With my cancer diagnosis came fear, sadness, physical pain, and emotional heartbreak. 

Cancer also introduced me to new experiences, forged friendships, and invited me to grow in uncharted ways. During my treatment and to this day as a survivor, I use Dialectical Behavioral Therapy to make sense of these tensions and share the concepts and strategies with my clients in my work as a therapist.

Dialectical Behavioral Therapy (DBT) is an evidence-based therapy modality designed to develop skills for practicing mindfulness, tolerating distress, coping with emotions, and improving relationships. 

Personally, I have found the knowledge and skills from DBT helpful in all aspects of my life and undoubtedly in my experiences with cancer treatment and survivorship. Professionally, I weave DBT concepts and tools into my work with clients—specifically with folks affected by cancer. 

Below, I reflect on personal experiences, using the Interpersonal Effectiveness Handout on Dialectics from DBT to share how these concepts apply to life affected by cancer.

All bolded text has been taken directly from the Interpersonal Effectiveness Handout, which can be found in the DBT Skills Training Handouts and Worksheets Second Edition by Marsha Linehan.  

Dialectics Remind Us That

1. The universe is filled with opposing sides/opposing forces

As a therapist, I draw on concepts from Dialectical Behavioral Therapy (DBT) on a daily basis.  Once you put on the DBT glasses so to speak, you can’t take them off. I see the dilemmas that my clients bring into the therapy space through the lens of DBT, which encompasses a framework for understanding the world as well as a toolbox of skills. 

At the core of DBT lies the concept of dialectics, which holds that two things that seem like opposites can both be true. For example, you can be devastated about receiving a cancer diagnosis AND accept the diagnosis as reality. The premise is simple yet profound and oddly, uniquely suited for navigating cancer. 

There is always more than one way to see a situation, and more than one way to solve a problem. 

While I know DBT works as a therapy modality because I’ve seen clients use the skills and experience improvements in their lives, I know DBT works because I became a student of it, both professionally and personally, when I was diagnosed with breast cancer five years ago and have found it indispensable ever since. 

2. Everything and every person is connected in some way

According to DBT, we can experience Reasonable Mind, Emotional Mind, and a synthesis of the two: Wise Mind. 

At the age of 30, I made a Reasonable Mind decision to have my ovaries and fallopian tubes preventatively removed to reduce my risk for developing ovarian cancer. Facts, reason, and logic rule the Reasonable Mind. 

Given that I carry the BRCA1 gene mutation, I knew that I was at increased risk for ovarian cancer and having already had breast cancer, I elected to have the surgery. My mom, also a BRCA1 carrier, had passed away from ovarian cancer after having breast cancer and I wanted to rewrite our collective narrative.

The waves and the ocean are one. 

Now, three years after my preventative oophorectomy and salpingectomy, I find myself more often than not in the realm of the Emotion Mind when the topic of fertility is concerned. Moods, feelings, and urges rule the Emotion Mind. My friends are having children and with each of their pregnancies, I feel an undercurrent of jealousy, envy, rage and sadness alongside happiness for these friends. 

The slightest move of the butterfly affects the furthest start. 

I am grieving my ovaries and with them the ability to become pregnant spontaneously. I am scared of what it will be like to try to have children of my own. At the same time, I feel abundant with gratitude for my health and powerful in my autonomy to make a choice to protect my health. 

Again, opposites that can both be true.

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3. Change is the only constant.

There is a before cancer and there is an after cancer. For me, I crossed that threshold during the height of the pandemic. I was ushered into a new era by a kind radiologist delivering the news that I had breast cancer at age 27. 

Meaning and truth evolve over time. 

The lines between before and after cancer are more blurry when I reflect back on my mom’s experience with cancer. I was too young at the time to know how our lives would change and I don’t remember a clear line drawn in the sand. 

More recently, two friends of mine from different circles of life have learned of their own breast cancer diagnoses. I have been a witness to this delineation for them and there is now even a new dimension of before and after for me. They have their before and after; I have my before and after. I have met various friends through the cancer community, but this is new: watching as friends who knew cancer peripherally are now part of this unique club. These friends are now before cancer friends AND after cancer friends. 

Each moment is new, reality itself changes with each moment.

4. Change is transactional

I felt drawn to work as a per diem social worker at the hospital where I had my double mastectomy because of the care I received as a patient. I wanted to support patients the way I felt supported as a patient myself. When I first started the job, I spent a few shifts shadowing another social worker before it was my turn to meet with a patient independently. The first case I was assigned when it was time for me to branch out on my own was a woman newly diagnosed with breast cancer. The sense of purpose I felt meeting with her in this new role was deeper than the patient could have known. 

The environment and other people influence us. 

A few years have passed, and I have since left that job and endeavored to start my own private practice specifically supporting folks whose lives have been impacted by cancer. In this work, I feel myself zooming in on the experience of the initial stages of diagnosis, the routine of treatment, managing side effects and navigating relationships. 

I know intimately what that is like. I can also zoom out and see the ways in which cancer is ugly and scary, and how it also plants the seeds for new meaning and connections to grow from the rubble. I can reach into the well of my own experience and perspective in the attempt to support others. 

What we do influences our environment and other people in it.