Therapist

A caregiver can provide research, present options and assist the patient in getting what the patient thinks will get them well. One option could be presented to the patient is to see a therapist. After that it's up to the patient to the side on the course of their treatment.

I know it's difficult for caregivers to watch the patient take what the caregiver believes is the wrong course of treatment, or not rest enough, or eat the "wrong" food.
Respect that the patient is in control of their life and ask what you can do to be helpful. Faina. Both therapy and coaching are client-centered which means it must be the choice of the cancer patient to seek therapy or coaching. As a caregiver, loved one or friend of someone with cancer if you notice they are struggling with issues, if you are involved with the medical team and aren't comfortable bringing up the subject yourself, you could privately speak to someone on the team (clinical director, oncology nurse or oncologist).

Let them know you feel your loved one may benefit from having a coach or therapist to speak to and why - what you've noticed may be coming up for that person where they need extra support. The medical team can then assess and possibly offer referrals or recommendations.

I often had sidebar conversations with my late husband's team however I was empowered by him to do so when we created our plan of how we would work together on his healing journey. If you don't have this kind of role defined first, the cancer patient can feel betrayed so be clear that this is part of your role in the process.

(The caveat to all of this is that if you ever feel like the cancer patient is so impacted emotionally, depressed or distraught that they may harm themselves you need to communicate this right away to a medical professional.)

If you want to have the conversation yourself, let them know that you have some concerns and you want their permission to have a conversation about whether they may need some extra support. We can't assume we know what is going on for the other person but you can check in with them. Something as simple as "I just want to check in to see how you're doing with everything that has been going on since you started treatment?" shows caring and concern on your part. Often people will say fine to avoid bringing others down so following up with something like, "what are your two biggest challenges right now?" can be a door opener. If they walk through the door, then you can share if therapy or coaching has helped you or someone you know and how it can help (you need to do your research first and have some resources ready to offer up - or offer to help them find information they need). "I've talked to some friends who found coaching or therapy to deal with those challenges can be really effective. What would it be like for you to have this kind of support?" If they say, great...you can go from there. If they say no, then ask them what else might help them with their challenges.

Be sure you are doing this at an appropriate time and in a way that keeps it private and confidential, not in front of a group of people. Finally, leave it up to them and if they become defensive at any time, just let them know you brought it up because you care.

Before I started therapy, I had the support of friends and family. They were great, but they couldn't possibly understand what I was going through and it was hard on them individually. As caring professionals, my therapists made clear that they were there solely to support and listen to me. They asked me hard questions, but they always stood close beside me as I worked on the answers. And very importantly, I didn't feel the guilt of burdening them that I felt when I let my family see my distress. It was a safe place to go and completely be who I was at that moment, without any obligation to be anything else for anyone else. For a mother and wife, that was an amazing gift. Before I started therapy, I had the support of friends and family. They were great, but they couldn't possibly understand what I was going through and it was hard on them individually. As caring professionals, my therapists made clear that they were there solely to support and listen to me. They asked me hard questions, but they always stood close beside me as I worked on the answers. And very importantly, I didn't feel the guilt of burdening them that I felt when I let my family see my distress. It was a safe place to go and completely be who I was at that moment, without any obligation to be anything else for anyone else. For a mother and wife, that was an amazing gift.

There are many types of professionals who are specifically trained to help people with depression. Their degrees, training and clinical approach may vary but each is qualified, trained and experienced in treating mental and behavioral health problems. The most common headings of mental health providers are:

Professional Counselor/Mental Health Counselor - Degree: Minimum of Master of Arts or Science in Counseling/Mental Health Counseling. Completes a practicum/internship in Professional Counseling prior to graduation and a supervised clinical experience following graduation. Engages in talk therapy; does not prescribe medication.

Clinical Social Worker - Degree: Minimum of Master of Social Work. Completes a practicum/internship in Cliniical Social Work prior to graduation and a supervised clinical experience following graduation. Engages in talk therapy; does not prescribe medication.

Marriage and Family Therapist - Minimum of a Master of Arts or Science in Family Therapy. Completes a practicum/internship in Marriage and Family Therapy prior to graduation and a supervised clinical experience following graduation. Engages in talk therapy; does not prescribe medication. Focus is often on couples and family counseling.

Psychiatric Nurse Practitioner - Requires Nursing License and Minimum of a Masters in Nursing Science (MSN) and completion of specific training in psychiatric nursing. Can provide both talk therapy and prescribe medications under the supervision of a doctor.

Psychologist - Generally reguires a Doctoral Degree (PhD or PsyD) in psychology or clinincal psychology. Completes a practicum/internship in Clinical Psychology prior to graduation and a supervised clinical residency following graduation. Engages in talk therapy; does not prescribe medication. Also directs in depth psychological assessments for such things as cognitive functioning and learning disabilities.

Psychiatrist - Requires graduation from medical school (MD or DO) and a medical residency in Psychiatric Medicine. Can engage in talk therapy but the practice is dwindling. Does prescribe medication.

How you decide which professional is appropriate for you may rest on the level of severity of your distress, cost of treatemnt, insurance benefits and restrictions, availability of local professionals and the need for pharmological treatment.

Each of these providers has professional organizations and state licensing boards whose job it is to keep the consumer safe and regulate the provision of services. If you need help making a choice, try talking to your physician and ask for a referral. You may also look the websites for your state's boards for professional licensure and uncover information on complaints and outcomes of investigated claims against a provider.

Take the time to research your choice well before you commit to treatment and don't be afraid to talk to family, friends or even your clergy. You may be surprised to learn someone else close to you has sought out professional help as well. You can see your family doctor or a clinician who specializes in mental health care—whichever you feel more comfortable with. You can choose to see a clinical social worker, psychologist, or counselor, who can provide talk therapy but not prescribe medication, or a medical doctor who specializes in treating mental health conditions, called a psychiatrist. Your regular doctor can rule out physical causes for depression such as thyroid issues and prescribe medication to treat your depression. Your doctor may also refer you to a therapist or psychiatrist. You can also find a therapist and/or a psychiatrist on your own.

For more about depression and its treatment, see our article: http://www.cfah.org/hbns/preparedpatient/Vol3/Prepared-Patient-Vol3-Issue1.cfm