On the Use of Different Disciplines in Cancer Treatment (June 1, 2016)

Elçin Biçer (2006), a graduate of Boğaziçi University’s Psychology Department, is working as a psycho-oncologist.  In an interview conducted for Boğaziçi Magazine, the monthly publication of BU Alumni Association (BUMED), Biçer talked about the types of therapy used in the treatment of cancer, the role of various branches of art in cancer treatment, and how to support the patient and the patient’s family.

Can you first talk about yourself?

I was born in Istanbul in 1982 and graduated from Boğaziçi University’s Psychology Department in 2006. I received my Master’s Degree on Psycho-social Oncology from Istanbul University, Preventive Oncology Department.  I have been working as a psycho-oncologist at Neolife Medical Center since 2010.  During this process, I attended cognitive behavioral therapy courses, received psychoanalysis training from the Istanbul Psychoanalysis Association, dance/movement therapy training from the International Advanced Dance Movement Therapy Institute, and medical hypnosis treatment from the Medical Hypnosis Association approved by the European Society of Hypnosis. I am continuing my self-enrichment, deepening and learning processes in intervention as well as techniques.

Could you explain your area of specialization as a psycho-oncologist?

 A psycho-oncologist is a psychologist with a specialization in cancer.  Individuals who have had cancer experience, their families and their caretakers, and the therapy team are the population I work with.  When cancer is diagnosed, it affects everything in a person’s life, his health, body, looks, relationships, home life, professional life, and financial situation. An immediate and rapid process of change begins.  Treatments take a long time, from 6 months to life.  It is a period of intense reactions for the whole family, a period during which a previous psychiatric condition, if there were any, could flare up.  In addition to the necessary psychiatric and psychological help, we provide support for the psychosocial aspect of the treatment.  In other words, even though the patient’s psychiatric state is not at a level to require treatment, during this difficult and devastating period, he can get professional help to cope with and adapt to the emotional, mental, social and intellectual aspects of cancer.  Our fundamental objective is to enable the patient to cope with the illness, adapt to the treatment, and live through this process in the mentally most comfortable and assuring way possible.

However, humans are thinking, feeling beings.  When cancer hits on top of all the positive and negative events that already exist in the patient’s life, he has the opportunity to review his whole life, his habits, the relationships he has with his self and others, his attitudes, the meaning of life, and the reality of death.  Therefore, we prefer to consider cancer as an illness in which the rate of cure has improved, the quality and length of life has been improved with the developments in diagnosis and treatment; it represents an opportunity for transformation. We continue the therapies that we start at the onset of the illness and continue through to the end of the illness.  At that point, we work on the person who has undergone through change since the time of initial diagnosis, a person who has developed so many new concepts and viewpoints that we call refer to “the new me”, as well as address adaptation and anxiety about the recurrence of the illness.

Oncology professionals are at high risk for “burnout syndrome.” We also offer individual support to the members of treatment teams dealing with this illness, which reminds them of death all the time, and periodically conduct need-based motivation and coping training and workshops.

We also participate in public seminars and panels to raise awareness about the perception of cancer and preventive checkups.

Can you tell us about the context of your work so far?  What is the place of this work in Turkey?

The work that we have been doing on raising interest in and awareness of the topic has sort of been the “first” of its kind in Turkey; we are pioneering researchers.

The first thing we did was to establish a system that would make psychology a part of oncologic treatment.  In addition to measuring the fever, or blood pressure of each patient who comes into our Center, we also conduct a mini test of the patient’s psychological state, which we refer to as the 6th vital sign.  We invite the patients that we believe need support to speak with them both individually and in the presence of their family, and determine their needs: it is a kind of counseling service free of charge.  I can say we are the only health center in Turkey that has incorporated this service into the health system.  Our capacity to provide service at world standards has been accredited by the International Psycho-Oncology Society.

Other than individual counseling and therapy, we conduct all other work free of charge, in the context of social responsibility.  Among them are the psycho-training sessions for patients and their families, which we offer once a month for a year.  For example, we have held training programs on how to answer questions like “How must I treat the patient?” “How much and how do I tell the patient about his illness?”

For a duration of three years we applied 12-16 sessions of drama therapy to three groups.  After the therapy sessions ended, each group performed a theater play for the public after a 2-3 month preparation period.  Not only patients and their families, but doctors, nurses and other health professional from our treatment team participated in the play.  Participating patients exchanged an experience of cancer that they would not want to remember with an experience in acting and lots of good memories.  The fact that life goes on despite everything, the increase in the patients’ will to live, the support and courage that came with being part of a group also displayed some positive choices for “life despite cancer” to other patients.

As of this year, we have started using dance movement therapy.  I must talk about our Enhancing Connections project.  We meet a lot of patients with growing children. You can imagine that the most difficult thing for these patients is their children. Many questions come up.  For example, how are they going to answer their children’s questions about cancer?  How much should they tell them of the side effects of the treatment, such as hair loss, extreme tiredness, and pain? How proper is it for the child to witness the parent experiencing intense emotional highs?  Or how should parents intervene in the emotional reactions children may display in the face of the parent’s cancer, or the neglected parental functions?

Prof. Fran Lewis and Research Associate Ellen Zahlis of Washington University have created a program called Enhancing Connections, which is the result of their 30 years of study on the issue and over 700 pieces of research.  We have turned this program into a social responsibility project and are using it in Turkey. BUMED hosted a three-day training program by the creators of the Enhancing Connections program to ten volunteering psychologists. We started our pilot work in Istanbul, Adana, and Eskişehir in cooperation with the mayors of these municipalities. We offer this program to everyone that reaches us, free of charge, in those venues.  It is a communications training program that consists of five sessions, and teaches mothers and fathers individually how to communicate with their children during this process.  The program has been implemented and tested in five states in the United States and has been shown to result in a decrease in the feelings of depression and anxiety in both parents and children, long-term strengthening in family ties, and long-term improvement in parental roles.

How do you benefit from art forms like music or drama?  What is the role of such activities in the treatment of cancer?

A person undergoing cancer treatment thinks about cancer every time he or she looks in the mirror.  They spend time in hospitals and treatment centers nearly every day.  Therefore, for the most part, they need to have some cancer-free moments.  This situation also can cause resistance to classical psychotherapy.  Coming in and talking about the illness…

When we look at cancer as a sudden, devastating experience, we can define the moment of being diagnosed with cancer as a traumatic experience.  In such traumatic situations, art therapy is used rather than verbal procedures that will remind the person of the trauma.  Music, painting, art, and drama offer a safe and pleasurable way to relieve the emotional burden.

Currently, we are using dance/movement therapy; it is a program we have enriched with the inclusion of the tools of art therapy such as clay, paints, and simple musical instruments.

Every change in the body affects the mental state and every change in the mental state has an impact on the body.  Like the unconscious, the body also loses a lot from the womb to the present.  In the first few months of our existence we discover the outside world through our bodies.  The first time the mother holds her baby, the baby’s first fight against gravity, crawling, the first steps, the first falls… They constitute the repertoire of relationships and movements that we form with life and the outside world through our bodies.  We can say that in dance/movement therapy, we follow a path of treating what comes from the body with the body.  Recently, awareness of the body has been increasing in psychotherapy.  It is about bodily factors and considering the person’s body and mind as a whole.  I recommend dance /movement therapy not only at times of illness, but to everyone interested in self-discovery or self-transformation.

What do you recommend to cancer patients?

I recommend that patients’ families frequently ask themselves, “What does my patient need?”  rather than guessing what the patient might need. Rather than trying to be cheerful, amusing, and funny all the time, they can go along with the patient’s emotional state.  Thus, the patient finds environment suitable to voice his emotions.  Instead of trying to answer questions that have no answer, instead of feeling obliged to say the same things over and over, it is better to be a good listener; this better meets the patient’s needs.

Research indicates that intense emotions, if unexpressed, pave the way for such illnesses.  Maybe it is for that reason that we tell the patient, “put yourself first.”  I can tell you what patients can do, at last during the therapy period: everyday they can do something good for themselves. They can allow themselves the freedom to share their emotions with a person they feel comfortable with when emotions run high; they can address their questions to their doctor, if the therapy is directed by a doctor they trust, instead of surfing the Internet (where there is too much information pollution and confusion); they can benefit from all available resources throughout the therapy (a person or cooperation); and they can ask for psychological help before a major breakdown hits.

Interview:  Şenay Çınar, Office of Corporate Communications