilocks solution. While in deep contemplation about my wig wearing in the office, I found myself looking up wig salons and then sitting down in a stylist chair trying on wigs. Initially, I went in attempting to find another fun one, although quite frankly, fun had been a bit elusive in that time period. As the trying on proceeded, I realized I wasn’t looking for an escape wig; I was looking for a wig that reflected where I was then, not a wig that was to replicate the old me or to turn me into fantasy fun me. I was drawn to a wig, with colouring similar to my perhaps not original colour, which was cut short and stylish. I felt relieved and somewhat rejuvenated. I could breathe. I pictured wearing this wig in the office and when out and about. This was a more accurate reflection of who I became. It may also be a transition wig because in time my hair will be growing back. It was quite short with very different colour than on that fateful day and that took some adjusting. Even then, for those patients I haven’t told, they will know that something has changed and transformed me.

A year before I started on my cancer journey, I made a radical change in my appearance. I cut 4 inches off my hair, making it chin length. It was a major change for me. I did not stop to consider if the change would have an impact on my patients other than who would notice and who would comment. I just knew that I wanted a change for myself. I then asked myself, would the third wig be any different than if I went to the salon and said that I wanted a makeover.

Through my own anecdotal research in my office and conferring with hairstylists, I came to realize that women often make dramatic hairstyle changes when their lives have changed dramatically. They want their exterior to reflect their interior or life changes. Maybe this was what my third wig was about. It was about recognizing that I underwent a radical change, even if I desperately didn’t want to do so and didn’t want others to know. Maybe that’s why I never considered naming the new wig.

As I thought about wearing the newest wig to work, I had parts polarized by this dilemma. One part said that it’s no different than having had a makeover and we’ll see if they notice. This part sensed a lively energy; an ability to breathe deeply and fully. It also recognized that it could be a catalyst for bringing the discussion of my treatment into the room. The other side of this argument said that it’s a prop. If you really wanted to talk about it, you’d bring it up as the adult therapist that you are. A young part asked, “Do I have to?”

How optimistic was I to think that I could get through treatment so unscathed that no one could notice! Perhaps that optimism was driven by parts that also wanted to believe that I wouldn’t notice it myself. So much has changed, yet at the core, not so much. To Dr. M’s question: Is my Self accessible during the sessions since starting treatment, the answer was yes. My work deepened as I more fully understood when pain and/or fear to move forward is paralyzing. I could share that understanding, whether or not I’ve disclosed to them my cancer treatment. I dared my patient who frequently looks to wave the white flag, after experiencing my own sense of waving my white flag with 75% of the treatment completed, that we together could find the strength to help each other move forward on our arduous paths. I learned that I can endure the physical changes, discomfort and pain that were thrust upon me. This gave me the surety that my patients can also endure what has come before them. We all can thrive in wellness after walking through the storms.

Joyce Bloom, Ph.D. earned her doctorate at Hofstra University and postdoctoral degree at Adelphi University Derner Institute. She currently is training in Internal Family Systems through the Center of Self Leadership. Dr. Bloom is a clinical psychologist practicing in Manhattan and Roslyn Heights, NY.

Joyce is a married mother of three children and grandmother to four. She is a two time breast cancer survivor. She pursues her life long interest in dance by performing and choreographing for a senior tap dance troupe called The Red Hot Mamas.