Ten Years of Doing Psychotherapy While Living with a Life-Threatening Illness: Self-Disclosure and Other Ramifications

Do not ask to know for whom the bell tolls: it tolls for thee.

The author describes the impact on her clinical practice of a 10-year struggle with recurrent breast cancer. Informed by tales of therapists who kept their disease secret and thus deprived patients of the experience of saying good-bye, she explores a process of clinical decision making involving self-disclosure and the clinical indications that patients were ready and wanted to learn about her illness. Nonverbal communications from patients, relevant history of disease in friends and relatives, and parallel experiences with others in their current lives were among the indications cited for self-disclosure about cancer. In clinical vignettes, the author explores her process of deciding who and when to tell, and the subsequent work of helping patients deal with the information and potential loss. She considers as well decisions about accepting new patients, countertransference challenges regarding her illness, and the authenticity that self-disclosure provides in allowing patients to determine for themselves whether or not to continue or terminate treatment.