Male cancer patients less likely to seek counselling but respond very well when they do

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Published: 11 Nov 2014
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Helen French, Counselling Services Manager - Tenovus, Cardiff, UK

Helen French talks to ecancertv at NCRI 2014 about how counselling services are accessed differently by men and women, with reference to socialised behaviours and mentalities – some of which can be useful but others less so. Men, on the whole, were less likely to seek help than women, but once they did they made progress more quickly than women, perhaps due to a "let's fix this" attitude.

We’ve done a research study of 139 clients that accessed our counselling services last year, that’s not the total number that accessed but those are the ones that completed an evaluation form. So we use a form called CORE-10, which is a Clinical Outcome Routine Evaluation form, to gather information on where clients are starting in terms of their emotional wellbeing and then the outcomes at the end where there has been any improvement in their emotional wellbeing. What we’ve seen in particular with men who access counselling, only one in five men of clients that came from counselling accessed the service. They actually report significantly higher scores than women in three areas which are anxiety, depression and hopelessness. So they’re reporting scores of 64% compared to women of 46% and we think the reason for that is that because men are presenting much later in their emotional journey, if you like, their anxiety and depression is a lot more formed than women’s. However, the good news for men is that they actually get to the nub of their issues a lot quicker. So again what we’ve been able to evidence through this research is that over six sessions men’s outcomes are a lot better and a lot quicker. So, again, it’s a bit of a generalisation but women, we like to talk and we’re used to talking with family and friends and so forth; men find that more difficult, more challenging. But what we’ve evidence is that when they do come for counselling, they start their counselling, they’re able to get, as I said, to the nub of things quicker and they go on to have really good outcomes in a lot shorter timescale than women. So that’s what we’ve found from our research.

What issues do you see?

I think with men in particular, again it’s a little bit stereotypical with gender stereotyping now, but we’re seeing that they like to be seen as the copers; certainly in Wales there’s quite a gender bias towards head of the family. It can be a generational issue as well that they’ve learned that they have to keep a stiff upper lip and they shouldn’t cry and all of those sorts of issues. So when men come for counselling quite often we see them quite upset and usually it’s about communication, they fell they can’t communicate with their partners because they’re the head of the house and they have to keep everybody else safe. So we start breaking down some of those barriers and we enable men to find ways of communicating with their families a lot better than they have been. Again, I think if you were to compare this to fixing a car, so a man will go out, know he needs a part for his car to fix the engine, he’ll buy the manual, buy the part and he’ll do it, and that’s very similar to counselling. So they come for counselling, we give them the tools, if you like, to be able to do the work they need to do in counselling and then they can go home and fix their relationships or whatever it is they’re concerned.

What about the impact of diagnosis on family life?

Depending on what stage of diagnosis they’re at, so if they’ve just had a diagnosis that can be quite difficult. We see a lot of people who are living with the diagnosis and then who are terminally ill. So again we hear from men, “I need to look after my family.” So they know they’re dying, they know they may not have long to live but there is still something about they want to look after the family and they’re struggling with their own mortality and what they leave behind. So they’re looking to leave some form of legacy and sometimes they don’t quite know or understand what that looks like. So we can help them make a plan, if you like, for what that looks like.

How does this differ to some of the women’s issues?

I think women seem to be more pragmatic in that they’re used to juggling a lot of things so they’re used to juggling family, work, everything else. I think men really struggle, it hits them really hard, and I think it goes back to that, “I’m the head of the household, therefore I need to be able to keep strong.” When an impact of cancer diagnosis happens, they struggle with how they can do that because they’re not necessarily used to juggling all those things. That might be a little bit controversial but I think they’re not used to juggling in the same way as women. Women are used to having to cope with lots of things and they can compartmentalise things whereas with men we find that it overwhelms and that’s where we’re seeing more people with undiagnosed depression and anxiety. That leads on, then, to how they live the rest of their lives – are they going to lead the rest of their lives with depression or are we able to work with them and seek medical help for depression as well? So it’s very, very different. Initially men find it very difficult to talk as well so in the first session we do a lot of work around what counselling is: we’re not there to fix things, we’re not there to give advice. So for men it’s a very, very different session than it would be for a woman.

Will these findings have an impact on the way you counsel patients?

I would like to see an uptake in the numbers of men accessing counselling services and I think it’s really important for them to understand what counselling is and isn’t. I think there are quite a lot of myths and still some stigma around the word counselling and what it means. So if we can get more men to access counselling services for that emotional support, psychosocial support, it can only benefit not only them but the impact it has on their families, their work colleagues. So a lot of the time when men become quite insular, and that could be through depression and anxiety, they will withdraw from the world. So that’s not a great way of coping. So what counselling can enable them to do is to look at the ways they cope and become less insular so they can still do the things that they would normally do while still coping with the cancer diagnosis. So I think a counsellor working with male or female can help with those issues.