‘The work concentrates on essentials: the things that really matter to people’

Anna is the lead psychologist for the clinical health psychology service and cancer psychology team at Great Western Hospital, Swindon, where she has worked for 15 years. She talks passionately about how challenging, yet fulfilling and rewarding, it is to work with people with cancer. Anna feels more psychologists should consider it as a field of practice.

'I was interested in working with either older adults or in the field of psycho-oncology when I qualified. One reason is that the work concentrates on essentials: the things that really matter to people, their meaning and purpose. The conversations you have make real connections with other people. You often work with clients who have good inner resources, who were living good lives before the diagnosis; suddenly, they face a completely different reality and discover their usual coping strategies might not work. But you can often make a big difference with those people in a relatively short time.'

Anna estimates that around a quarter of the clients she works with have incurable cancers, but the others have different prognoses. 'And fear of recurrence is a major worry for people.' She is hugely influenced by the work of Irvin Yalom, the existentialist psychotherapist who is an emeritus professor at Stanford University. 'The themes he identified appear in therapy with cancer patients frequently. These include death anxiety; isolation; existential freedom and meaning/meaninglessness.

There can be a big self-pressure on people who go through this experience to live life as meaningfully as possible after the cancer. Bucket lists and big adventures are often talked about in the media, but life really exists in the smaller, everyday things, like connection with ourselves and those who are important to us.'

Anna notes that experiences of cancer can change the way people want to live. 'One frequent example is women with young families who may have been putting their own needs aside for quite some time. Cancer can make them realise that they want to create a little more time for themselves, and their own needs. The therapeutic discussions can be about how to achieve this.'

Anna says that this area of work can also make healthcare professionals think deeply about fundamental issues. 'One of its rewards is that it makes you think about what really matters in life and what changes to make, accordingly. It is also work that adds personal meaning in the form of supporting people at difficult times. But it can be challenging as well.

I have found my colleagues in cancer services to be very compassionate people who really care about the people they support. This can involve feelings of sadness at times. We can also end up being perhaps over-aware of our own health and mortality.'

The importance of seeing the whole person

Anna's interest in psychology may have been influenced by the different cultures she experienced when growing up. 'I was born in Sweden, moved to Cyprus when I was eight, and to the UK when I was 19. I had long blonde hair when I was younger and looked very Scandinavian, so I stood out in Cyprus, where the culture was also very different from what I had been used to in Sweden. My early experience of being different from those around me probably led to my interest in psychology and has been helpful in my work with people who may come from different walks of life to mine.

'I did some of my A-levels in Cyprus and thought about psychology when a teacher leant me a textbook. I went back to Sweden for half a year and did psychology as an additional A-level before starting a BSc in Psychology in the UK. I suppose I wanted to try to understand those diverse cultures I'd lived in. A lot of the existential work that I'm interested in also seems popular in Sweden.'

Then, just after her last undergraduate year, Anna's mother died of bowel cancer. 'I took a year out and stayed in Cyprus for six months with my siblings. When I came back to the UK, I got a job as a support worker with adults with autism and I continued doing this while taking a Masters in Neuropsychology. I then had an assistant psychologist post working with adults with dementia, before being offered a place on the Bristol Clinical Psychology doctorate. In my first year of training I read Love's Executioner by Irvin Yalom, whose thinking had such an influence on me. The Bristol course was evidence-based in its approach but also encouraged creativity – in particular not to fit the person to the model but to see the complete person. We had speakers who talked about creative writing.'

This experience has influenced another element of Anna's work: her teaching and supervision activities. 'A few years ago, I set up a clinical psychology undergraduate and MSc module on clinical psychology. My own experience had been that clinical psychology can feel like a bit of a secret club, so I wanted to demystify it and make it more accessible. I also teach clinical psychology trainees regularly about working in palliative care. They often reflect positively on how the clinical work seems so different from other areas they have come across.'

Cancer and palliative care services are, according to Anna, 'very holistic in their approach. Working as a psychologist within a physical healthcare team, you are an expert in your area; your views are welcomed and valued.' But, while immensely enthusiastic about her work in the NHS, she identifies very real challenges.

'You're working in a system designed to address physical health and physical health issues are given priority when funding decisions are made. There's a move to map NHS psycho-oncology services in England and we've just carried out that exercise. It's shown that we need more than twice as many psychologists as we have at the moment, but we often get told there's no funding for that increase. We're still seen as something of a luxury: needed but not of top importance, even though the link between physical and mental health is well-established.'

'There can be a push within NHS services for clinical psychologists to see as many clients as possible but this is not healthy for the individual psychologist, neither does it consider our extensive training in consultancy, teaching, research, service development and leadership, and the wider impact that we can have as a profession. I am lucky to work within an NHS service that sees the true value of this skill mixture.

In our team, we do a lot of teaching and supervision to other healthcare professionals around the identification and addressing of psychological distress. This keeps us connected to our colleagues and also ensures that there is high-quality provision of psychological support at all levels within cancer services.

'We also work very creatively, continuously thinking about ways in which to develop our service and respond to client feedback. By doing research in collaboration with local universities, we are able to produce good evidence around the impact of our work and better understand the needs of our clients. Furthermore, by working on a more strategic level and linking in with our cancer alliance, local commissioners, NHS England and national psycho-oncology groups and networks such as the BPS Faculty for Oncology and Palliative Care, we can take a much more collaborative and far-reaching approach to increasing understanding of the psychological needs of people with cancer and improving provision.'

Inner Space

In addition to her NHS work, and the teaching and training she has mentioned, Anna also has a private practice – Inner Space. The two areas of practice go together. 'Private practice allows me to complement my NHS work. My present NHS role involves me in strategic thinking, developing teams, quality assurance. I therefore have less time for clinical work now. In my private practice I see a lot of people with cancer but I also work with clients experiencing a wide range of other challenges: from depression and anxiety to bereavement and relationship issues. That strengthens my therapeutic skills, widens my experience from cancer and physical health-related psychology, and returns me to the main motivation I had in training as a clinical psychologist: working therapeutically with clients. So my private work helps me in my NHS activities by keeping me grounded in therapeutic work.'

Finally, Anna is on the committee of the British Psychological Society's Division of Clinical Psychology Faculty of Oncology and Palliative Care. She says: 'It has a big job in representing the important role that psychologists can play in these areas. It's a huge honour and responsibility to be involved in the field of cancer care and I hope more psychologists will consider it.'