Abstract
This doctoral portfolio is almost exclusively about the psychological effects of cancer. In view of the fact that one in three people will develop cancer in their lifetime, and that a third of these people will develop significant psychological problems, it is fitting that clinical psychology is increasingly turning its attention to this important area of human experience. Psycho-oncology is a small but growing field with many significant questions still to be answered. It could be argued that the public's dread of cancer, as a physically wasting and unremittingly painful disease, is misplaced. The growth of palliative medicine from its origins in the hospice movement, have led to enormous advances in symptom control. Rarely is physical suffering an issue where palliative care services are well developed. However, the psychological effects of cancer probably bear a much closer resemblance to common images of the disease as wasting and painful. The trauma of diagnosis heralds turbulent and far-reaching changes in a person's psychological and social world, many of which slowly eat into the fabric of people's lives. As yet, the small field of psychosocial oncology has had little impact on the urgent need to help people negotiate this time of personal crisis and prevent some of the suffering associated with it. Thus, all three parts of this portfolio concerned with cancer attempt to take an implicitly preventative perspective. The first review paper examines the evidence for whether the diagnosis of cancer constitutes a trauma leading to post-traumatic stress disorder, and what this implies for improving the way in which the diagnosis is delivered. My interest in this area stems from my patients' apparent need to talk about this particular moment in their cancer journey, the bad experiences many of them recount, and their often persistent and intrusive memories of it. The second paper concerns what the lay person refers to as the process of "coming to terms with cancer"; in other words, the psychological adjustments that people make in the process of restoring some quality to their lives in light of the implications of their disease. This prolonged period of psychosocial transition is the fertile ground from which psychological disorders develop yet, despite their crucial role, the processes of adjustment have rarely been articulated or even described within the field of psychosocial oncology. The clinical research is a randomised controlled trial of an intervention designed to prevent psychological problems by enhancing the effectiveness of couple support. The motivation for this research again came directly from my clinical work. Over the past few years, I have met countless women who have expressed profound disappointment and disillusionment at the level and quality of support they have received from their male partners; a story I have virtually never heard from a man. Finally, I have attempted to inject the clinical audit paper with something of a personal tone in the belief that, more than most professions, clinical psychology necessitates personal involvement. The paper attempts to address some of the innate contradictions which appear to exist within clinical psychology, taking the trainee selection process as an example.