Frances Goodhart

I’m really excited today because I get to talk to my new friend, Frances Goodhart who wrote this great book called “The cancer Survivor’s Companion: Practical ways to cope with feelings after cancer”.  Frances is a clinical psychologist and it’s a real privilege to hear from her because she genuinely cares about people like you and me who go through these tough times.  Today, Frances shares some fantastic insights and practical tools to tackle cancer that you can start applying right away:

  • Why it’s hard to bounce back after cancer
  • How to manage anxiety and conflicting emotions
  • Finding emotional backup when the going gets rough
  • On dealing with anger
  • How to get relationship issues out of the way
  • The importance of exercise after treatment
  • How to manage your energy better
  • Step by step relaxation technique you can apply anywhere
  • Using visualisation to help you relax
  • How to break the vicious cycle around lack of sleep
  • Finding way back to sex and intimacy
  • and much, much more!


About Dr Frances Goodhart

The Cancer Survivor’s Companion: Practical ways to cope with your feelings after cancer

Full Transcript

Joe:                 Frances, first of all, what made you write a book on cancer?

Frances:           I was working in a cancer psychological support service.  I was seeing a large number of people post-cancer treatment.  They were coming in for appointments.  They came in just incredibly apologetic.  It’s as if they felt embarrassed, guilty even about using up psychological resources for particularly at the end of treatment.  I would spend a lot of certainly the first session, and often many sessions, trying to reassure people that it was very natural, very appropriate for them to be coming to a psychological support service.

What I wanted to do was to be able to add to my own voice by directing people to information that would illustrate that, that would reassure them that post-cancer treatment was valuable and important to address psychological issues.  I couldn’t find a book anywhere because I was particularly looking for a book because I feel that seeing things printed out on paper that have been published just adds a weight to that information.  I couldn’t find a book anywhere, so in the end I thought, it’s not there, there’s a gap in the market and I better fill it.  That’s how I came about the idea of writing.

Joe:                 That’s fantastic.  I think I found the same.  I found that there’s really not that much out there at all, in terms of real practical advice.  One thing I want to come back to, Frances, one thing you said that really surprised me is that you said that the people you actually spoke to, that the people felt guilty about coming to you and asking for help.  What’s with that?

Frances:           Well, it may be something about being British.  I think as a nation there’s somehow an element of stiff upper lip.  I think there’s still an element of just keep pushing on through.  I think it’s changing hugely now, but this was ten/fifteen years ago, and I think there was still a stigma actually about seeking psychological input, seeking emotional support.  I think that people were bringing that, in a sense, in the consulting room with me.

Joe:                 Yes, absolutely.  I think there is definitely that.  I think people feel guilty in a way.  I think I certainly did at one point because you feel that you’re supposed to deal with it on your own.  If you don’t, it’s somehow like a weakness.  Does that make sense?

Frances:           It makes total sense.  Again, I think this is changing now, but ten years ago, I don’t think all of the medical teams were perhaps as aware of the psychological impact of the cancer diagnosis and treatment and weren’t exploring with their patients how they were coping emotionally.  I think if you’re going to a cancer service and you’re being told you need chemo, you need radiotherapy, surgery, whatever it might be, I think the teams were addressing psychological issues, weren’t signposting people onto psychological support services.

I think that was a real problem because if your medical team are talking to you from the start about both the physical and the psychological consequences of diagnosis and treatment, then it’s just a natural part of the process.  If you are having to bring up the fact that you’re struggling or anxious or finding the whole process difficult emotionally as well as physically, that’s a tough ask, really, I think.  I’m really pleased that within the NHS in Britain, we’re now routinely screening for and thinking much more holistically about cancer support.

Joe:                 That’s fantastic, Frances.  One thing I want to touch on is, you mentioned that when it comes to writing the book, you felt that there was definitely a gap, in terms of the approach to the book and how you were thinking about it, did you find certain patterns that came up when you were talking to people?  Certain themes that would come up over and over again, that maybe made you think, “I need to write this down”?

Frances:           Absolutely.  In a sense, I think the chapters in the book that I cover, in a sense, illustrate most of those areas.  The overarching issue, I think, for people was anxiety, was fear of recurrence.  There was a lot beyond that, as well.  I think that cancer diagnosis and treatment and then coming through the other side, it just inevitably makes the people who were coming to see me, I recognized that was a self-selecting group, and other people may be able to just put treatment behind them.  The people that I was seeing were acknowledging impact on mood.

I think particularly at the end of treatment, there are huge expectations that you’re going to feel elated, excited that you’re going to get back to normal very quickly.  Actually, in my experience, that’s not what happens to people.  Then I think, again, that array of distress, guilt, shame, low mood, sometimes a clinical level of depression, impact on relationships, sex life, of course.  That was something that, again, being British, we’re not always comfortable in talking about.  Actually, it’s really key to look at and to acknowledge and to talk about.  I think that people’s self-image is often really profoundly altered by a cancer diagnosis and treatment.

Then the interface between psychological and physical, I think people were often bringing issues around sleep, around fatigue, around some of the consequences of chemo brain and memory issues.  I suppose those were probably the key themes that struck me.

Joe:                 That makes so much sense, Frances.  One of the things I really love about your book is that it’s so practical, it’s so heads on, it’s got so many things that you can apply today in real life.  Cancer is such a difficult place to be, right?  You’re constantly in between tests and treatment and visiting specialists.  How do you deal with worries, with stress, with anxiety?

Frances:           Thank you, Joe.  Thank you for your comment about my book, but also for picking up the fact that it’s a practical book, because that was so important to me, to create this companion in a sense, that people can carry with them, can dip in and out of, and pick out practical techniques.  In terms of managing worry and anxiety and fears, I think the first thing I would say is you don’t go through cancer or beyond cancer without those emotions.  I just don’t believe anyone is super-human enough to face all of that without some level of anxiety.  I think that sometimes we put pressures on ourselves and we have expectations of ourselves that are super-human, that are beyond what any of us can manage.

Partly, I think in terms of managing anxiety, one of the things is not to build it up into something greater than it is.  You just recognise, okay, today is a worry day, or actually I’m coming up to a check-up moment, my mind is going to be racing, I am going to be anxious.  Not building on that anxiety by feeling that somehow, you’re not coping, you’re not managing.  That’s the first thing.  I think just being able to acknowledge and at some level accept, okay, this is an anxious day for me today, that’s okay.  It’s not going to have any impact on me long-term.  That’s the starting point.  I think that there are also very practical things that one can do to stop those thoughts from dominating.

I don’t think you can stop them from coming into your mind.  I hope that’s one of the themes that comes from my book, this isn’t about making you go through life without emotion, it’s just how do we manage it?  With worries, write them down.  If you put them onto paper, they’re out of your head.  I think our brain is this extraordinary organ that works once we’re anxious.  It seems to want to keep us anxious.  We will mull over, ruminate, repeat anxious thoughts.  Actually, if you can just write them down, that’s a starting point, that can help.  I think the other thing to do, another thing, is to try, I recognise it’s not easy, but try to give yourself a part of the day where you say, “Okay, now it’s my worry time.” You actually allow yourself to look at those thoughts, to let them come into your head, to explore them, to examine them.  You do that for a time limited period of time.

I think sometimes this idea of just don’t think like that, push those thoughts away.  Sometimes when we’re strong, we can do that, but other times we can’t.  I think just saying, “Okay, I’m going to have ten minutes of worry time now and then I’m going to cook the kids supper or watch a TV program or call a friend”, so that it’s time limited.  I think that there are relaxation strategies that one can use.  Again, not to make the thoughts go away but just to help them feel like they’re more controlled.  Then I think the other thing is that worries, and anxieties sometimes need to be explored and verbalised, but also looked into.

If you find a useful source of information, use that, look at that, but be very careful about Dr.  Google.  Sources of information that we don’t know how reputable they are, they can increase anxiety.  Actually, if you want to look at some of your concerns and you have a website or a book that you’ve been recommend or that you just feel instinctively has been helpful, use that.

Joe:                 That’s fantastic, Frances.  I love it and I especially love the tool about worry time.  I haven’t obviously used it just yet, but it intuitively feels just right.

Frances:           Thank you.   I think what intuitively feels uncomfortable to me is this idea that one simply pushes worries, distress away.  I think that can work for a while but actually, long-term, I have a concern that it actually over time allows the distress to build up.  I think that idea of just accepting, yes, I have some worries, let me look at them, but not look at it so that it’s disrupting your whole day.

Joe:                 Absolutely.  You mentioned that it is incredible stressful.  That makes me start to think about the fact that many people don’t get the emotional support that they need from their friends, from their family, from their co-workers, is that something you come across?  If so, what should you do if you feel overwhelmed and when you feel alone?

Frances:           Thank you.  Yes, of course, I come across people who feel incredibly alone.  I remember a very powerful session I had with a man who talked to me, he said, I went into this room full of family and friends, I think it was a party setup to celebrate his successful end of cancer treatment.  He said, “I was surrounded by my closest family and friends and I’ve never felt more alone.” That has stuck with me.  I also think that emotional support is an incredibly difficult thing for family and friends to provide.  I think that a lot of the time, people going through cancer and people after cancer treatment don’t always know for themselves what would be helpful.  One hour talking would be helpful.

The last thing someone wants to do is to talk.  I do want to acknowledge that I think it’s a minefield.  Support from family and friends is really difficult to provide at times.  Of course, there are amazing intuitive, supportive family and friends who get it right, but I think a lot of the time, people get it wrong.  I don’t think they mean to, I’m quite sure they don’t.  I think people long to help and support, but they don’t always know how to best do that.  That’s where I really think finding a listening ear, finding whether it’s a psychologist, a counsellor, an online cancer support chat room.

I just think that sometimes what people need is the chance to talk, to think, to reflect with someone who isn’t emotionally involved themselves.  I would encourage people to think about that, not to see seeking outside help as weakness.  Very far from it.  I see it as a very positive, proud step that’s part of the armoury of tackling cancer.  It doesn’t replace support from family and friends, it’s just a different way of seeking emotional backup, I guess.

Joe:                 Absolutely, Frances.  I couldn’t agree more.  I also have a deep belief that if you’re going through cancer or after cancer, or wherever you may be, that you should use every available tool at your disposal to help you get through it.

Frances:           I couldn’t agree with you more.  I’m quite sure that there are a whole raft of approaches and tools that I don’t know of.  I would say to people, follow your instincts.  If you think something would be helpful, try.  There’s no harm in trying things out.

Joe:                 Absolutely, because you’re going through an incredibly rough time and you’re experiencing a whole range of emotions.  At times, you feel angry.  Speaking of angry, Frances, is it okay to be angry when you have cancer?  How does it work?

Frances:           Not only is it okay, I think it’s completely natural.  At times, really helpful to acknowledge anger.  I think cancer is a threat.  Cancer is just the most enormous threat that most of us ever face and our natural instinctive response to threat is the fight/flight mechanism.  The fight bit is a very strong part of that.  I don’t think most people can go through cancer without experiencing and at times, expressing anger.  What I think is important is firstly that the anger doesn’t impact on your treatment.

Secondly, that the anger doesn’t irreparably damage the relationships and the support around you.  Obviously, you need to be able to manage and control the anger, so that it’s not hurting either yourself of other people.  Actually, I would say beyond that, express it.  Find a place either with somebody that wants to come with you or on your own, shout, scream, let the anger out, punch a pillow, go for a run if you can.  Just never hurt anybody else or yourself but let it out and express it.

Also, don’t forget, that you can also say sorry to someone.  If you’ve shouted at them or you’ve responded in an angry way that isn’t your usual style, just acknowledge that and acknowledge that this isn’t how things are always going to be, it’s just that you’re under threat and you’re angry.

Joe:                 Absolutely.  That makes so much sense, Frances.  All the normal rules apply.  If you screwed up, it’s a good idea to say sorry.

Frances:           I think sorry often seems to be quite a hard word for many of us, but it’s a good one.

Joe:                 I wouldn’t really know because I’ve never been wrong in my life.

Frances:           Of course, Joe, of course.  Should we discuss that with your friends and family?

Joe:                 Yes, I’ll definitely call my wife over to talk about that.  Frances, speaking of that, from personal experience, I know that many relationships are tested during cancer.  We spoke about this earlier, about friends, about all this stuff.  What advice do you have in this area to avoid common pitfalls and misunderstandings and so on?

Frances:           Thank you for asking that.  I completely agree with you.  I think the impact on relationships is one of the most profound impacts of going through cancer and treatment.  Again, I think saying sorry when one needs to, both sides, it is worth considering.  Actually, at a more practical level.  I think the advice I would give is to really try to listen to each other.  That’s an easy thing to say, how do you actually do that?  In the book, I talk about trying to bring, in your own personal relationships, to bring some of the structure of therapy sessions into that.  In a therapy session with a couple, I start by getting each member of that couple to talk about why they’re there and to talk about their concerns and their issues.  I don’t let the other person interrupt.  You’d be surprised, actually, how hard that is.  Actually, maybe you wouldn’t be surprised.

Joe:                 I’ll take it as a compliment.

Frances:           I think that thing of that actually in a relationship and friendship, often conversation is a rapid two-way process.  Actually, just when you’re dealing with such deep and profound emotions around cancer, try not to interrupt.  Listen to each other, let that person, that first person talks until they’re talked out.  Then the second person gets the chance to reply.  I think the other thing about therapy is that it’s time-limited.  I think a lot of times people are anxious about really talking or listening to each other, because they think, “We’re going to open this can of worms and we’re never going to be able to stop.”

I think saying to each other and setting an alarm, saying, “We’ve got an hour, or half an hour” – I wouldn’t do more than an hour, really.  It might be 20 minutes, that you just – and then you set the alarm, then when it goes off, you draw it to a close and you stop.  I think having a way to bring these deeply, at times, distressing conversations to a close actually can help you start them.  The other thing is, try, if you can, not to have these conversations in the bedroom, in your kitchen, in your sitting room.  If you can, be somewhere outside of your home.  I think, again, in therapy you’re outside of your home, and I think that means that the home doesn’t get contaminated with all of those articulated expressed feelings.

Joe:                 I love this advice, Frances.  Really, it’s another theme that I’ve just picked up on, this idea of time-boxing.  I think that’s really fantastic, like putting this time box around your worries, putting a time box around talking things through.  I think that these are fantastic tools.  Frances, what about fatigue?  It’s something that affects pretty much everyone going through treatment, how can you manage your energy better?

Frances:           Again, I think at times I may sound a bit repetitive, but I think one of the things is look at the expectations of yourself and try to be kinder or simply more realistic to yourself.  Going through cancer treatment and coming through cancer treatment, your body has been through the most gruelling experience and you are simply not going to have the same energy levels.  Really try to prioritise things, work out what is the most important thing for you to be using your limited energy on and then let some of the other things go.  It doesn’t mean they’ve gone forever.

It might be, you might decide, I never want to do the hoovering again.  More seriously, I think it’s about just prioritizing what you need to focus on.  I think the other thing is just building in planned, structured breaks or rests in your day, so that you’re not only resting when you’re exhausted.  You’re actually trying to give yourself some downtime before you’ve become worn out.  I think that’s something I would really recommend to people, try to rest before exhaustion has kicked in.  I recognise that for some people, even the term “rest” is an unforgettable one.  Change the language.  Talk to yourself.  Don’t say, “I’m going to have a rest”, say, “I’ve got some downtime, or I’m going to have some restoration time, or I’m going to take a break.” It doesn’t have to be rest, but it needs to be conserving your energy.

Don’t look at is as self-indulgent or weak.  I sometimes prescribed it.  For my clients, and sometimes they needed me to do that, but I think it’s really important to – as part of your wellbeing – to look at your energy levels and conserve them, but, and this is a big but, I also think that counter-intuitively you also need to look at your exercise levels.  You need to look at your fitness levels.  I know for many people it’s very counter-intuitive, but our bodies decondition so quickly.  I think just having some advice from your medical team about how to exercise.  What’s safe?  What’s appropriate?  What’s comfortable?  How to build up your exercise and build exercise into your daily routine?  Actually, does start over time, in fact, rather than to tire you out, it helps to build up your energy reserves again.

Joe:                 That’s fantastic advice, Frances.  I remember that when I was going through treatment, my oncologist recommended that I do walks every day.  I started doing it every night.  It was pretty tough sometimes, but it actually helped me to clear my head and I was actually incredibly grateful because it made me feel so much better and it became something that I’m doing to this day now, more than a year from treatment.

Frances:           Yes, I’m so glad to hear that.  I can’t believe I’m saying this, I’m an old-fashioned type person, I grew up thinking if you feel ill, if you feel tired, rest, stop.  Actually, I hated sports at school and in university.  I didn’t have a physical routine in my life and actually in the last decade, I think because of being a psychologist and because the information was so profoundly changed, that everyone said exercise is vital for you both physically and psychologically.  I thought, I better check this out.  I now go for walks or occasionally a little job, but it’s a daily part of my routine now.  That’s without having gone through a cancer diagnosis and treatment myself.  I tell my children, I tell my friends, I think it’s the most important psychological tool that we have.

Joe:                 Good on you, Frances, and good on you for following on your own advice.

Frances:           I don’t always do that.  I try.

Joe:                 I love what you said about managing your energy with respect to resting even when you’re not exhausted.  I know that when I was going through treatment, my first round of chemotherapy was again counter-intuitively a lot tougher for me because I was pushing myself through exhaustion, through feeling tired and for my second and third rounds, I understood there were peaks, there were ups and downs, and I would actually take rest before that.  It allowed me to take it in a much better way.  Even in terms of seeing people, I would have friends or family come to the hospital and I knew for a fact that in the evening I would be completely smashed.  I said, if you want to come in, come in the morning.  That really helped.

Frances:           Exactly.  I love the fact, Joe, that you had worked that out, that you were also able having worked that out to express that.  Again, that’s not easy, you’ve got family, friends, people wanting to come see you.  Actually, you knew that you had to prioritise your own wellbeing, you had to prioritise and safeguard your energy levels and you were able to articulate that to them, and they were able to hear that and respect that, too.  It’s a complex process.

Joe:                 It is, absolutely.  Another thing, of course, Frances, when people say to you, relax, take it easy, sometimes it’s actually not that easy to do.  How do you actually do it?  Can you give us some specific things to help you relax?

Frances:           Thank you so much for asking that, Joe.  I happen to have to go for a few blood tests myself recently.  I may at some point actually talk to the nurses who were taking the bloods about that, because they all say, “Just relax”, but they don’t tell you what to do.  I happen to have some strategies up my sleeve, so I know how to relax.  I just keep thinking, if only the nurses, the phlebotomist, the doctors, whoever is doing the blood test or whatever intervention it is, could actually say to someone, “What I’d like you to do is make your out breath longer than your in breath.” That is a way of physically introducing relaxation.

What you do, I tend to encourage people to count their breath in.  I say, “Take a breath in for four, hold it for two, and then breathe out for seven.” The out breath taking longer than the in breath, I don’t fully understand the physiology, and I probably ought to, but it induces relaxation.  I think that’s the first and, to me, the most practical relaxation skill.  Your out breath longer than your in breath.  Find your own root, find your own way of counting.  Some people like to think about it visually.  They like to imagine breathing out through a straw or trying to keep a feather up in the air.

Anything that makes your out breath longer than your in breath.  That’s the first thing.  Secondly, there’s abdominal breathing, that’s where you put one hand on your chest, one hand on your tummy and you take a breath in.  A deep breath in.  You make your tummy, the hand on your tummy move out further than the hand on your chest.  Again, that introduces a deep level of abdominal breathing that induces relaxation.  Then the third thing, again, a practical strategy is something that I call muscle tense release.  Again, don’t get caught up in, “Have I clenched my fists and raised my shoulders?”

It doesn’t matter how you do it, just tense your muscles, clench them up, talk yourself through it.  “Okay, my muscles are tight and tense, I’m holding them, I feel it, they’re hard”, then you very slowly and gradually release that muscle tension.  You let your fists gradually open.  You let your shoulders drop down.  You reveal the release.  You actually talk yourself through.  You say, “I can feel relaxation flowing through the muscle groups that I’ve tensed.  There are a lot of apps on the phone that you can use.  You can find scripts to help you with muscle tense release relaxation.  Again, as I say, don’t get caught up in how to do it, just find a way to tense some muscles and then release them.  Then focus your attention on the relaxation flowing through.

Joe:                 That’s fantastic advice.  One of the things that helped me, Frances, especially, for example, when I was getting something in my hand, was to visualize something positive.  For me, it was an image of me playing with my son, for example.  That took my mind off whatever was happening.  It helped me relax.  What’s your take on that?

Frances:           I think that’s great, and thank you, because the relaxation strategies that I was talking about are quite physical relaxation strategies.  Actually, thank you, because it’s really important to recognise that you can also relax your mind using visual imagery.  I really do try to imagine myself on a beach and I can tell you, in Britain in February, it’s quite a challenge of the imagination, but what it does, and what I think what I would say, and I don’t know whether you did this with your visualisation, Joe, but to actually with visualisation, try to build in some of the other senses, as well, so that you’re actually thinking about, okay, so I can feel myself kicking the ball to my son.

Imagine the laughter that you’re hearing from him.  Think about what you can feel.  For me, with my imagery of the beach, I’m actually almost trying to feel the warmth of the sun on my skin, I can hear the lapping of the waves on the beach.  I can feel the sand between my toes.  I can smell the sea air.  Use your imagination and build in all of those senses.  Then you can really take yourself out of the horrible medical setting that you’re in, to a place that’s a better place for you.

Joe:                 That’s fantastic, Frances.  I love your advice.  That’s a whole different level of sophistication to that visual imagery.  That’s great.  Frances, another thing I want to talk about is sleep because that’s a problem.  Sleeping, is it before, during, or after treatment?  Why does it happen and what are some of the steps that you can follow to have better sleep?

Frances:           I think the diagnosis and then the treatment of cancer and, as I say, post-cancer treatment, sleep is incredibly disrupted for all sorts of reasons.  Obviously, I’m a psychologist, so mind racing is going to be the top of my list.  Your mind is going to be racing with all sorts of thoughts.  I think that the treatment that you go through has a gruelling affect on your body, that impacts on your body’s natural rhythms and sleep is such a habit.  Changes to the routine, cancer may disrupt your usual routines in a really profound way.  It’s not at all surprising that sleep is disrupted.  I think the other thing about sleep is that it’s at night time that I think the loneliness and the isolation, and the fears kick in again back to mind racing.  How do you manage that?  Well, in the research I did for my book, I was really interested to discover that even without a cancer diagnosis or treatment, people worry a huge amount about sleep.

They think that we overestimate how much sleep we actually need to function.  The first thing I would say is, actually, if you’re having a bac night of sleep.  Again, try not to catastrophise the: My next day is going to be ruined, I’m not going to be able to manage the next round of chemo, whatever it might be that’s going through your head.  Just reassuring yourself that you can rest, letting your body just loosen and unwind and lie down.  That in itself has a deeper effect physiologically than we realize.  That’s the first thing.  I think the second thing I would say is, is really look at your sleep habits.  Try not to let cancer diagnosis and treatment disrupt those sleep patterns too profoundly.  Try to go to bed and get up at roughly the same time each day.

If you have a disrupted night, it’s very natural to think, “I’m going to try and catch up during the day and I’ll have some naps and rests and sleep in the day.” Actually, if you can, rest but don’t sleep during the day, because then you won’t perhaps sleep or get off to sleep as well when you’re then trying to do so at night.  Look carefully at your bedtime, the time you get up, and this idea of compensating for lost sleep.  I think that can get one into unhelpful habits.  I think another thing I would say is, we can get into the habit of almost associating bed with lying awake and worrying.  If you’re aware that that’s something that you do, that you almost start to worry the minute your head hits the pillow, actually try to break that association.

Look at finding a way to maybe just have a chair in your room, near your bed, so you that instead of lying in bed, you just get up and you’re warm and comfy, in a nice arm chair, then when you think you’re about to fall back to sleep, then get back into bed.  Try to have bed the place where you sleep and not the place where you lie awake worrying.  Then, at a practical level, have a notebook and bed by the bed.  I know I often have my thoughts about, “I need to order that, or get that for my daughter, or sort something out.” Actually, just being able to write it down helps to allow me to put my mind at rest.  I think those would be the things I would suggest.

Joe:                 Yes, that’s great advice, Frances.  I definitely feel like I have to write something down or I’ll forget, and the world is going to end.

Frances:           Exactly.  The middle of the night is such a tough moment for that – exactly.

Joe:                 One thing you touched on, Frances, is cancer disrupts so many things in our lives, during treating and after treatment, as well.  That includes sex.  What would you say to someone?  How do you go about making that better?  How do you go about improving it?  You’ve got a lot to deal with but at the same time, you want this to be just a normal healthy part of your life?

Frances:           Absolutely.  I think it comes back to actually talking as a couple together.  Acknowledging fears.  I worked with a woman who was really so distressed by the fact that she and her husband had stopped having sex and she felt all the insecurities associated with that.  Actually, what happened was that eventually she did agree to invite her husband to come in and meet with us jointly.  Actually, what it turned out was that he was deeply loving towards her, still very attracted to her.  She had thought that he no longer felt any physical attraction to her.  That wasn’t the case at all.  He was absolutely terrified of hurting her.  She’d had a mastectomy and he was really anxious about touching her.

He also had found some really wrong site that said that after chemo, a woman’s risk of having a heart attack during sex could be increased.  There was no basis to this.  I don’t even know whether that was actually what he had properly read.  That’s what he had taken from this.  He was just really frightened about initiating physical contact at all, let alone sex with his wife.  We talked that through.  Then what we did, they hadn’t had sex for months, if not for a bit more than a year.  What we talked about what just not to go straight back into sexual intercourse, but to find a way just to resume intimacy together.

I’m really conscious that people going through treatment, and some of the treatments, there’s no getting around, that some of the treatments do have an impact on sexual function.  As a couple, I think it’s about finding ways to talk about it and finding ways to maintain a loving, physical intimacy with each other without or despite the impact of the cancer.

Joe:                 That makes so much sense, Frances, because ultimately, yes, like you say, intimacy is so much more than sex, and this is what we all think, this is what we’re all looking for to be understood, to be loved, to be cared for, and for our partner to show that in the right way.

Frances:           Exactly.  I do think it is so hard for the partners who may have been with you through those most intimate but awful moments of treatment and side-effects.  It can, for some couples, change how they feel about each other’s bodies.  I think the point is, exactly as you’re saying, to look at the breadth of love and how one can express love and intimacy, and not to get caught up with it.  It has to be intercourse straight away.

Joe:                 That’s right, not to get caught up in the mechanics or that it has to be a certain way.

Frances:           Exactly.

Joe:                 Fantastic, Frances.  I’m sure there are things that get overlooked by people when they’re going through cancer or after cancer.  What would you say are one of the biggest things that tend to get overlooked?

Frances:           I think the biggest thing is actually being kind to yourself and really looking at the expectations that you have of yourself.  I think people expect themselves to be strong, skilled, competent, confident, not all the time, but a lot of the time through this whole process.  I think that there’s something about just recognising the inevitability of psychological ups and downs, in the same way that you will have physical highs and lows.  I think if I could train oncologists and oncology nurses, I just think, just talk to people about the fact that they are going to find this hard.  That they will go through it.  Those deep moments of doubt, anxiety, anger, fear, depression, and just acknowledging that, you don’t get caught up in it so much.  Nor do you start to add in self-punishment, guilt, all of those extra emotions on top of that.

Joe:                 Absolutely.  That’s fantastic advice, Frances.  What would you say to someone, what is the best advice you can give to someone after cancer?

Frances:           After cancer, I want to celebrate with someone, I want to join in with that excitement, that achievement involved with all of that.  I think that the thing that I would add to that wonderful news is that it’s the start of a new chapter rather than the end of the story.  I know that sounds a bit trite and not very practical.  I think it is really important.  From my experience, what a lot of people do is they actually, the treatment is so gruelling, and they just have to keep putting one foot forward.  They find a way to get through the treatment.  I think, for many people, it’s only after treatment and the successful complement of treatment, that they actually begin to process emotionally what they’ve been through.  I think not everybody does this, but I think the majority of people do.  I would just like that to be just acknowledged and highlighted for people at the end of treatment.  Celebrate but also be aware that there may be more complex emotions than you expected.

Joe:                 Yes, that’s fantastic advice, Frances.  I know that with cancer, things will never be the same, but at the same time, like you just said, life after cancer is a new beginning and a chance to do things in a different way.  That, in many cases, is doing things in a better way and starting things that you may have missed out on.  Now, every day is really a present that you receive and it’s up to you with what you do with it, isn’t it?

Frances:           Absolutely.  I think you described that perfectly, Joe.  The only little thing I would add in is that there will be days when you wake up and you don’t think it’s a present.  It’s a bad day.  You’re in a bad mood.  That’s okay, too.  I completely agree with you.  It’s about what you make of this new chapter in your story.

Joe:                 Exactly.  If we are to take this present analogy even further, I would add to that that maybe those bad days is one of those times when you got a present you didn’t want, so maybe you can put that to the side.

Frances:           Exactly.  Yes.

Joe:                 We probably exhausted this analogy about the present.  Frances, I loved your book, I think it’s fantastic.  If someone wanted to check it out and check out your other books, what is the best way to go about it?

Frances:           Thank you so much.  I really appreciate your kind words about the book.  Also, the chance to tell other people about it.  In Britain, I believe that the publisher, we sent a copy of the book to all of the public libraries in Britain.  Whether they’re still there, I don’t know.  Obviously, Amazon is probably the easiest place to get hold of the book.  What I would also say is, if people feel comfortable in talking about it with their medical team, if you can check whether the medical team have their own little library of resources for their patient group.  That would be a wonderful way of seeing if you mentioned it to them, if they have the funds to buy a couple of copies.  Then lend it out to people.

That would be a great way of getting the book.  I think it is known about, but it’s a little bit haphazard.  Anything that tells people, look, there is this particular resource, I’m very appreciative of.  As I said, it’s on Amazon, it’s in paperback.  It’s not hugely expensive.  I think it’s about £8.00 in the UK.  I’m afraid I don’t know what it costs in the other countries.

Joe:                 That’s nothing, Frances.  I liked what we talked about, you should use every tool that you can find.  This happens to be a fantastic tool.  Thank you so much for your time, Frances.  That’s been incredibly insightful.  Thank you for your practical advice and for the fact that you clearly still care about this area and you care about the outcomes for people.

Frances:           Joe, I can’t thank you enough.  It’s been just a delight.  I was a little bit nervous at the start.  I just reminded myself, thank you.  I do feel very passionately about it.  I love the chance to talk, so thank you for that.

Joe:                 Thank you, Frances.  I appreciate it.