’Why Mutilate Me Before I Die’: An Emotion-Focused Conceptualization of Breast Cancer Clients’ Experiences of Anxiety and Depression

ABSTRACT

The study set out to study the experienced distress of clients with breast cancer who also meet criteria for comorbid anxiety and depression (CAD) from the perspective of emotion-focused case conceptualization. A theoretically informed qualitative case analysis of 15 recorded psychotherapy sessions across three women was conducted using an emotion-focused case conceptualization as domains of inquiry and an interpretative framework. Experiences of mastectomy-related shame appeared to be maintained by cancer side effects, whereas social identities relating to gender and class triggered self-blame for cancer and shame at not functioning as well as expected. Existential fear, worry, and hypervigilance were indicative of cancer as an ongoing trauma. Unmet needs for safety were related to unclear communication with the medical team during treatment, while triggers relating to childhood adversity and insecure attachments perpetuated present-day distress. The findings suggest that emotion-focused treatments in psycho-oncology include a trauma-informed lens that allows for greater processing and integration of past trauma. Future research should explore breast cancer distress in women across different social identities for a broader and more inclusive understanding of distress presentations.

KEYWORDS:

• Emotion-focused therapy
• breast cancer
• comorbid anxiety and depression
• case study

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Sonia Pillai

Dr. Sonia Pillai is a counselling psychologist interested in exploring the intersection of mental health and social justice, and conducting research for advocacy. Her clinical work and interests include complex trauma, psycho-oncology, grief, and marginalized populations. She completed her doctoral training in Trinity College Dublin and currently works in a child and adolescent mental health service in Ireland.

Allison Connolly

Dr. Allison Connolly has worked as a counselling psychologist in public healthcare settings as well as in private practice. She has lectured at the postgraduate level, supervised research, presented research internationally and produced a number of publications, primarily focused on psychotherapy research. Dr. Connolly's educational work includes providing supervision to doctoral level psychologists and teaching psychological skills to healthcare professionals.

Natalie Hession

Dr. Natalie Hession is Principal Psychology Manager/Head of Psycho-oncology Services in Psycho-Oncology Services at St. Luke’s Radiation Oncology Network (SLRON). She has worked as a counselling psychologist, educator and researcher in the area of cancer care and chronic illness for 17 years. Dr. Hession has a track record for being committed to the development of psycho-oncology in Ireland and has contributed by way of policy development and as well as publishing widely in the field.

Ladislav Timulak

Ladislav Timulak, PhD is Professor in Counselling Psychology at Trinity College Dublin, Ireland. Ladislav (“Laco”—read “Latso”) is involved in psychotherapy research, particularly the development of emotion-focused therapy (EFT). He currently is adapting this form of therapy as a transdiagnostic treatment for depression, anxiety, and related disorders. He has written or co-written ten books and more than 100 peer reviewed papers and chapters. He maintains a part-time private practice.