Courtney Bitz is a licensed clinical social worker who heads the Couples Coping with Cancer Together program for City of Hope, a comprehensive cancer center in Duarte, Calif. When a woman is diagnosed with breast cancer, research has shown that having a supportive partner is one of the most important factors in helping her cope. But partners may struggle with knowing what to say or how best to support a loved one. The only program of its kind, Couples Coping with Cancer Together helps women and their partners identify problems that are most important to them as part of their overall medical care.
Listen to the podcast to hear Courtney discuss:
- how the Couples Coping with Cancer Together program works
- specific examples of how a woman can ask for and get the support she needs
- the different ways women and men cope with stress and how each can understand the other better
- common requests that women who have been diagnosed with breast cancer ask of their partners
Running time: 27:25
To help our visitors, Courtney provided the Partners’ Guide to Managing the Challenges of Breast Cancer (download the PDF). It offers tips on what partners can do to help a woman who’s been diagnosed, as well as tips for what diagnosed women can do to get the best support from their partners and other loved ones.
These podcasts, along with all the other vital content and community support at Breastcancer.org, only exist because of the generous donations of listeners like you. Please visit Breastcancer.org/support to learn how you can help keep our services free for you and the millions of women who depend on us.
Show Full Transcript
Jamie DePolo: Hello, everyone. Welcome to this edition of the Breastcancer.org podcast. I’m Jamie DePolo, the senior editor here at Breastcancer.org, and today we have Courtney Bitz as our guest. Courtney’s a licensed clinical social worker who heads the Couples Coping with Cancer Together program for City of Hope, which is a National Cancer Institute-designated comprehensive cancer center in California.
When a woman is diagnosed with breast cancer, research has shown that having a supportive partner is one of the most important factors in helping her cope. But partners can struggle with knowing what to say or how best to support a loved one. The only program of its kind, Couples Coping with Cancer Together helps women and their partners identify problems that are most important to them as part of their overall medical care, and Valentine’s Day is just around the corner. So we’re so thankful that Courtney's here on this podcast to talk about ways couples can support each other when one has been diagnosed with breast cancer. Courtney, welcome to the program.
Courtney Bitz: Thank you, Jamie. I’m really honored and excited to be here talking with you today on such an important topic and something that I’m really deeply passionate about. So thank you.
Jamie DePolo: That’s great, and I know that there are a lot of people who are listening who are very interested in this topic as well. We have Discussion Boards on our site, and there are always a lot of questions posed about this topic.
So, to start, tell us a little bit about how Couples Coping with Cancer Together works. What’s the whole... in a nutshell, I mean, you don’t have to go into all the details, but just give us a little overview of how the program works.
Courtney Bitz: Sure. The first thing I always want to talk about in terms of the couples program is that it really is a true representation of a multidisciplinary team effort. The team really consists of patients and their partners, physicians, nurses, social workers, navigators, and many, many more people, but each of them are really uniquely vital to the care we’re able to provide patients and partners. You know, the couples program is really built upon this foundation of strengths-based care, and I think one of the most innovative aspects of it is that it’s actually integrated into standard of care for all new breast cancer patients and their partners. It’s just how we do care at City of Hope, and I think this integration into medical care really starts the process of normalizing and destigmatizing and giving couples hope starting with their very first phone call to City of Hope.
Jamie DePolo: So really, that means that when a woman or man -- we’ll get into that later -- if someone's been diagnosed with breast cancer, even going along with treatment and meeting with your doctors, being part of this program is right in there right from the start?
Courtney Bitz: Yes. When they’re calling for their appointment with their physician, we’re already starting the process of telling them how important it is to have their partner there with them, that they’ll be meeting with a team to help support them and their family, and so we are already starting that process with them.
Jamie DePolo: Okay. That’s great, because then it just becomes the norm.
Courtney Bitz: Right, and this isn’t about something's wrong with them as a couple, but this is just bigger than they are. This is a universal experience. So when couples actually come to the City of Hope for their initial consultation, they first complete what we call a support screening. And what it is is it’s a screening on an iPad, and it asks questions of the patient and partner about physical, emotional, psychological, relationship, and practical areas of distress. Those results are then emailed directly to their team, including their physician and their social worker, and we’re able to take what the patient and partner tell us is most important to them and really tailor our encounter using that information.
Jamie DePolo: So pretty much everybody gets almost an individualized program?
Courtney Bitz: Yes. Definitely. And like I said, we’ll talk more about that and how important that is, because not one size fits all. And with the screening, we ask questions that might be unique... The very first appointment, we’re asking about their family and how they’re feeling emotionally, but we want to model this importance of open and honest communication from the very first encounter. So after the screening is completed, then the couple will have a standardized session with trained clinicians, and in that session, we’re communicating to the patient and their partner that their concerns are paramount. They’re what’s most important to their team. We start by normalizing differences in communication and coping and even that the healthiest of couples often struggle with how to best support one another and solve problems with one another during times of stress. And then we really share some of the wisdom that we’ve learned from past patients, partners, research, our clinical experience, and provide them with really concrete and specific, practical behaviors that actually work to help support them in problem solving with one another. And most importantly, I think we reinforce that even despite the stressors that they might experience along the continuum, that this is actually an opportunity, and many couples report growing closer to one another through this process.
Jamie DePolo: I know you said that each couple almost gets an individualized program, but is there a standard or average length for it, or does that depend on the needs of the people?
Courtney Bitz: Yeah. Because this is integrated right into the medical clinic before they meet with their physician, we typically try to keep it as a 30-minute introduction: “Here is the wisdom that could be helpful for you moving forward, ” but by no means does this have to be our only conversation. And we offer ongoing short-term couples counseling, a couples support group, all of these other resources available through the supportive care team, but this is introducing them to the topic and to their team.
Jamie DePolo: I see. I see. Okay.
Courtney Bitz: Yeah, but I think what is interesting is after they learn about these behaviors or we have this conversation with them, they then immediately go into their consultation with their physician, and that’s an initial consultation just first getting information. But they’re able to actually incorporate and practice these supportive care behaviors that they learned just prior in that session. And physicians also tell us that they often find these patients and their partners much calmer and able to really focus on the medical content, which really is, you know, the goal of our program, is to help relieve some of the psychosocial issues so that they can get the best out of their medical care.
Jamie DePolo: Okay. That makes good sense, because if you know that you’ve got a supportive person next to you who you can communicate well with, then you could focus on what you need to focus on from your physician.
Courtney Bitz: Right. And oftentimes, they’re going to have to make a lot of complex decisions with breast cancer treatment, and, one, having the medical information, feeling that you can communicate with one another and your team, it really does make a difference moving forward.
Jamie DePolo: Oh, I’m sure. Now, we know that men do get breast cancer, too. Have you had any male patients come through your program with a partner, or is it really focused on women?
Courtney Bitz: Yes, of course. I mean, obviously, the majority of the population is women with breast cancer, but our program is actually open to all types of couples dealing with breast cancer. That includes men and also same-sex couples. There are universal themes that couples often experience when coping with a cancer diagnosis, but our team, like I said, does not see this intervention as a one-size-fits-all. We really try to tailor it to the interaction with that couple, and men with breast cancer, lesbian, gay, bisexual, transsexual patients are often a more vulnerable population because they have lack of adequate and tailored information and support, societal and familial discrimination, healthcare discrimination, and so it has been really important to our program to be open to all of these perspectives and tailor what we do to each individual.
Jamie DePolo: That’s great. Now, I’m curious, are there certain common triggers that seem to come up when one person is diagnosed with breast cancer? I mean, are there some things that just happen to everyone, or no? I’m curious.
Courtney Bitz: Yeah, and I think there definitely are some universal themes. What we and our team here at City of Hope is really interested in -- and because of what research tells us -- is how gender impacts how we cope with stress. Research is clear that men and women often do cope differently during times of stress. Though sex and gender are inclinations, not determinations. We do find that there’s some typical reactions. Women often typically want to reach out to others and share their concerns, talk about their fears, while men, we find, often have the fight or flight response or even tend to go it more alone. But what we find is that men, women, these natural inclinations that they have, it can be helpful or not helpful depending on the context of the situation. So what we really try to do with couples is help them understand what the motivations are behind their partner’s behavior so that they can overcome any misalignments in communication or how they cope or problem solve together. And so we really talk about, it’s important to ask your partner why they’re doing what they’re doing and not just assume that we know. And fortunately, those skills can be taught to men and women and can have immediate positive impacts on a relationship. So I’ll give you a couple examples, if that’s...
Jamie DePolo: Sure. Yeah, that would be great.
Courtney Bitz: So, for instance, women might say something like this to their partner: “So, when you spend hours on the Internet or watching television, I feel like you don’t care about me. Can you please teach me how this helps you to cope with the situation?” And I think this is common because we find that men do typically cope best with stress if they have some social withdrawal or isolation before kind of coming to process that with their partner. So it’s not about distancing themselves from the women they love. It’s more about how they cope with stress. On the other hand, I’ve often heard men say something like this about women: “When you talk about your cancer in detail to people we hardly know, it makes me feel uncomfortable. Can you teach me how this helps you, because I want to be supportive?” And I think men often don’t recognize that women’s natural inclination to connect with others, talk about their concerns, helps them find comfort in these times of stress. So I think it’s really about understanding why people do what they do by asking, and that’s how men and women can really learn how to best work together as a team.
Jamie DePolo: Oh, I like the way you said that, too. “Can you teach me how this helps you,” as opposed to saying, “I hate it when you do that. Why do you do it? ”
Courtney Bitz: Right. Stop that.
Jamie DePolo: Right. Right.
Courtney Bitz: I agree. It really does change the context of the conversation. And we always talk with couples about being curious about your partner, even partners that have been together for long periods of time. You’ve never gone through this exact experience with one another, and so be curious about what your partner might be doing and thinking.
Jamie DePolo: Sure. That’s great advice for anything, and I guess that leads into my next question. Certainly dealing with a breast cancer diagnosis is very stressful and very unique, and it has its own set of stressors, but it sounds like the tools that you teach people could be applied to any stressful situation in a relationship, whether it’s an illness, financial problems, employment. It just sounds like they’re universal. Am I accurate in thinking that, or are these real specific to illness?
Courtney Bitz: Definitely, and I think we’re not so isolated in the breast cancer world, but I think with couples, by learning how to better communicate when you’re under stress, understanding your partner’s behavior and motivations, but also being aware of, “What helps my partner the most and least when they’re under stress,” all of these translate to managing the normal stressors that come with life: home life, work life, raising children. And so what we really try to focus on is, yes, right now we’re in this really stressful experience with breast cancer, but this is actually an opportunity to start living the relationship that you have always wanted. And that’s where I want to be there to help them, and our program wants to be able to help them with that goal.
Jamie DePolo: Okay. That’s pretty amazing. Now, your program, I understand, is the only one of its kind in the country or perhaps the world. I’m not quite sure on that. I know it’s the country. So if I’m a diagnosed woman... I don't live in California. I live in a very small town in Maine, say, I’m not going to be able to go across the country to take advantage of your services even though I would like to. Are there things I can do on my own? Are there things that I can learn? Do you offer online stuff? How can I help myself, in a sense?
Courtney Bitz: Yeah. I mean, I think that’s a great question, and I thought what might be helpful is to start in giving just a couple key tips that we really often share with couples right at the beginning of their diagnosis. And I’m going to start with what women tell us their partners can do to best support them, and then I’ll transition to what partners and families have told us that women can do to get the best out of their support system. So I think women tell us, to start with, having a partner that’s physically present when she’s going through cancer treatment, and that doesn't mean just being there. It means really being actively involved in medical care, asking questions, doing research on illness and treatment, and really working with the physician as a team. Not only does this help women logistically and practically with integrating complex information, but it makes women feel safer and supported by their partner to have them actively involved. I think the next thing that I’m going to talk about is actually applicable with patients and partners or women and men, and that’s really to reflect before reacting. We really encourage partners to be mindful about the impact that stress can have on even the simplest of things in daily life. You know, driving your car, remembering tasks, but most importantly, it often impacts how we communicate with each other and with our family, and so it will take extra attention, time, mindfulness to manage those responses. So we always say, “Take a breath, and ask yourself, looking back, ‘Am I going to be proud of how I’m showing up for my partner in this moment?’” And we find that just asking that simple question and pausing really helps partners show up best for one another. So, for women, they tell us how important it is for their partner to listen without giving advice, trying to fix problems, or give reassurances. Women tell us that being able to openly talk honestly about both rational and irrational fears and concerns really is important, and having their partner just kind of create this space and place and not rush into these other supportive behaviors makes women feel more connected and less isolated during a time where it can feel really isolating when you’re going through a breast cancer diagnosis.
Jamie DePolo: So it sounds like they want a space where they can just sort of vent it all out, “And don’t try and solve this for me. I just need to get it out.”
Courtney Bitz: Right, and I think for men, there are so many positive strengths about men, and I think one of the reasons this is challenging -- and we hear from a lot of men -- it’s because how deeply concerned they are and how hard it is for them to see a woman they love go through something as distressful as a cancer diagnosis and not be able to fix that or take that away. So it’s with good intentions that they often want to provide reassurances or get right to problem solving. And so when we talk with men about what you can do, is be the only person maybe that she can share all of these fears and concerns with, whether it’s noon or 3 a.m. -- that is how you can best help this woman that you love.
So then I think the last thing I always like to mention for partners is, when we’re going through gathering wisdom for our program, we often will talk with couples, say, 5 years past their experience. And we’ll say, “What worked? What didn't work? What do you wish you would've done and not done?” And we often hear from partners, “You know, I wish I would've shared some of my own fears and concerns or thoughts with my partner while she was going through breast cancer. I really didn't share that with her because I wanted to protect her. I didn't want to burden her.” But what we do know is that when partners share their fears or concerns or some of their own thoughts, it actually makes women feel less worried and anxious, not so alone, and more connected to their partner. And so open, honest, and timely communication, especially about challenging topics, is often where people report growing as individuals and as a couple.
So, women aren’t off the hook either.
Jamie DePolo: Yeah. So what can the diagnosed folks do?
Courtney Bitz: Yeah. Yeah. Obviously. So, a couple things for women in terms of what we learn from partners and families about how they can get the best out of their support system. And the first one is exactly what I had talked about with partners, and that’s also being very mindful about reflecting before they’re reacting, and taking that deep breath, and asking oneself, “Is this how I want to show up in this moment? Will I be proud of this looking back?” We also talk with women about avoiding testing and being very specific about what you need. There are going to be a lot of different types of support that women often need from their partners throughout this continuum of treatment and diagnosis, and it can change on a daily basis. And there are no partners that I’ve met, at least, that instinctively know exactly what to do our how to support the woman they love in any instance. So, by women starting the conversation with her partner about what it is that she needs from her partner in that moment, it really sets up for a positive interaction and makes partners feel confident in knowing how they can best support the woman they love. So it could sound something like this: “I’m having a really bad day. I’m worried. I don’t know why, but I just need you to listen to me, or hold me, or actually help me solve a problem.” And by knowing that, the partner can then provide that specific need to their partner and both feel proud and that they can do that for one another and feel connected.
Jamie DePolo: And when you say testing, do you mean, say, the woman doesn't say what she wants and then is sort of testing her partner to see, “Well, is he or she going to deliver on what I need just instinctively?”
Courtney Bitz: Yeah, and I think some of it’s just our natural desire to have a partner in tune with us. I think women are often in tune or attuned to one another and to others’ needs. But I think we often see this, for instance, with coming to appointments. Sometimes women will say, “No, you don’t have to come to an appointment; I’m fine,” but then if their partner doesn't come, then that’s upsetting to them. So just being really specifically clear about what it is that you need from your partner. And I think part of this is becoming comfortable with asking for help. And that’s challenging for a lot of women because we’re often used to being the caregivers, the nurturers, taking care of others, and it can be a challenging transition.
Jamie DePolo: Okay. That sounds great, and I didn't want to cut you off if there’s...
Courtney Bitz: No, and the last thing I kind of wanted to talk about in terms of women is this whole concept of, we really talk about staying in the present and avoiding revisiting past conflicts or past hurts. And we talk about this because when you’re going through such a stressor of medical care, you only have so much energy. All that energy needs to be on wellness, and managing medical symptoms, and supporting one another. So we really encourage couples to stay in the moment, and moving forward, and telling themselves this is an opportunity to perhaps re-experience or redo ways that we may have not been that great at in the past, but we can now have this new opportunity to learn and support one another in a different way. And I think that relieves some pressure, you know, and some stress from both the patient and the partner. Like, “Hey, we can do this differently because we know more now about one another.”
Jamie DePolo: That makes good sense. Just don’t look back. Look forward, and use what you’ve learned. And so I have one last question for you. Now, what if a woman’s partner doesn't really want to attend these sessions? Are there things that she can do to support herself through a cancer diagnosis? And maybe that’s never happened. I don't know. I’m just sort of envisioning the worst scenario.
Courtney Bitz: Yeah. Obviously, our program is really tailored and focused on the couple need, and believe it or not, we rarely have any partners or couples say, “No, we don't want this.” Maybe they don’t know exactly what it is, but partners... What we find, they truly want to be there, know how to best support them, and are eager to have this information and get support.
Jamie DePolo: But what if a woman doesn't have a partner, too?
Courtney Bitz: Exactly, and so when I was thinking about this question, I thought about the importance... some of the core values that I just talked about, this importance of social relatedness. And oftentimes, women might get social support from other areas or a variety of places. Friends, family, church communities, cancer support communities. And still, women often do struggle with asking and accepting support from their support networks. So what we talk about with... Because, one, they don’t want to burden others, or it’s uncomfortable to ask for help, or they’re used to being really independent, which is a good thing, but hard to do when you’re going through a breast cancer experience. And what we find is if your support system doesn't know how to help you or what to do, couple things: they’ll trip over themselves and maybe do unhelpful things, or sometimes you’ll even notice that they’ll disconnect because they don’t know what to do. And so I really encourage women to have a defined list of time-limited concrete things that you can ask your support system to help with, and it might be, “Can you drive me to my chemotherapy appointment and then spend a couple hours with me on Monday,” or, “Hey, my second week after treatment, I’m really feeling good. Take me out for coffee, and let’s have girl talk, right, or do something fun,” or, “Can you drive my child to school? I have a doctor’s appointment.” So having these kinds of helpful behaviors really does help manage the increased demands when you’re going through treatment, but I think most importantly is we talk about this opportunity for women to really role model for those around them. That when you’re going through challenging times, whether it be a cancer diagnosis, or a lost job, or a divorce, whatever it might be, that it’s okay to talk about it and about the distress, to ask for help and accept help, and it allows those that love you and want to support you to feel connected to you and really show you that they care. And I think that’s really the gift that accepting and asking can do for women and their loved ones.
Jamie DePolo: That’s excellent advice. Courtney, thank you so much for being here. All valuable, valuable information, and I hope we can have you back again. Thank you so much.
Courtney Bitz: Oh, my pleasure. It was so great. Thank you.
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