Time to talk: the benefits of psycho-oncology

Psycho-oncologist Dr Charlotte Tottman knew she would enjoy her work but never thought she would find herself dealing with a breast cancer diagnosis of her own.

Dr Tottman started her own psycho-oncology practice after completing six years of full-time postgraduate study, and focuses on working with clients who have been diagnosed with cancer. She believes it is one of just a small number of dedicated private psycho-oncology practices in Australia.

“It’s wonderful. I get emotional when I say that my clients are the most extraordinary population – and their family members and friends. They are incredible,” she says from her Adelaide home. “It’s an enormous privilege to work with them. The idea that I could mitigate their distress in some small way is incredibly rewarding.”

Previously a senior executive in the manufacturing and construction areas, the mother of four sought a career change in her late 30s and retrained as a clinical psychologist. As part of her training, she undertook a five-month clinical placement in psycho-oncology which she says “felt like a natural fit”.

Breast cancer is the most common cancer among Australian women, and two-thirds of Dr Tottman’s clients have been diagnosed with the disease. However, receiving her own breast cancer diagnosis in July 2018 came as a shock.

Charlotte Tottman

Psycho-oncologist Dr Charlotte Tottman

“My parents died when I was relatively young, both from cancer. I learnt young that life is impermanent, and you have one shot at it, but the shock was that I got cancer when I did – at 54, being fit, slim, [someone who] exercises, eats well and promotes good health.”

Dr Tottman took two weeks off and returned to work on reduced hours while she was in active treatment.

“Purpose and meaning are really important in anyone’s psychological functioning, and a traumatic knee injury a couple of years ago taught me that the human body is incredible – and also that I need to work; it takes the focus off me.”

Dr Tottman’s combination of clinical training and personal experience give her a unique take on the psychological difficulties a breast cancer diagnosis can have on a person.

“[My diagnosis] made me review my own clinical advice and tools. Nothing came up wanting, but the thing I find that I get now that I didn’t really get before is the fear of recurrence. The fear is visceral and now I understand that. My fear is like a metal, silver, heavy, grey fist, a relatively small thing but powerful. That’s the stuff that I have a much better understanding about. I think that helps clients because of my willingness to really go there.”

Charlotte hopes psycho-oncology becomes a growing field because “there is so much work”.

“It’s a specialised area. Clients don’t have to explain the language of cancer – diagnoses, treatments, medications, prognoses. It doesn’t scare me or distress me.”

She says her service is a place where clients can safely talk about their experience, canvas death and dying, and talk about treatment decisions – or absolutely anything.

“Cancer has a long tail. Its legacy is large. There are benefits in having psychological treatment for some time and often for a long time. We don’t just talk about cancer. We talk about all parts of people’s lives.”

Common themes that are raised in sessions include adjustments to a diagnosis, post-treatment, mortality, end of life and all the changes that come with a diagnosis.

Emotional isolation is also a regular discussion point. This involves when other people – family members, friends, colleagues, or anyone – “don’t get it”. Charlotte says clients often present the best version of themselves to the world, with make-up and wigs for example, but how they look is not necessarily how they feel.

“It’s one thing to feel emotionally isolated when you’re alone but it’s worse when you’re surrounded by people who don’t get it and there’s a feeling of ‘I’m in this all by myself’.”

“I keep a snow globe on my consulting table. I use it as an analogy. I hold it up – this is your life, cancer comes along and shakes up your life. The flakes are your values and priorities, and when they settle, they settle somewhere different. Some things that mattered before don’t matter anymore, and some things that didn’t seem to matter before now do. People get more clarity about what they will and won’t put up with and have more willingness to live according to that clarity. For example, ‘I’m not going to that barbecue today because I don’t want to’, or ‘I’m not going to go back to that job’, or ‘I am going to book that holiday’.

“Not that anyone ever wants cancer, but that’s the transformative thing that comes out of cancer – it shakes up people’s lives, sometimes for the better.”

What do people living with a breast cancer diagnosis want to talk about?

  • Post-treatment/survivorship
    “Clients often find that when treatment stops, this can be quite sudden and it may not be another six months before the next appointment with a medical professional. There’s a lot of pressure from themselves and others to get back to how life was before, but post-treatment recovery can take up to two years. You’re never going to be the same as what you were – you have changed at a cellular and psychological level. You can’t go back.”
  • Fear of recurrence
    “It’s very real. You acknowledge it. You try to find out what the triggers are, get clients to talk about it and name it. I never tell clients to make the fear go away – it’s actually a good thing; it’s part of your internal burglar alarm. We just want to get clients in the driver’s seat rather than the fear being the driver.”
  • Friendships and relationships
    “Clients are often surprised by the people who disappear and the people who step up. Sometimes there is a need for a strategic “letting-go” of a relationship – it simply may not be the best use of your resources to chase that person. Go where you’re understood … Strategically keep away from where you’re not understood (but) not aggressively. You’ve got to be kind to yourself.”
  • Children
    “In terms of telling young children about a cancer diagnosis, they will be somewhat protected because their brains will only process what they are capable of at that time. Giving children information is the best thing you can do. It’s important they get the truth as quickly as possible at the same time as each other. Do not tell children things that are not true as they may be less inclined to believe what they hear from you at other times as a result.”
To access a private psycho-oncologist, you can ask your GP for a referral to a clinical psychologist with experience in dealing with cancer-related distress. Alternatively, visit the Australian Psychological Society website and go to Find a Psychologist. 
Issue 84
Autumn 2019