Dr Clare Jacobson was the first specialist teenage and young adult clinical psychologist at Guy’s and St Thomas’s Hospital in London. Her post was funded by Leukaemia UK for two years. Dr Jacobson explains why her ground breaking approach to psychology is having a major impact on her cancer patients’ wellbeing.

"Cancer is not just a physical condition, it affects the body, mind and soul. It has an impact on all aspects of life and relationships. Integrating psychology within the medical team in an all encompassing approach reminds everyone that we are dealing with a human being, not just a body.

Here at the teenage and young adult clinic, we see every single patient at the point of diagnosis, end of treatment and follow-up long into remission. At each time point we have a screening interview which helps us pick up distress at an early stage, enabling early intervention to prevent problems escalating and becoming entrenched.

Psychology is a completely integrated part of the young peoples’ treatment, which is invaluable. Because of this, problems don’t have time to escalate and get entrenched which can lead to severe anxiety, phobias, relationship breakdown or severe depression or unhelpful coping strategies, such as resorting to alcohol or social isolation to deal with how you are feeling.

There is a lot that is going on under the surface. With blood cancer especially, a lot of the effects are invisible. We find that about six months after treatment, when your hair has grown back and you look well again, that is when the real psychological journey begins.

What is unique about our way of doing things, is that as everyone has seen me from the start, so it demystifies ‘psychology’ and hopefully destigmatises it too. Typically, psychology has been a disconnected service which people get referred to if they are perceived to have a “problem”, but our approach here is different.

The specific psychological approach (‘systemic’) aims to normalise and de-pathologise psychological distress, making it feel less scary to open up about feelings. We find out about peoples’ lives, the positives as well as the challenges, and are interested in what’s happening to them. We want them to know that the way they are feeling is understandable. Low mood and anxiety are on a continuum - in many ways it would be strange if people weren’t feeling low with what they’re going through.

We talk about coping strategies, psychological tips on how to approach treatments like chemotherapy and communicating with their friends, family and medical team and whatever other help is needed. Psychological problems are certainly not an inevitability but we explain why it is completely understandable that people might feel a particular way.

There is a lot that is going on under the surface. With blood cancer especially, a lot of the effects are invisible. We find that about six months after treatment, when your hair has grown back and you look well again, that is when the real psychological journey begins.

Leukaemia UK’s funding allowed me to stay in post for two years and really develop the psychology service. I was able to train up junior psychologists which meant I could offer a variety of psychological therapy groups, including designing a ‘fear of relapse’ group for patients struggling after cancer. The groups are generally really valued and receive very powerful feedback. I could also offer family therapy and support to partners. I also teach Clinical Nurse Specialists about how to recognise signs of distress and either address these or refer on so that we can intervene at an early stage.

My hope now is that we can address another unmet need, which is that of the families of people with blood cancer. I would love to be able to outreach to parents and siblings and offer specialist support to them. We are limited at the moment in how much resource we can offer, so we run occasional therapy groups, which can be very powerful.

I was also able to develop the National TYA (teenage and young adult) Clinical Psychology Network, which I set up in 2012. This professional body has grown significantly and we are leading national projects such as developing guidelines for psychological care pathways in TYA cancer. Research is a key part of my role and there are a number of ongoing projects, particularly looking into the effects of trauma in TYA patients and how we can minimise these by working differently from the beginning. All research is directly clinically relevant, meaningful and generated by current patient need."

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