Coaching through the eyes of cancer
Paula Feathers shares with us a profound and honest reflection on her experience with cancer and how it has allowed her to invigorate her ability to coach.
The handy alliteration allows me to link two seemingly unrelated words. And mostly, to be honest, they have little in common. Whilst both are challenging, and may provide opportunities for ‘personal growth’ (hands ironically poised in mid-air making quotation marks…); cancer is cruel, painful, random and scary…whilst (organisational) coaching can be energising, insightful, educational and exciting.
But as I entered the dark tunnel of cancer treatment and recovery, my experience and training as a coach became strangely relevant. And, perhaps not surprisingly, cancer provided opportunities to revisit and improve my coaching practice.
Diagnosis and treatment
I was diagnosed in November 2016. I’d had a weird lump on my neck for several weeks (probably a gland said my GP) but when it began to grow I had further investigations. Cancer cells were subsequently discovered on a couple of lymph nodes. The cancer is called a Squamous Cell Carcinoma and can occur anywhere on or in the body. Mine was in the neck. This was described as ‘really bad luck‘. I had always assumed that I was low risk for cancer – I’m a usually healthy, vegetarian, non-smoker who has the odd glass of wine with dinner. But cancer respects no such boundaries and nothing is fair, so after a very brief and pointless “why me?” moment of self-pity, I embarked on possibly the most significant challenge I’d ever faced, determined to get well. The treatment included radiotherapy and chemotherapy, and more than one medical specialist said it was the most gruelling treatment given to any cancer patient (the oncologist joke is that they can usually kill the cancer, they just try not to kill the patient in the process…) I should mention that my journey was not undertaken alone. On my team I had my husband, our three adult kids, and numerous friends. From the UK, my sisters, cousins and friends cheered on the sidelines, and one cousin, Susy, came over for three weeks to help.
During my (I’d have to say harrowing) six months of treatment and recovery (I shed 13 kilos and lost a large patch of hair), I’ve had plenty of time to think – mortality focuses the mind. Here are some of my conclusions about the connections between coaching and cancer.
As coaches, we aim to ask questions which deepen the individual’s understanding of who they are. Sometimes we use psychometrics, or ask questions which go deeper than the superficial. We attempt to surface the unconscious drivers and assumptions so that we can understand automatic behaviours. We encourage people to articulate their strengths and what/who supports them. The aim is for them to be self-sufficient, capable and resourceful. We invite them to explore their narrative, the stories they are telling themselves. We then encourage them to look at which parts of the story are supporting and helpful, and which parts are destructive or holding them back. And by inviting them to challenge their narrative, we can support people to think in different ways about their problems. Once we know ourselves well, and understand unconscious patterns, we can, with help, choose our own solutions and decide for ourselves the best way to approach dilemmas rather than asking for advice or relying on others’ well-intentioned suggestions.
My training as a coach has allowed me to have a deeper understanding of who I am, understanding my strengths and capabilities as well as my flaws and limitations. As a result, I knew instinctively that for me to face this challenge, I needed people around me. I made sure that I NEVER went to the hospital alone. As an extrovert, I needed to be able to verbalise my feelings, so I had people around me constantly, as I processed the (often confusing, sometimes alarming) information.
Other cancer patients I’ve spoken to have said they preferred to go it alone. One friend said he treated it like a job, and became interested in the science behind the treatment. For him, it was a personal journey and he felt empowered and in control by always attending treatments and appointments alone, despite the fact that his wife was more than happy to accompany him.
Another friend told me that she wanted permission to be ‘not herself’ as she underwent treatment. She’s normally larger than life – centre of things kind of woman – with lots to say. But for her she needed to be ‘someone else’ whilst undergoing treatment. She realised she needed to separate herself from what was happening to her. This meant going to hospital alone and not engaging with anyone – not even speaking unnecessarily with the medical staff. Just having the radiation and going home.
For each of us a clear understanding of our own psychology allowed us to make choices which worked for us.
Listening and questioning
As coaches, our stock in trade is our ability to listen and ask questions. I recognised that the conversations with medical specialists would be amongst the most important of my life, and determined to listen to everything that was said, planning my questions beforehand.
Drawing on my experience as a coach, I asked mainly open, non-judgemental questions. “What would you do in my situation?” “What are the drawbacks with this approach? ““What other treatment options are there?” “What can I do to maximise the chances of recovery?” “How can I help prevent the cancer from returning?”
I listened with focused attention to the replies, noting specific words and repeating them back. Some doctors used euphemisms (and occasionally riddles!) which needed further probing. “When you said ‘tricky’ – what did you mean?” “You talked about a good outcome. What might that be?”
I also became aware of their questioning skills. A helpful one was “So Paula, what do you already understand about your condition?” My answer gave the oncologist all the information he needed to assess my understanding, and he could then correct any misunderstandings and fill in the gaps. Another asked “What else do you need to know, that we haven’t already covered” which is so much more helpful than “Anything else?”
Appreciating the need for human connection
Listening and questioning are skills we teach new coaches, and of course they are essential. However, it’s the space between human beings which can make the crucial difference between a warm, caring interaction and a cold, clinical one.
Each time I visited the hospital, I was seen by one or more medical specialists. This included a surgeon, oncologists, a speech therapist, a dietician and various specialist nursing staff. Once (daily) treatment had begun, I often saw a junior doctor or registrar instead of the main specialist.
Within a matter of seconds, I was able to tell whether or not this person could make a real connection and build rapport. The highly skilled ones walked in the room smiling, making eye contact, extending their hand and using my name whilst apologising for the wait (consultations were never on time). They would introduce themselves briefly and then explain in non-medical language the purpose of the consultation and how they expected things to proceed. They were warm and empathetic and I felt they really cared about me. They allowed plenty of time for questions, listened intently, nodded sympathetically and made sure they had addressed all questions and problems. The best ones said things like “Oh dear that does sound awful” or “You poor thing. That is tough. Let’s see what we can do to sort that out for you.” These interactions were never hurried and I left feeling positive and resourceful.
However, one or two (usually more junior staff) managed to make me feel like a bit of a nuisance. They arrived late, didn’t apologise, didn’t make eye contact, instead taking refuge in taking copious notes or scrutinising the computer screen. I had a disturbing encounter with one who, when I said I was in constant pain and not coping with the treatment, said “That’s strange, most people sail through at this stage!” I left that particular consultation feeling demoralised, a failure and wondered how I was going to cope.
The importance of the difference cannot be overstated. The connection between the mind and body is now well understood by the health profession – the ability to have the patient feeling hopeful, capable and resourceful can have a significant positive impact on the eventual outcome.
Similarly, in coaching we need to consider how well we are connecting with people. At the conclusion of a session, are we leaving them feeling powerful, self-sufficient, resourceful and able to take action? Or have we inadvertently judged them, diminished their personal power leaving them feeling dependent, powerless and victim-like?
Experiencing life as an introvert
I am known as a high energy extrovert. I find meeting new people easy and energising, love to attend social events and hold myself confidently in any space. I particularly enjoy facilitation where there is robust discussion and challenging dynamics. Being with people feeds and sustains me.
One of the side effects of the treatment meant that I was temporarily robbed of my ability to speak. And when I regained my speech, it was painful to speak for long periods or to raise my voice. My voice changed from being strong and easily audible to being at times more like a whisper. As a result, I have had to rethink my interactions with the outside world. In short, I have been forced, to some extent, to experience life as an introvert. My energy level dropped and in social situations I gradually moved from the centre of things to a quieter space in the shadows. In the early days, I felt as though my personality had been stolen, and began to wonder about this new identity.
For a while I avoided company, except for close interactions with friends, as I found it hard to insert my voice into conversations. And even now as my voice returns, when in company, I find I am rehearsing my contribution before verbalising it. I am easily shut down and have lost the ability to engage in robust debate. I have always had strong opinions and never had any difficulty expressing these, but now I am, at times, experiencing the frustration of being unable to be heard.
This experience has been truly humbling. Previously I found it hard to fully understand why introverts didn’t freely engage. I can now see how easily and mostly unconsciously, we extroverts dominate and discourage the full range of contributions.
I am now more thoughtful and reflective. I have greater respect for the quality and depth of the introvert’s reflections and wisdom. I also read much more and rather than trying to finish a book in record time, find that I linger over words and meanings. Life has become richer as a result. I am stopping and smelling the roses. As part of my recovery I was encouraged to have quiet times in the day when I didn’t talk at all. This provided a perfect opportunity to read and write, both activities I have always said I’d like to find more time for.
Becoming truly compassionate
The treatment for my cancer meant that I was in near constant pain for several months. Mostly my painkillers took the edge off this pain, but sometimes they just didn’t touch it. I am also occasionally and unexpectedly gripped by anxiety about the future. Whilst my treatment has been judged ‘successful’ there is still a risk that it will return in some form, perhaps in another part of the body. This could happen years from now, or not at all. The statistics are on my side, but there is no denying that having experienced cancer, it has become more of a reality. It can be hard not to interpret every twinge and ache (natural parts of the aging process) as a sign of something more sinister. It is hard not to experience my body as a dangerous place harbouring life threatening malignancies and hidden lumps. This experience of both physical and psychological pain has again provided new insights.
My frequent trips to the cancer clinic have brought me into contact with other sufferers. The waiting room is always packed, and each person is on their own personal cancer ‘journey’. As I wait for my turn (and this can be an hour or more as they never run to time) I observe my fellow patients, hear snippets of conversations and have developed an increased understanding of what others face day in, day out. Many are worse off than me.
I am reminded that we have no idea what other people are dealing with. We learn to put a brave face on our most harrowing experiences and can appear to be high functioning individuals. People tell me I’m doing “really well”, but sometimes I wonder how they know that. Some days I’m definitely not doing well, but have become expert in creating the façade for the outside world to see. I am now more capable, when coaching, of seeing behind this ‘mask’ and staying with people as they reveal deeper concerns.
I’m also more aware of how mood changes regularly. So, when people say: “How are you?” I find that a difficult question to answer. During treatment and in the early stages of recovery my truthful response might have been: “Really angry and pissed off that I, of all people, have cancer. It’s a cruel disease, I’m in constant pain, life is unfair, at times I’m gripped with an overwhelming anxiety about what the future holds and I’m not sure whether I’ll be here in a year…But enough about me, how are you?!” Lol.
Of course, I don’t ever say that! Sheryl Sandberg in her book, Option B, which is about the grief she experienced following the sudden death of her husband, concluded that the better question is “How are you today?” which allows people to give a more accurate response about their present state, which is, of course, fluid and changes day to day, hour to hour, minute to minute. Nothing, as we know, is permanent. This too shall pass.
Mindfulness – we are not our thoughts
Mindfulness is not a substitute for medication. However, it is proven to help patients cope with the suffering and pain arising from cancer treatment. I have been aware of meditation and mindfulness for some considerable time, but like many people, have not used it on a regular basis. My six months of treatment and recovery gave me an opportunity to practice techniques which would reduce the anxiety, stress, depression and insomnia associated with chronic pain.
Of course, most of our coaching counterparts are not suffering physical pain, but many are dealing with psychological anguish. Some may be facing a perceived threat and have the associated increase in heart rate, or bodily tension as they prepare for the fight, flight or freeze response. And sometimes these responses are hardwired into the brain and have become automatic. Mindfulness moves us out of our thinking state which plans, remembers, analyses, judges into a calmer ‘being’ mode which lives in the moment rather than being trapped in the past or worrying about the future.
Our coaching interactions can allow busy people a chance to slow down, break the damaging cycle of rumination, and challenge repetitive modes of thinking. The paradox here is that we get good at what we practice, whether it’s helpful or not. So, if we‘re in the habit of catastrophising and imagining disastrous scenarios, then our brain will return to that repeatedly. Mindfulness can structurally reprogramme the brain to develop a new, more functional habit.
It’s early days in terms of my thinking and learning from this unwelcome ‘experience’ – there is no doubt that I am not the same person as I was pre-cancer. At some point in the future, I may be able to say cancer was a largely positive life changing event. I’m not there yet. But I hope it has changed me in some ways for the better. And I am determined to learn the lessons and apply them in a way that’s useful to others. Coaching seems a good place to start.