I am a therapist: should I tell my clients I have cancer?
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I am a therapist: should I tell my clients I have cancer?
Should I tell my clients I have cancer? The literature says no, but for therapist Miri Mogilevsky, their ethics told them something else.
Self-disclosure – what to share about yourself with a client, and how–is a big topic of debate among therapists. Some old-school psychologists think that you should share as little as possible, and be a “blank slate” to avoid distracting the client from “the work.” Other therapists, especially those who operate within a feminist or relational lens, tend to believe that appropriate self-disclosure can strengthen the professional relationship and move the work along.
Most agree on a few things, though–don’t share personal medical details with your clients, and don’t share anything that you haven’t fully worked through already. It’s one thing to mention to a client that you went through a divorce years ago and that there’s no shame in it and that healing will come; it’s another to tell a client that you’re actually on your way to the attorney’s office after work.
Early in my career, I was completely on board with these general guidelines. Then I got diagnosed with cancer in late 2017, and suddenly they didn’t work for me anymore. I started to ask myself, should I tell my clients I have cancer?
Immediately after my diagnosis, I dreaded having to explain my upcoming absence to my clients. I didn’t know anyone in my field who had ever gone through anything like this. Neither of my supervisors at work did, either. Most of the time when something medical interferes with work, it’s much more straightforward than cancer treatment–for instance, a surgery. You tell your clients, coworkers, and supervisors varying degrees of detail about the fact that you’ll be out for 6 weeks, and gently shut down any inappropriate questions.
But I was about to start chemo and I’d be working through it. I wasn’t sure how much, and I knew that might change as I went through treatment. As it turns out, it’s uniquely impossible to be vague or coy about cancer treatment. I knew right away that if I tried to spin some bullshit about how I’d be off a few days every other week for “my treatment” and then start showing up in wigs, I would come across like I’m either ashamed of it, or think my clients are children. People know what it means when you miss work every two weeks and lose your hair.
Should I tell my clients I have cancer?
Unable to get any clear direction from professionals with more experience, I turned to Google and searched: “should I tell my clients I have cancer?” Here I found a number of articles by therapists who’d had cancer. They all told their clients that they’d be “leaving this position” and referred them to other therapists. I was confused. Were they not planning on returning to work? Would they have to just build up an entirely new client base? That sounds like a lot of fun on top of recovering from chemo.
Read more: Keeping cancer a secret
One article described a therapist processing her imminent departure with her clients and having to pretend that she was moving on to another job, and reassure her clients that it wasn’t because of them and that she really valued working with them. Later, she received an email about her own former therapist, who had terminated treatment with her the same way. He’d died of cancer.
Why I told my clients I have cancer
Ultimately I decided that this level of deception and fakery not only goes against my ethical values but would literally be impossible for me to manage. Telling my clients I had cancer was painful enough; I couldn’t imagine having to also pretend that the cancer was actually a cushy new job, or having to apologize to my clients for leaving our work unfinished as if it had been my decision, rather than a horrible thing that happened to me.
So I went for the opposite extreme. I told every single one of my clients that I’ve been diagnosed with breast cancer and would be undergoing chemo followed by surgery. I invited them to ask me any questions they wanted about it and reassured them that I wouldn’t answer anything I truly felt uncomfortable with. Some didn’t ask for any details at all. Most asked if I felt okay to be at work. (I did.) A few wanted to know more–what stage, what type of surgery, what chemo feels like, if cancer runs in my family.
Was it awkward? Sometimes. Did it distract from the client’s therapeutic needs? Maybe, in some ways. Is that ideal? No.
“Vulnerability isn’t just good for my friendships and partnerships; it’s good for my professional relationships too.”
Therapists are human too
The problem, though, is that therapists are in fact human, and we have human bodies that fail in the same glorious ways as everyone else. I don’t believe I could’ve continued to do this work effectively throughout my chemotherapy while actively deceiving clients about what I was going through. I also don’t think that would make me a very good role model.
A lot of surprising conversations came out of it. One client revealed his own battle with cancer, years ago. He’d never talked about it. A few mentioned that they really ought to be doing breast self-exams because it runs in their families; I told them where to get more information and explained that when caught early, breast cancer is extremely treatable. One client, surprisingly, brightened and smiled when I told her. She explained that a beloved relative of hers is a survivor of breast cancer several times over and that this relative is her mentor and source of inspiration.
Another client said she was glad I told her. “I’ve been working on being more vulnerable and open with the people in my life,” she said. “If you’d tried to hide this, it would’ve sent the wrong message.”
That conversation was a reminder that while therapists often keep personal information from clients in order to “protect” them or to avoid distracting them, clients may interpret this secrecy as a product of shame, callousness, or both.
That’s not to say that my transparent approach didn’t have its downsides. It did sometimes make my clients feel awkward about sharing their own problems; cancer tends to be that thing people remind themselves at least they haven’t got, so it can be weird to vent about your shitty job when someone’s just dropped cancer into the conversation. But I always reassured my clients that 1) I was there because I wanted to be, and 2) I still saw their problems as valid and important even though I had cancer. The awkwardness usually didn’t last.
It did sometimes make things harder for me, though. When I was first diagnosed and didn’t know the staging or prognosis, I could hear the unasked question on many of my clients’ minds. No, I didn’t know if I was going to survive or not. (Even now, in remission, I can tell you that I’m pretty unlikely to die of cancer, but recurrence is a thing and it could happen anytime.) I could only tell my clients the same thing I could tell myself–that I had no reason to expect the worst, so therefore I’d hope for the best.
Sitting with uncertainty is one of the most difficult things in life, and probably the most difficult thing about cancer especially. Yet it’s also one of the most important skills to develop, for me and for my clients too.
As the treatment went on, I often found myself having to be a bit performative when clients asked how I was doing. It’s true that chemo isn’t too bad for many patients nowadays and that I felt okay most of the time. But some days were very hard. Yes, there were days when I wished I’d stayed home from work, but I didn’t because I wanted to be as consistent as possible with my schedule. There were other days when I called off even though I’d planned to be there.
Most days, I wasn’t my best self at work. I just wasn’t. It’s just impossible. The only other option would’ve been to take all four months of chemo off work entirely, but that would’ve been worse for my clients, worse for me, and ultimately impossible. I didn’t actually have enough medical leave for that.
So although I didn’t tell my clients many details about treatment, I continued to be transparent. I told them that I felt tired a lot. I mentioned that chemo sometimes left me with bone aches, which is why I stayed home a few days after each treatment. I kept a positive attitude and told them that many chemo side effects are very well-managed with medication and that chemo isn’t what it used to be. My hope is that if any of them end up being diagnosed with cancer, or having a loved one who is, they’ll remember that, and they’ll remember not to be afraid and to ask the doctor for help if they need it.
Disclosing this to my clients a week after diagnosis–telling 40 or so people that I have a potentially lethal illness and then taking care of them around that disclosure–is the most difficult challenge I’ve faced in my professional career so far. I found myself having to reassure people about something happening to me, something I found (as most people would) horrible and terrifying.
This situation turned the usual ring theory inside out. Normally the person at the center of trauma or tragedy is the one who gets taken care of by everyone else. But as a therapist, it’s my job to take care of my clients. This is probably why the conversations were sometimes so raw and awkward–my clients sensed that they “should” be the ones comforting and reassuring me, but they also understood that that’s not their role. And because of the strong therapeutic relationships we’ve already cultivated, we were able to talk about that directly.
I had my last chemo treatment in February 2018, so things became more straightforward after that. But that doesn’t mean I’ll be able to stop having conversations about this with my clients. I have other surgeries and treatments in my future and it could drag on for years. I may not be able to be at work as much as my clients (or I) would like, but I hope that by being open and honest I can reassure them that help is available even when I’m not there and make sure they know how much I wish I could be there with them.
Between getting diagnosed and finishing treatment, I had to radically redefine what professionalism and appropriate self-disclosure mean to me. As it turns out, vulnerability isn’t just good for my friendships and partnerships; it’s good for my professional relationships too.
Miri Mogilevsky is a writer, teacher, and practicing therapist in Columbus, Ohio. They hold a BA in psychology from Northwestern University and a master’s in social work from Columbia University.