This article is an abstract of a presentation made at the 1997 International Psychosynthesis Conference in San Diego, Ca. A compilation of abstracts (including this one) is available from Psychosynthesis International, PO Box 279, Ojai, CA 93024

Eight million people alive today have or have had cancer. This population is more inclined than ever to seek psychological help around the issues of their illness, due to increased consciousness and recent findings in mind/body medicine. Several popular studies have validated the positive effects of psychological intervention both in terms of quality of life and longevity.

As a practicing psychotherapist with a psychosynthesis orientation, I was introduced to this work in 1987 by a client with inoperable lung cancer, given four months to live. I had no training in the field and so relied on my psychosynthesis as the primary mode of orientation. The client went on to cure herself (alive and well today) and to write about her experience with a great deal of information on her therapy . This book, Mind, Fantasy and Healing by Alice Epstein was published in 1989 and opened the door for many clients to come into my practice having read her book. Thus began my specialty in work with clients with cancer and other life threatening illness.

The first principle in this work, as I understand it, is that the work is about healing, not cure. Healing is and always has been the domain of psychosynthesis as the very name implies. Cure is beyond any practitioner's power to effect. That remains in the arena of mystery.

Working with a client in this situation I want first to know what their natural tendencies are in times of crisis. In the first moments of a diagnosis their strengths and weaknesses present. These will pave the way for an understanding of what natural gifts can be used to support the process and what blocks, neurotic patterns, or limiting subpersonalities need to be worked on to create an internal healing environment.

Some of the key issues that clients face at this time are: a shattered sense of stable self, loss of future orientation, the call of the status quo to act normal, the power of the medical system to influence, the pull of the family and culture to respond in ways deemed appropriate by that group. In general the client is easily hypnotizable in these early stages and must struggle to find an inner self and inner knowing that can choose from personal values and beliefs.

Some of the risks at this time include: self abandonment, denial of feelings, passivity and compliance, lure of the miracle cure, denial of needs, rebellion and reactivity towards authority figures, powerlessness and the recurrence of patterns of primal wounding.

Key psychosynthesis concepts that play out in work with clients in a life threatening situation include: self and subpersonalities, identification, disidentification and self identification, will, the spiritual dimension, and synthesis.

Subpersonalities are a key concept in that the client needs an internally cohesive subpersonality system. Many clients feel that they caused their cancer or deserve it in some way or that with the right attitude they could cure it. These subpersonality configurations may be at odds with each other and with the movement of healing. Often they default to early wounding and the scripts that were created as a result. In addition, when clients are involved in treatment for cancer, often difficult or frightening (surgery, radiation, chemotherapy) they may have subpersonalities that resist or oppose the choices they make, creating a conflicted environment for the intended healing. Subpersonalities, ideally, need to be allies in the healing process. At the least they need to be acknowledged and accepted, included in the process.

The identification, disidentification process is also crucial in that limiting identifications create fear and conflict. Disidentification as the process of coming closer to the truth of Self is essential when facing serious illness or crisis. The question, in current psychosynthesis theory, of how to use the disidentification exercise may have effect here. The classic, "I have a body, but I am not my body," tends to support the all-too-Western tendency to deny body and see it as the beast of burden for the Self or soul. When the body threatens to quit, this stance is likely to be counterproductive and impossible as the client fully experiences themselves in the ill body. A variation that is more inclusive, "I have a body and I am more than my body," or "I am my body and I am more than my body," may be more useful.

The issue of will comes with the many choices the cancer client is forced to make. Choices in treatment are the first, but life choices, based on changing visions of life, are immediately important. The client is often faced with what has been named "a wake up call" and the choices that fall from this demand the ability to act, as in the true act of will, from purpose, meaning and values. Distortions to willing become therapeutic agenda.

The transpersonal dimension, of course, becomes essential as the client grapples with meaning and purpose. As recent research has affirmed, the impact of prayer(and we can assume other types of spiritual practice) is real. The common wisdom and the theory and technology of psychosynthesis have always validated this and so support for the emergence or strengthening of a spiritual life is key in this work.

Finally, the principle of synthesis stands out as the umbrella under which this work is practiced, because, in the face of the unknowable, our need to be inclusive is required. Working in this domain we must embrace life and death, choice and not knowing, joy and sorrow.

The role of the therapist in this work may involve several atypical elements. Being an ally, in the political sense of advocating for and standing with those who are oppressed or disenfranchised seems vastly useful. The client facing death is in many ways an invisible, unaccounted for minority in our society which is acutely avoidant of issues of death. The therapist in taking that role extends her/himself beyond traditional definitions of the therapeutic relationship, while continuing to respect needed boundaries, and of course, ethical demands. Boundary issues may change however, especially as a client is dying. At certain times, the client's family may be involved and the therapist may be called upon to act outside the normal therapeutic venue, negotiating with family members, talking to doctors, helping the client negotiate in what may be an increasingly limited world.

It is important for therapists to watch their subtle shoulds, their ideals, the way they would want to face an illness, face death, etc. Personal religious beliefs may also become problematic if the therapist projects them on the client.

Above all, the psychosynthesis concept of presence defines the requirements for the therapist of being in this work. It is an invitation to be open in ways that therapy does not often require. It is an invitation to touch and be touched in profound, life altering ways. It is a responsibility and a gift.

Reference
Epstein,Alice, Mind, Fantasy and Healing,1989, Delacorte, NY. [out of print, but available through The Synthesis Center]