TRAJECTORIES # 3 - Caring when life feels most threatened - Psychooncology
- 3 days ago
- 9 min read
‘We live in a society where we want to be taken care of, but we don’t take care of those who take care of us.’
Personal reflection: Professional path, area, approaches/methods, recommendation
Hi everyone! I’m Natalia, Spanish, 26 years old, and a psycho-oncologist in progress!
Although I’m ’in progress’, I have been working in this field since I finished university in 2021. But before moving on, I think it would be useful to explain how I decided to get into this very unknown but fascinating field.
This trip started during my internship (Psych-degree). I was searching for places to do it (obviously, searching for the BEST place, because they labelled an internship as a life-changer experience), and my mum came up with a contact who works in the Asociación Española contra el Cáncer. She remembered him being kind and an amazing professional because he helped my family during my grandmother’s last months of life. When I checked what the internship would look like, I saw that it was in a hospital, pure clinical… So, I decided to do it there, at least I would have the hospital experience! I thought. Everything was approved, but COVID got into our lives, and instead of doing my internship in the hospital, I did it in the clinic they have outside the hospital (hospitals were professional-only allowed). Before day 1, I remember having zero expectations, as my career goal was to work with children and adolescents, but this internship was an easy way to get credits, with a good schedule and a few minutes from home. When I finished my internship, I had the opportunity to have a brief rotation in the hospital, where I finally discovered my passion, palliative care (I know, it sounds weird, but it’s real, it's a fascinating field of psych). I fell in love with this stage of life because I probed what vulnerability really means. My tutor and I moved around Segovia and its millions of villages to put a silver lining to people who were struggling with life-changing decisions (last wills, testament, last goodbyes…). They opened the doors of their houses, and they made us part of their last moments alive. You can help them to decide, to communicate, to make sure they leave this world the way they want (or at least you try, because it is not always as easy as it seems.)
When my internship was over, a new Natalia was born. I completely changed my mind from going into child psychology to oncology and palliative care. Although it was a more complicated professional and personal path, as, at least in Spain, psychologists are not always part of the healthcare team.
The years after, I had the opportunity to have different internships and jobs in places where I worked with the elderly, chronic diseases and end of life. In all of them, I could discover new ways of helping people, the importance of working in multidisciplinary teams, and the importance of introducing mindfulness (as being present, not meditation or relaxation) in our daily practice.
During my experiences, I’ve learnt that clinical psychology sometimes is not about fixing brains or changing people’s conduct, but more about accompanying and being there for people when no one else knows how to do it. We have a natural tendency to save and fix everyone, and sometimes this is our source of frustration. Because, on the contrary, we do not have to save anyone, we have to give them light when they are lost, and hold them when life gets hard, giving them our tools (according to their needs and context) to add to their toolbox.
Currently, I’m working in the same place where my path began (Asociación Española contra el Cáncer). It is an NGO in which we help patients, family and survivors to go through cancer and its changes, in multidisciplinary teams, to be sure that they receive comprehensive care. I’m working as a clinical psychologist but also as a community psychologist, another unknown area of psych in which you work with the resources of the community (social and health systems) to bring about social changes related to health promotion and cancer prevention. So, in summary, I have the best of both worlds, my clinical psych hours, in which I could help people, and my community hours, in which I have a more dynamic, macro and transcendent work.
If anyone reading this has been touched by any part of my ‘’testimony’’, it could mean that you may have sensitivity for this type of vulnerability. Although everything that I addressed in the paragraphs below sounds fascinating and easy, the reality brings us a more complicated path as psychs are not as recognised as other professionals (e.g. doctors, nurses…)in the healthcare system. But, fortunately, hospitals are not the only places where we could work with cancer, the elderly and the end of life (and they are even more fascinating). NGOs are a good example of places in which you could work as a psychologist, and you will have a psych role, and you will be recognised as one. Also, nursing homes are recently incorporating psychologists and social workers in their teams as they believe that they are essential pieces to improve their residents’ quality of life. These two are just some examples in which I’ve had first-hand experiences in how psychologists could work in their teams, and they value our work, which is not as easy as it seems. So, what I would recommend is to search for any NGO, nursing homes, or associations in your city/town and to get in touch with them and see how they work, if they have any volunteering that you could do to get in touch with them or even if they have any fellowship or project you could join, because this is how many of us end up working in this field, you get into a fellow, you prove a necessity and they find the needed funds to create a full-time job.
Tools & resources
Before moving into the resources or tools that I used as a psycho-oncologist, I think it is key to mention the areas in which you could work if you decide to move into this area of expertise. As psycho-oncologists, we could help people in every stage of the disease, from the diagnosis to the survival stage, or, if the disease does not have a cure, we can accompany them during the end of life and in grief. We are taught to assess any need that arises from cancer in any dimension. And I think being taught is essential because in psychology, my expertise is not as seen as in others, but I believe it is needed. Because you do not go to a cardiologist to check your brain, if your brain is damaged, you make an appointment with a neurologist. That’s how I believe it should be in psychology, we can not know about everything, we need to be specialised, because each area has its peculiarities, and it is professional and ethical to attend only to what is within your knowledge, never go further. This is why I, as a psycho-oncologist, as hard as it can be sometimes, I only help with cancer-related demands; if something else is around, I refer to another professional. Hence, I would say that our first KEY resource would be to have a list of the mental health resources in your town- meaning, psychologists, psychiatrists, mental healthcare centres…- because when you face a problem in your practice that goes beyond your competencies, you will know where to send your patient, so you will not feel like abandoning them.
Secondly, as I mentioned before, cancer is a life-changing experience. Literature says that there is a ‘’before cancer-reality’’ and an ‘’after cancer reality’’. It is experienced as a tsunami that arrives and turns everything upside down. Therefore, a key aspect to work on is values, self-perception and roles because they change in almost all cases and they need to be reconfigured. In order to do so, I think it is key to work from a contextual point of view, and I think Acceptance and Commitment Therapy is really useful. I would say that I begin my cases, most of the time, with the metaphor of ‘’The Garden’’ because it gives me a clear picture of the real-time situation of the patient. Plus, it gives me a source of evaluation as we can update it as we work on the different areas.
Also, this therapy is very useful because it works with something key to cancer-related events: denial. Many times, we face patients who wish they could avoid having cancer, and it is their main source of pain and suffering. Therefore, working from an acceptance and commitment therapy approach helps us to understand that we can not avoid certain events, but we can choose how to relate to them. For this, I would work in self-compassion, inner dialogue and mindfulness (again, as living presently, not as relaxation). For this last, I like to work with ‘’anchors’’, which are grounding techniques that help to set your mind in the present moment. These 3 areas touch the core sources of suffering that affect a person who is diagnosed with cancer: uncertainty, not being able, and rigidity.
Furthermore, we need to work with them in integrating different relaxation techniques because they are subject to high levels of anxiety and uncertainty, and they must learn how to lower their stress and regulate themselves, because otherwise, they end up burnt out. The most useful tools for this (for me) are diaphragmatic breathing and progressive muscle relaxation from Jacobson (careful with this if your patient has any physical pain!).
Last but not least, although when we talk about cancer, we need to tackle the most transcendental dimension, and so we use more third-generation approaches. I believe that it is also essential that we work on the most basic psych-work: cognition. We must evaluate and work on their beliefs and how they are used in their daily life. We may need to adjust some of them, and we need to make them aware that the way we think and the way we speak will influence the way we feel and how we act. For this, I have flashcards with different cognitive dissonances and an iceberg to illustrate automatic and core beliefs, and it helps me to work through the ABC model from Ellis.
To finish, I have mentioned some of the key areas and tools that are essential to manage if you want to become a psycho-oncologist, but, as in any field in psychology, we are constantly evolving, and new techniques and approaches are born. Hence, I would recommend you to keep in touch with associations or schools in the field that you want to specialise in, because they are always up to date and they will inform you about the latest news in the field.
Oops, I almost forgot the most important part of today’s reading: take care of yourselves. Self-care among psychologists is greatly undervalued, especially by ourselves. We take care of others, we put others first, but what about us? If we do not dedicate a bit of time every day to ‘watering ourselves’, we will burn out, for sure. So please, eat enough, sleep 8 hours, keep in touch with your significant others, do exercise every day, and ask for help if you need it. Suffering is difficult to bear, and we need to ‘charge’ ourselves every day to be able to do it.
Why do we decide how we are born, but we do not decide how we would like to die?
In conclusion
We close this issue with a reflection that doesn't offer easy answers, but holds space for necessary ones: looking at human development also means knowing how to stand beside someone in their most vulnerable moments — without flinching, without fixing, without rushing toward resolution.
Approaching the experience of cancer isn't about minimising suffering, but about trying to walk alongside it; it's not about removing uncertainty, but about helping people find their footing within it. As Natalia reminds us, our role is not to save — it is to accompany, to illuminate, and to hold.
As psychologists, students, and researchers, we are often called to balance presence and distance, care and professional boundaries, hope and honesty. It is a work that demands tools and training, but also a gaze capable of sitting with the unknown.
If this issue has stirred something in you — curiosity, discomfort, recognition, or new questions — then it has already done its job. Our library grows right here: in the spaces where knowledge meets vulnerability and allows itself to be transformed.
As psychology professionals or students, how do we prepare ourselves to face mortality — our patients' and, inevitably, our own? Is end-of-life care a topic you feel drawn to, distant from, or somewhere in between?
Tools & Resources
Natalia shared several tools she uses in her practice. Among the theoretical references, Acceptance and Commitment Therapy (ACT) is the common thread running through her work — particularly the Garden metaphor and anchoring techniques for staying present. For those who want to dive deeper, the go-to book is "ACT Made Simple" by Russ Harris, accessible even for those approaching this framework for the first time.
On the cognitive side, Natalia works with cognitive distortion flashcards and Albert Ellis's ABC model — classic tools that remain highly effective for making a patient's inner dialogue visible.
For those interested in exploring psycho-oncology, a good starting point is the Sociedad Española de Psicooncología (SEPO), which publishes up-to-date materials and organises training programmes. In the UK and internationally, the British Psychosocial Oncology Society (BPOS) plays a similar role. Many associations, like the AECC, also offer resources for professionals and volunteers.
Book of the month
"Being Mortal" by Atul Gawande
A physician reflecting on what modern medicine so often forgets: how we want to live until the very end. It's not a psychology book, but it may be the best meeting point between care, vulnerability, and the meaning of accompaniment — the very heart of Natalia's work.
Want to share your world of psychology or share your resources? Send us an email: thedevelopmentallibrary@gmail.com — our library grows thanks to you.
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