Emily is a 52-year-old divorced Caucasian woman of working-class origins who was self-referred to the radiation therapy social worker for assistance with health insurance coverage concerns and assessment of need for supportive counseling regarding coping with treatment.
A major stressor for this patient and family was the ending of a 27-year marriage in what was described as a “messy divorce.” Emily’s coping skills were impressive. She continued to work part-time at her job in a community church. She maintained a positive working relationship with her ex-husband. She welcomed her grown children and grandchildren who “boomeranged” back all the while going through her own health crisis of coping with stage I breast cancer.
Initially our work focused on concrete services and needs. We acknowledged that she had many concerns with medical bills and her financial situation, and early on we determined what resources would be appropriate. These sessions then led to further discussion about finances, which revealed the fact that she has been financially supporting her grown children. With my assistance, she applied for financial support from cancer support organizations and then discussed negotiation strategies with the hospital billing office.
Subsequent sessions became more goal-oriented, especially with regard to the management of the home situation and family dynamics. She spent time with other adults honoring her needs for support and relaxation. When treatment side effects became an issue, I referred her to the Yale Cancer Center’s Complementary Medicine Program. She followed up on the suggestion of attending my Patient & Family Support Group. Additionally, I referred the young at-risk family to a local Nurturing Program. Emily continued to take steps to nurture herself as well by attending the American Cancer Society’s Look Good, Feel Better I co-facilitate, and gradually began to seek out more opportunities to spend time with peers.
Resilience was also a theme in much of the sessions which were brief, goal-directed and parallel to the medical treatment. Working within a host setting as a medical social worker/case manager gave me access to this client who otherwise might not have entered counseling. Each session was an opportunity to apply a compelling new theoretical model, Strength-focused and Meaning-oriented Approach to Resilience & Transformation (SMART). The goal is to improve client resilience and promote transformation in the face of extreme adversity through construction of meaning. Emily continues to move towards meaning-making with regard to her experience as a breast cancer survivor.
Toward the end of the first-year anniversary of breast cancer diagnosis, Emily started a new intimate relationship, continues to set more limits with her grown children and found low-cost counseling and family support with a pastoral counselor. During follow-up with her oncologist, a successful post treatment mammogram revealed no evidence of pathology. Emily had taken steps to care for herself and her family and also negotiated a major life crisis, becoming strong in the broken places.
