Do any of your clients have a cancer diagnosis? How can you provide a more nuanced therapeutic approach to clients that are overcoming cancer? Which positives can EFT specifically provide therapists who are working with clients battling cancer?
In this podcast episode, Joe Sanok speaks about working with people with cancer through Emotionally Focused Therapy (EFT) with Carly Fleming.
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At Blueprint, they believe that nothing should get in the way of you doing your best work, which is why they created a platform that provides therapists with an array of clinical tools – things like therapy worksheets, intervention ideas, and digital assessments – that are designed to help you and your clients can stay connected and confident throughout the care journey. Even better, Blueprint helps streamline your documentation so that you can spend less time on your notes and more time on the things that matter.
Carly Fleming is a Registered Psychotherapist in Hamilton, Canada and is the owner of a virtual practice called Everwell Counselling. Carly spends half her time in clinical practice, specializing in supporting people dealing with cancer and grief using Emotionally Focused Therapy. The other half of her time is spent running her group practice and developing ways to support psychotherapy students and contractors in this wild and wonderful career.
I think everything gets incredibly intensified. So, where there was some conflict, where there was some insecurity, where there was some relationship distress, you add a cancer diagnosis and treatment into that and those things all get incredibly intensified.
This intensification that can often happen with clients that are overcoming cancer is sometimes not what they expected.
For example, some might expect that the diagnosis can help relationships to reform or become better, rather than worse if there was tension already present.
Furthermore, that threat to survival looms in the background and can add another heavy layer of tension.
The threat to the survival of the people that you love is incredibly distressing. If we look at it through an attachment lens, it is sort of a primal fear, and so that is never far away in a counseling session with somebody who has cancer or who is caring for a loved one with cancer.
How to work well with clients battling cancer
If you are working with clients that are currently battling cancer or who are caring for a loved one with cancer, realize that a stoic nature may come up that can – accidentally – suppress their emotions.
This could either be an intentional or accidental suppression, but that stoic nature to get to all the appointments, undergo tests, and get through treatment can leave little time for dealing with the emotions that are pushed underground.
Sometimes those emotions are not welcome, either.
I have found, depending on the care team, depending on the family, it’s really scary to be in the presence of that significant emotion … which can start to add to their stress.
Therefore, using an emotionally-focused therapeutic lens with clients can help equip them with the skills to process their emotions as they come and go so that additional stress can be avoided.
Returning to emotion is a natural thing and I find that clients respond to it extremely well when they’re invited to then come back and interact with their emotional experience safely, and that’s where the therapy space creates this safe, accepting, warm environment for a client to share their emotion when they may not be finding that [space] elsewhere.
Core EFT teachings
EFT is an attachment-based intervention: it looks at all human interactions between individuals as a seeking of connection, safety, and authenticity.
Through the lens of attachment, EFT looks for distress: emotional or relational tension
EFT can be used for any type of relational attachment between couples, parents, and children, and even (in the case of cancer patients) between doctors and the clients themselves
The two main approaches within EFT are empathic reflection and then intentional relationship restructuring (if necessary). Afterward, these new stories of attachment are consolidated.
Even in that initial assessment and intake, we are really looking for ways that the client is narrating their emotional experience to give us an idea of how accessible and safe they feel with their own sense of emotion.
With cancer work, realize that it can often be like working with grief, bereavement, or anger.
Carly’s advice to private practitioners
Tend to yourself! Therapists give so much to their clients and carry their stories of suffering. Remember to intentionally let go of what is not yours, and maintain a healthy boundary between your life and theirs.
Joe Sanok helps counselors to create thriving practices that are the envy of other counselors. He has helped counselors to grow their businesses by 50-500% and is proud of all the private practice owners that are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.
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This is the Practice of the Practice Podcast with Joe Sanok, session number 871.
I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast. Whether you are starting a practice, growing it, or maybe even exiting it, this is the podcast for you. Usually, we’re covering tons and tons on the business side of how you run a counseling therapeutic private practice. But this month and last month, we have been covering tons on specialties, so digging into maybe some of those clinical issues that we’ve left back in grad school. So we’ve talked about screen time, we’ve talked about being a Gottman Level Three couples work, we’ve talked about infidelity, LGBTQ care. We’ve talked about financial stress, toxic families, trauma, EMDR, all sorts of different things we’ve covered. So those all started back in episode 861, so about 10 episodes ago and we’re going to be doing about five more of these throughout the month of May.
So thanks so much for tuning in today to hang out with us and learn some clinical skills. I am so excited today I have Carly Fleming. Carly is a registered psychotherapist in Hamilton, Canada and is the owner of a virtual practice called Everwell Counselling. Carly spent half of her time in clinical practice, spends half her time in clinical practice specializing in supporting people dealing with cancer and grief using EFT, and the other halftime is spent running her group practice and developing ways to support psychotherapy students and contractors in this wild and wonderful career. Carly, welcome to the Practice of the Practice Podcast.
Thanks so much for having me, Joe.
Yeah, I am really excited to have you here. I always enjoy hearing the Canadian perspective because it’s nice to just have a little bend to the culture. And also I feel like being in Michigan, oftentimes I feel more like a Canadian than I do connecting with people that live in other parts of my country. I was going to name specific states, but then I thought I might offend a few people.
I totally hear you. Michigan is, it’s our neighbor.
Yeah, absolutely. I mean, we would go up to like Searchmont, Canada to go skiing and I remember we would always be so excited when the Looney was like more in our favor because we, when I was a kid my brother and I had been saving up for a Turbo Graphics 16, and when we were in Canada, it ended up being like $20 off from the conversion rate and we were like, oh my gosh, that’s like months of allowance.
It’s like hitting the jackpot, totally.
It is, yeah. Well, Carly I’m really interested in hearing a little bit about your story and especially how did you get into specifically specializing in supporting people dealing with cancer and EFT?
Okay, I would love to share that. I actually come to the area of grief bereavement and working with people and family members where cancer is a part of their life through a personal route. I think lots of therapists find themselves there. So I had the experience as a young person in my family of a family member with cancer, that was a really pivotal developmental experience for me. I was old enough to sort of see how different people in my family managed these, this huge life change, huge life transition and I learned a lot about what seemed to feel supportive and look like it was going well and actually also what didn’t seem to be going well. I think that’s the part that allowed me to see it through the lens of emotion, through the lens of the, or through the need to be able to access painful, vulnerable emotion when people are going through something as significant as cancer.
So I come to it personally and very early on in my career, my first couple of sort of jobs were at hospitals working with individuals with cancer as well as their families and I fell in love with the work. I mean, you’re really working with people at such a critical time in their life. It’s just so rich and so beautiful and it lends itself to the sharing of vulnerability. So what I’ve done is over the years got some training in emotionally focused therapy as a way to really hone in on working with this population and then moved out into private practice where that has become my area of specialization. That’s how, that’s where I’m at today.
Now, when you think about working with families or individuals that have a cancer diagnosis, and as a cancer conqueror myself I appreciate the work that you’re doing, what for you are some of the bullet points of things that maybe are layers that those clients bring to therapy that are different than maybe the average person dealing with stress in their life?
Yeah, good question. Well, I think everything gets incredibly intensified. So where there was some conflict, where there was some insecurity, where there was some relationship distress, you add a cancer diagnosis and treatment into that and those things all get incredibly intensified. That’s maybe sometimes the opposite of what the clients themselves expect. I think the clients sometimes might expect that people start behaving or the relationships will somehow start to reform and it doesn’t happen all that often. So there’s sort of a tenderness needed to understand the intensity of the life stress that’s pre-existed, this diagnosis. And then I think what we all know somehow in our bones, or just because we’ve lived it, is threat to survival, threat to your own survival or threat to the survival of the people that you love is incredibly distressing. If we look at it through an attachment lens, it is sort of a primal fear and so that is never far away in a counseling session with somebody who has cancer or who is caring for a loved one with cancer.
Now if you look at the overlap between EFT and cancer work, I think that’s such a great tool and modality, walk us through why EFT for you was important to have as part of your primary toolbox in helping people that have a cancer diagnosis.
Okay, yeah. Naturally that fear and sadness and stress that comes from a life altering diagnosis, it not truly lends itself to emotional, the experience of emotions. I mean, we hear it, we see it, it makes a lot of sense, but what can happen quite quickly is that those emotions can get shut down. They can go underground because now there’s just the business of attending to treatments, going for tests, navigating the people in your life who are worried. So what I see over and over again is actually this sort of the brave more stoic approach shows up and those emotions go underground and they’re not gone. But they’re really not welcome either. I have found, depending on the care team, depending on the family it’s really scary for people to be in the presence of that significant emotion.
So individuals see it as, well, let’s just keep it stuff down because it’s inconvenient to me. It’s inconvenient to the people who I’m working with or who love me. That then just starts to add to their stress. It starts to add to their bodily sensations, their symptoms and that thing. So to bring an emotionally focused lens back to them is really returning to a natural state. In EFT, I mean, emotions are our core, sort of like me, Sue Johnson calls it sort of the music that our lives are played to, returning to emotion, is such a natural thing. And I find that clients respond to it extremely well when they’re invited to then come back and interact with their emotional experience in a safe way. Then that’s where the therapy space creates this safe, accepting, warm environment for a client to share their emotion when they may not be finding that else elsewhere in their world.
Yeah, I mean, you think about even the language that we use of, oh, you’re so strong, you got this, you can kill cancer, take it down. Like, yes, but what about when I am fearful that I don’t have this or if things don’t work out and to say, oh, you are so brave through cancer. But then it’s like, what if there’s times when we don’t feel brave and we just are so sad that the life that we had sketched out in our brains maybe won’t come to fruition or it’s just different? There’s such a grief and worry that but the primary narrative, at least that tends to be there from my perspective, is that like bravery, go kick its button. It’s meant to be inspirational to people and keep a positive mindset, but I had never thought of it until you just said it, that it’s also then forcing people to say like, your emotions need to not be front and center during this process.
That’s exactly, that is exactly what I see, that’s right.
Providing great therapy day after day can be challenging even for the best of us. At Blueprint, they believe that nothing should get in the way of you doing your best work, which is why they created a platform that provides therapists with an array of clinical tools, things like therapy worksheets, intervention ideas, and digital assessments that are designed to help you and your clients stay connected and confident throughout the care journey. Even better, Blueprint helps streamline your documentation so you can spend less time on your notes and more time on the things that matter. To learn more and request a 30-day free trial, visit blueprint-health.com.
Now, for those of us that have been out of grad school for a bit that maybe haven’t focused in on EFT, could you take us through some of the core teachings or modalities of EFT and then link those to the work you do with cancer, people with cancer diagnoses?
Sure. I would love to. So EFT is first and foremost an attachment based intervention and paradigm, so looking at all human interactions, between individuals as primarily a seeking of connection, a seeking of safety, a place where we wish to show up as our true and honest selves. So EFT looks at any relational distress, emotional distress through that lens of attachment and so when we are, any of us as humans feel as though attachment is threatened, for example is who will be there for me? What if I’m rejected? Will I be met with love and care? When we, when any of us humans are faced with those questions we have emotional reactions. So we have bodily arousal that can come from that a feeling. We have, we make meaning of what is happening. We can often take action when we have felt something so threatening to us.
So that often can look like things like withdrawing from relationships pursuing, overly pursuing the other person in an attempt to get things met in a way that is not necessarily healthy for the relationship. These relationships, of course, EFT primarily was developed as a couple’s modality, and so of course they exist in attachment relationships between romantic couples, but in the context of cancer, they also exist between parents and children. They also can exist actually between a medical professional and the individual with cancer. When you’re putting your sense of safety in the hands of a medical professional, that becomes a proxy for an attachment relationships pretty quickly.
So yeah, through the lens of attachment we look to firstly, the stage one of EFT is to stabilize, deescalate any really significantly distressing emotion. There’s lots of different ways that we do that. We, as therapists, the number one tool we use is empathic reflection. At that stage, we just create that safe space. Then we move into stage two, which is actually restructuring the interactions between the individual and their attachment, their attachment relationships. Similarly we’re doing that through sort of reflecting, reframing, shaping interactions, helping navigate the negative meanings that we create, the negative messages that we might be holding onto. Stage three is we consolidate these new stories of attachment, we consolidate new ways of being in the world. All of that sounds nice and clean, of course, and real in real sessions, like all of us know. That can be a long and meaningful process, that’s for sure, but as the therapist, ultimately our job, our role is to create corrective emotional experiences for our clients so that they can experience safety and vulnerability with us, and then they can go out into the world and find it with others.
So if you were doing an intake with someone that had a cancer diagnosis, whether it’s with them or with their family what would be some ways that you’re incorporating EFT into that work or those questions that maybe the average therapist wouldn’t think of or it wouldn’t be top of mind to them?
So we are really looking for, even in that initial assessment, that initial intake, we’re really looking for ways that the client is narrating their emotional experience to give us an idea of how accessible and safe they feel with their own sense of emotion. So very quickly you can, you tend to, when as soon as you begin to be curious about an emotion they’re talking about, you can get a sense if they’re quickly withdrawing, that, oh, no, no, but it’s actually, no, it’s fine. It’s fine. That’s not not a big deal. Or maybe sometimes it’s quite the opposite. Now they’re delving into a lot of tears or a lot of narration about the sort of significance of the distress. So right away we’re paying at attention to that. Actually sort of more important, the emotion becomes more important than the contextual story. Of course, we want to know what they’re going through and what the person in their life may be with cancer is dealing with, but more important is actually the way that they’re attending to emotion in the way they speak with us.
So when, what else would you want to have the average therapist just really have a working knowledge of with EFT? Then I want to dive into a little bit more of the specialty and your own group practice and how you make sure that that stays how you think it should. Well, I’ll get into that question next, but anything around the average therapist that isn’t necessarily an expert in EFT, but like skills that they can incorporate today into their work?
Yeah, that’s a great point. Actually I work with lots of students and we, they aren’t necessarily pursuing EFT training. So I always have a few sort of key highlights. Firstly, I like to recognize, and we all know this as therapists, that we really do live in quite an emotion phobic culture. So I think we need to check, be really careful that we’re checking that at the door of our therapy spaces so that when a client shows us some emotion, we don’t have that automatic response of somehow wanting to avoid it or to ask a different question that these are real signals to us that there’s an opportunity to express curiosity to go deeper. So I think fundamentally that would be my number one, is that your clients will give you cues and give you clues to their emotional experience. The door might be open only at just a small amount, but if we are really tender with it and curious about it and create safety around it, we can gently push that door open and have the client experience that emotion with us in session, which is really an incredible place to begin some healing and some processing. I don’t think you need to be an EFT trained therapist to be able to do that, and probably many people already are, but it’s just a really nice reminder.
Yeah, yeah. Now, as you grew your group practice and were leveling it up, there’s always that push and pull of the founder clearly knowing what they want and how they have the DNA of their work. How did you make sure that your focus on EFT and the DNA of what your vision for your practice was, how’d you make sure that that continued as you added people to your practice?
It’s a challenge. It’s a real challenge, but right out of the gate, I would say that I was really focused on, not even per se the practice of EFT as a specialty, but more the philosophy of EFT as a way to live one’s life, to be honest. So, I mean, that’s what, how I am the most impacted by this model is in my own life. So being sure for me that I was attracting and developing relationships with therapists who shared some of that philosophy around warmth and acceptance and the sharing of vulnerability between two human beings is the most important thing we do. So of course, we do that with our clients as therapists, but what I’m looking for is therapists who can do that with me and who can maybe respond to some of my cues around being vulnerable and I can provide a safe place for them to share. So it’s really in our interactions between the two of us that I know whether that’s the right fit or not, almost regardless of what their areas of specialization are. That’s how I designed things, even like from that early branding, like the early website development. It was always from the place of an emotionally attuned and aligned practice.
Now, are there systems that you have, and I know we’re not talking tons of business, but I mean, I’m interested in, are there certain questions you ask or is it just an intuitive feeling if someone can connect with you on that emotional level? Like how do you, that’s hard if you think from like an HR perspective to be like, we want them to connect from an emotional level, but like, how do you —
It’s very hard though.
How do you do that?
Well, ah, good question, so I think that the, I think that number one is actually just around that non-clinical way of interacting in those first interviews. I think you’re right, it is hard to systematize. So I would, I do, I conduct interviews in a way that says, okay, I see that you’re a very established clinician. You’ve got lots of training, but tell me about yourself. Tell me what touches you as an individual? What makes your heart open? What makes your heart close? So I’m having these conversations pretty straight out of the gate, to be honest. I guess when I think back, actually, I’m probably building that into my job ads as well in the wording of what I’m looking for, so I’m hoping I’m attracting folks who speak this language.
But then I think foundationally too, it has been finding other therapists who I can have on my leadership team who share the vision. So that has come from working with folks on the team, they may be contractors, they’re therapists, but we’re connecting in our growth together and then I invite them in the leadership team in a way that I know that they are sort of representing us and speaking the language in a way that feels really authentic to me. So I can trust that anything that’s going through them is equally as aligned as anything that’s going through me.
Now what did we miss, like what around EFT and cancer, like what did we miss in this conversation? I feel like there’s a bunch of things I could ask that maybe I don’t even, I’m not even thinking to ask. What did we miss?
Yeah, good question. I think it’s always worth noting with, when we’re talking about cancer that you know it easily and not certainly, not always, not even the majority of the time lends itself to grief and bereavement. So I do that work as well through an EFT lens, and there’s a certain challenge that comes when an individual’s attachment, primary attachment figure has died. That work in practice is hard, but bringing an emotionally focused lens to it is just so very valuable. But I do want to recognize the uniqueness of the work when the attachment person is no longer there providing that day-to-day emotional attunement with them.
Now, it makes me think when should people refer out? Like when should somebody say, I want to find someone that specializes in EFT and cancer, or maybe not even cancer, like when would you say EFT you really should find someone that has some specialized training, and when should people do their own work and learn as a therapist and they’re fully competent in their own practice, when should they refer out?
Trauma plays a huge, is a huge variable here. Sometimes there are clients who we want to help them structure their emotional experience which is a key component of EFT. We are trying, and the client isn’t quite at a place where they’re able to regulate their emotions enough, have enough objectivity to them to be in that space with us in a therapy room. I think that would be a really important time to refer out, whether it’s to a trauma specialist or whether it’s to somebody who has a more, just has more training with trauma and EFT. That’s one place and I think the other is actually doing couples work with EFT, when we see couples where conflict is just so very, very high that we aren’t able to create a safe space in the therapy room. We try, we try hard, and we aren’t able to do that, and so it’s really not a good idea to continue with the deeper emotional work if we haven’t created a safe space for both individuals.
Such a great, great point. Now, if every private practitioner in the world were listening right now, what would you want them to know?
Number one is tend to yourself as therapist. I think that this is such a poorly understood part of our training that we carry so much of our client’s stories and suffering and emotional experience with us. That’s what makes us good therapists. We create the container, we hold it with them and for them, but we need to figure out a way to let that pass through our bodies, pass through our psyche so that we aren’t carrying a load that becomes so heavy that we can’t do the work anymore. I think for me, in my career, I’ve come to that later, and I wish I had come to it earlier and been better skilled earlier, but it’s never too late. And so to find our people and to find our own practices of embodiment so that we don’t end up being crushed under the weight of all of the incredible vulnerability that gets shared with us.
So awesome. Well, Carly, if people want to follow your work, they want to see your awesome website, I mean, Carly’s website stands out in such a great way, tell them where they can see that and find out more.
All right, I would love it. Come visit my website. I am at everwellcounselling.ca, the ca obviously because we’re in Canada, and counseling has two Ls in Canada. Be sure to come and visit us.
Thank you so much for being on the Practice of the Practice Podcast today.
Thank you so much, Joe. It’s been a pleasure.
Well, go take some action. As you hear these trainings and discussions maybe you can visualize your own specialty. Are there areas that you could specialize in more, that you could add layers of having a niche such as how Carly said she focused in on having people that have a cancer diagnosis? We were just talking just a couple episodes ago, let’s see, that was just, let’s see, two episodes ago with Anna, who was talking about redefining trauma with her lifeplottwist.com, where she was talking about the big things in life of death, divorce, and diagnosis. Maybe there’s an area that you want to specialize in just a little bit more.
Also, we could not do the show without our sponsors. Today’s sponsor is Blueprint. Blueprint has amazing digital assessments, intervention ideas, and worksheets, and you can sign up completely free. They’re offering this to our listeners right now over at blueprint-health.com. You can check it out so that they can help you streamline your documentation so you’re spending less time on your notes and more time on the things that matter. Again, that’s blueprint-health.com.
Thank you so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon.
Special thanks to the band Silence is Sexy for your intro music.
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