A Case Study By Nadine Kooiker, Career, Business, Leadership Coach, NETHERLANDS
Priority and Value: Reframing Perspectives, Even in the Hardest Times
The main players are Anne (who is undergoing the coaching) and myself, as a coach. Anne lives with her husband Pete in France. They’re in their early sixties and have lived in France for over a decade. Their children live abroad. They have a loving group of friends who they see often, who all have intercultural backgrounds. She misses her children and family in the Netherlands however they are also grateful to be able to live close to Lake Annecy, a serene lake fed by mountain springs and known for its clean water.
We have had around 4 sessions with each other, and the case study below describes one of the key challenges we have worked on.
The Challenge
The calm and beautiful nature is important to Anne, who is on medical leave and receives sick pay. To provide the right context, Anne has been diagnosed with stage 4 lung cancer back in 2020 and is undergoing continuing treatment, for which she is supported by a full medical and integrated health team. She’s been hospitalized a few times since as her immunity has changed dramatically due to a few surgeries. She’s undergone radiation therapy and is currently on immunotherapy. Apart from being a patient, she is a mother, grandmother, friend, and wife. This life-changing event has of course stirred up many, if not all, aspects of her life, identity, relationships, work situation, health, finances, and much more.
Her main challenge is that she is struggling to manage her life prognosis and the urgency that is attached to making the most out of today and balancing it so that for those around her, the day-to-day work is continuing.
Challenges encountered during the coaching session:
The abrupt ending to her work life: Becoming ill, meant Anne that she abruptly had to stop working as a nurse, a job that she had done since she was 17 and fulfilled her with such incredible joy and fulfillment. She is a naturally caring person and she enjoyed taking care of her patients. It gave her a sense of purpose. Whilst reaching retirement is a highly noteworthy goal for many, for Anne such a sudden transition was challenging. And it still is, after more than 2,5 years.
Being restrained in activities and social life: She is often alone at home while her husband Pete works full-time. He is a specialist nurse as well and works night shifts too. Their dogs Scooby and Lester died a few years ago, who kept them company. She’s very fond of dogs and would love to have another but due to her condition, it will be a bit challenging. Her level of energy decreased, which means she finds herself often at home, resting, and sleeping. She keeps busy, meditating, reading, resting, going for a walk, chatting with her neighbors, and watching TV.
Other friends of her aren’t sick and she misses hanging out with them as everyone around her doesn’t have as much time as her, and at the same time, she likely has little time as the cancer is not curable (yet).
Husband ‘needs to provide’ and final year before retirement: She said that the main challenge she has is that her husband Pete is working so much that she is left at home, alone. Her children are abroad and her friends are busy. She feels alone. She wants her husband to work less but she also doesn’t want to take work away from him as he has 10 more months to his retirement and they need the money. Anne gets less financial support than she used to when working. She feels conflicted because it’s her life too and she feels a bit alone right now.
Priority and Value
Challenge in Summary
This brings forward an urgency and challenge to make the most of her time and life. She misses her husband and would love to spend more time with him.
Feelings and Values Involved
There is a myriad of emotions, feelings, and values involved and present for Anne. She has talked about how cancer has completely changed her and how she perceives the world around her, on different levels related to this specific challenge and issue.
The Cognitive Appraisal Theory (Lazarus, R. S.,1991), explains how emotions are a result of our cognitive appraisal of a situation. According to this theory, our interpretation of an event determines our emotional response. For example, if we perceive a situation as threatening, we may experience fear, while if we perceive a situation as a challenge, we may feel excitement.
In this case, Anne is constantly battling with fear due to the uncertainty of the situation. This clouds her feelings, increases the fluctuation in her feelings, and has changed her values. This is backed up by Stanton et al (2019) who state that cancer can lead to feelings of uncertainty and loss of control, which can affect a person’s sense of self and identity. Park et al (2012) also state that cancer can lead to changes in a person’s values and priorities such as an increased appreciation for life and relationships.
Her identity and self: She feels uncertain and has a loss of control over her life. She does not know how ‘long’ she will have and how the disease progresses. In the winter months, it’s often more difficult as a cold can progress into a lung infection, which results in a hospital stay. This loss of control has affected her sense of self and identity. In relation to this specific challenge, it means that she values ‘getting the most out of her life and experience as much as she can’.
Her body: She cannot ‘trust’ her body the way she used to. During our sessions, she mentioned she is a very aware person, has done a lot of mindfulness, and feels in tune with herself. Not knowing how her body progresses, feels as if she cannot trust or control her body. She mentioned that her body can sometimes feel a bit external to her as if it has a mind of its own. She doesn’t want to be sick, yet her body is fighting it. In relation to this specific challenge, she wants to honor her body and values feeling as healthy and energetic as possible. That also means she wants to eat and drink healthy, avoid alcohol, and do light exercise to keep her strength and endurance. To have an overall balance in her life.
Her social world: Right now, she feels lonely. She said, “I know that I’m not alone, because I have a lot of friends and family that care, however, they just have less time than I do”. She feels that having a certain social context, such as the support of her family and friends, helps her cope with her emotions and stress. She feels lonely, which involves that she feels sad. She misses her children who are adults and have a busy life. They have a good relationship and they visit each other frequently, yet because they also have families she wants to provide them with the space needed to take care of their needs too. She is very independent and gets through the days.
Her relationship: She is of the opinion that Pete works too much. She feels lonely and misses him because she’s home a lot. She feels disappointed. At the same time, she values his opinion and also that he is in his last year of work before retiring so she doesn’t want to ‘take away his job from him’, just to be with her. She feels very conflicted about this.
Different disempowering perspectives and their respective power tools
Disempowering perspective: Reacting to daily habits in her routine
In general, Anne is a very positive person. Logically, she is dealing with sad and negative feelings around her sickness. We explored how she spends her time currently and how she would like to spend it instead. She has mentioned how she suppressed her feelings when she felt tired and stressed. During our sessions, she addressed that she was watching too much TV. In a way it made her feel better, as it distracted her mind from uncomfortable feelings and being alone, however, she addressed that the feeling of loneliness was growing. She then realized it was an automatic behavior, part of her routine. To the extent that she didn’t see it anymore.
New Empowering Perspective: Responding to Her True Needs
In one of the sessions, Anne mentioned she wanted to be more conscious about her activities throughout the day. I asked her what her ideal situation was. Anne mentioned a list of things. I asked her which one would have the most effect in providing relief. She identified that she could call a friend and ask her if she would like to join for a walk. Not every day, but ahead of time so they can plan and she will feel less lonely. She mentioned it’s often the afternoon she feels more lonely and will watch TV so she will plan ahead and schedule this in her routine.
Disempowering perspective: Truth vs. Fraud – not taking up her own space When asking her ‘what is it that you would love most to happen’? Anne mentioned that she would love to have her husband more at home so they can go on trips together, go for a walk, see each other and visit the Netherlands to see their children.
When asking her, ‘What stops you?’, she mentioned that her husband still has to work as it is his final year before retirement. She doesn’t want to take that away from him as work is important to him. They might need the money. But she wasn’t quite sure about that. When I asked ‘What have you discussed with your husband about your wish?’, she said that she didn’t want to bring it up as she didn’t think it was important enough for him to change around his career. That was a limited belief and prevented her from taking action. What was her truth here? Anne didn’t want her husband her issue to be impacting her husband so that he would miss out on an important part of his life, namely his work.
Empowering Belief: Change Can Happen – I’m Worth It – Her Truth
As a coach, I asked what happened and if she would bring it up with him. What would happen if she did not bring it up and it would stay as it is? She realized that she would absolutely have to bring it up, as she too, was important. It is their life together and she has an equal part in it. We explored what that means to her and she mentioned that perhaps he could work less. She realized she was just as important as him. Her health and final life stage were just as important as his final stage of work. For them to be happy together, they need to prioritize each other.
Her Feelings After
Her learning and insights led to relief. She actually mentioned that. She said, “Things are much clearer for me now. I see it differently. My time left here is just as important as his. It’s ours. I am really grateful. I feel relieved and I will talk to him about this”. In her expression and face, she looked excited, as if she regained new energy. She feels empowered and is ready to take action.
Decisions and Goals
Having an increased priority and value shift on relationships when having cancer is common. Northouse et al (2010) state that coping strategies, such as seeking social support, can help individuals with cancer manage their emotional distress. Finally, the social context such as the support of family and friends, can influence a person’s emotional well-being and quality of life during and after cancer treatment (Kroenke et al, 2006).
Her goal is that they will have more time together, which will mean that he will have to work less or in a different way. She decided that she will bring it up to her husband. In terms of accountability, she wanted me to check in with her in a week, and in the session we had thereafter she mentioned that he was on board with it. She felt very relieved. They even talked to their financial advisor, who confirmed that there was space for him to work less. Anne mentioned that her husband and she even worked out together, and she thinks it’s a bit of a relief for him too. The next step would be to arrange it definitely with his work.
References
Lazarus, r. S. (1991), cognitive appraisal theory, emotion, and adaptation. New York: Oxford university press.
Park, c. L., & Edmondson, d. (2012), meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning and restored just-world beliefs. Journal of consulting and clinical psychology, 80(5), 823-835.
Northouse, l. L., katapodi, m. C., Song, l., zhang, l., & mood, d. W. (2010), interventions with family caregivers of cancer patients: Meta-analysis of randomized trials. CA: A cancer journal for clinicians, 60(5), 317-339.
Stanton, a. L., & revenson, t. A. (2019). Adjustment to chronic illness: Theory and research. In s. Folkman (Ed.), the oxford handbook of Stress, health, and Coping pp. 311-325). Oxford university press.
Kroenke, c. H., rosner, b., chen, w. Y., kawachi, i., colditz, g. A., & Holmes, m. D. .(2006) Functional impact of cancer by age at diagnosis. Journal of clinical oncology, 24(18), 5424-5432.