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00:00:01
Diane Cooper
2 Plays23 hours ago
SG Podcast
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Transcript
Introduction of Dr. Diane Cooper Byram
00:00:01
colinyourbluff
We are pleased to have Dr. Diane Cooper Byram on the podcast today. Dr.
00:00:08
Dustin Mesick_ RDN
You want to start over?
00:00:09
colinyourbluff
Cooper Byram.
00:00:10
colinyourbluff
What?
00:00:10
Dustin Mesick_ RDN
and sort of You want to start over?
00:00:10
Dianne Cooper_Byram
Thank you.
00:00:12
Dustin Mesick_ RDN
Sorry. You made this noise. i That was really loud.
00:00:17
colinyourbluff
We are pleased to have Dr. Diane Cooper Byram with us on the podcast today. Dr. Diane Cooper Byram is a licensed clinical psychologist who has a PhD in philosophy with a specialty in behavioral medicine and psychoanalytic studies.
00:00:32
colinyourbluff
Dr. Diane Cooper Byram also started her career as a licensed marriage family and child therapist.
Career Beginnings and Shift to Cancer Therapy
00:00:37
colinyourbluff
She became interested in catastrophic illness and was fortunate enough to get a fellowship from UCLA to learn to deal with cancer patients and their families.
00:00:45
colinyourbluff
Now, after this training, she worked with the American Cancer Society at director of service and rehabilitation in the San Fernando Valley. And during this time, she was able to finish up her PhD. Just wanted to welcome you to the podcast.
00:00:58
Dianne Cooper_Byram
Thank you
00:00:59
colinyourbluff
Well, can you tell us about how you started treating cancer patients?
00:01:04
Dianne Cooper_Byram
you. started treating cancer patients almost serendipitously. i i am a BRCA1 carrier, and at a fairly young age, I was 27 when I was diagnosed with breast cancer.
00:01:20
Dianne Cooper_Byram
And at the same time, i had just gotten my license as marriage and family therapist. I was treated for the breast cancer
00:01:33
Dianne Cooper_Byram
with a modified radical mastectomy, which was fairly new at the time. It was in 1976. I found that I was going to have to go back to work.
00:01:46
Dianne Cooper_Byram
I had two babies that were two and three. And a i realized that I have a lifetime teaching credential for California, so i was going to go back to teaching and was told in 1976 that I could not go into the classroom after just having breast cancer. There would have to be five years post-diagnosis.
00:02:17
Dianne Cooper_Byram
Consequently, i was on a search for a job, and there was a job for director of service and rehab. at the American Cancer Society. And at that time, they were only hiring licensed clinical social workers, which had always been the medical piece of oncology in psychosocial services. And fortunately, was able to talk my way into the job.
00:02:48
Dianne Cooper_Byram
and lo And behold, here here I was as the director of service and rehab And my career with cancer started because i had that position.
00:03:08
Dianne Cooper_Byram
i was offered a one-year fellowship that was sponsored by UCLA Extension Medical School for psychosocial services and issues for cancer patients.
00:03:23
Dianne Cooper_Byram
Consequently, a I took that training and my career in essence just took off. of As I reflect back, it was such ah an incredible foundation to be exposed to so many different cancer patients and
00:03:50
Dianne Cooper_Byram
watching how they functioned, what was going on, what the thoughts were, having experts for consultation.
00:04:04
Dianne Cooper_Byram
My career started, i left the Cancer Society and about five years later and started my own private practice working with cancer patients and their families.
00:04:20
Dianne Cooper_Byram
And that's how I started treating cancer patients. It wasn't a goal when I started my career. It lent itself. And I'm not sure whether my own personal experience was the impetus.
Therapeutic Approaches and Personalization
00:04:37
Dianne Cooper_Byram
ah It did allow me to take a show on the road with several oncologists and plastic surgeons because that was the early stages of breast reconstruction after mastectomy.
00:04:56
colinyourbluff
That certainly sounds fortuitous.
00:04:58
colinyourbluff
You know, one thing I was going to just add is like, I know that you prefer to be called Dr.
00:04:58
Dianne Cooper_Byram
Yeah.
00:04:59
Dianne Cooper_Byram
Yeah.
00:05:01
colinyourbluff
D and that's probably what we'll refer to you from from now on.
00:05:03
Dianne Cooper_Byram
Yeah. doesn't matter yeah
00:05:05
colinyourbluff
So just I wanted to make that note.
00:05:09
Dianne Cooper_Byram
yeah
00:05:11
Dianne Cooper_Byram
yeah a
00:05:17
Dustin Mesick_ RDN
Well, Dr. D. Oh, did you, you're going to say something else?
00:05:21
Dianne Cooper_Byram
No, I had toys with the idea. i don't usually talk about my own cancer experience or my genetic family tree.
00:05:35
Dianne Cooper_Byram
hu But I thought it would be helpful at this stage.
00:05:40
Dustin Mesick_ RDN
Yeah.
00:05:42
Dianne Cooper_Byram
So
00:05:43
Dustin Mesick_ RDN
Yeah, sure.
00:05:49
Dianne Cooper_Byram
Let's stop this recording for a minute.
00:05:52
Dustin Mesick_ RDN
No worries. We can edit out anything that comes up.
00:05:54
Dianne Cooper_Byram
Okay. Yeah. because
00:05:59
Dustin Mesick_ RDN
Dr. D, what therapeutic approaches do you use with your cancer patients?
00:06:05
Dianne Cooper_Byram
Well, the interesting thing is that there's been so much research over the years on what's the best approach to work with cancer patients.
00:06:17
Dianne Cooper_Byram
And what I've discovered over the years is certainly cognitive behavioral therapy is always the first therapy chosen but because it tends to want to reframe
00:06:17
Dustin Mesick_ RDN
Hmm.
00:06:37
Dianne Cooper_Byram
the um experience to a more positive direction. with doing some guided imagery and talking about
00:06:55
Dianne Cooper_Byram
what the goals are
00:07:00
Dianne Cooper_Byram
And I discovered that
00:07:06
Dianne Cooper_Byram
you have to move very slowly and adapt the treatment plan to each patient. It depends on what the patient is coming to the diagnosis with.
00:07:22
Dianne Cooper_Byram
Sometimes doing psychodynamic psychotherapy in and finding out what some of the psychiatric disorders are that the patient is dealing with to then see if they can hope
00:07:43
Dianne Cooper_Byram
with the stressors that go along with the diagnosis. So consequently, use a much more eclectic approach.
00:07:55
Dianne Cooper_Byram
There's, like I say, there's so many psychosocial oncology studies that talk about the best way to deal with the cancer patient.
00:08:06
Dianne Cooper_Byram
And there isn't one common way of dealing. It's a common sense approach. You figure out what the patient's coping styles are. You figure out what the patient's defenses might be.
00:08:19
Dianne Cooper_Byram
Figure out what their quality of life issues are. And you begin to work with them at whatever level they're at. um
00:08:32
Dianne Cooper_Byram
Dr. Poston out of, I believe it's the University of California, San Francisco talks about the first step in dealing with the diagnosis is to be supportive with the patient. and there isn't one right way they're supposed to feel or do or focus.
00:09:03
Dianne Cooper_Byram
We want to build a pyramid concrete
00:09:10
Dianne Cooper_Byram
stabilization to begin the journey into this cancer experience.
00:09:23
Dianne Cooper_Byram
So we have to evaluate what will be best for the patient, what kind of support system do they have, what kind of
00:09:41
Dianne Cooper_Byram
right are they showing?
Family Support in Cancer Treatment
00:09:45
Dianne Cooper_Byram
And can are they physically strong? Are they mentally strong?
00:09:51
Dianne Cooper_Byram
We have to figure out what ways they're going to take in the the information.
00:10:02
Dianne Cooper_Byram
um What I have found is therapist's role is so integral to the cancer journey that it's really important that the therapist have some sense of
00:10:29
Dianne Cooper_Byram
what this means to the patient. So the first step in dealing with the patient, if it's a A patient that you have currently that's come in for therapy prior to diagnosis,
00:10:49
Dianne Cooper_Byram
you already establish a relationship.
00:10:54
Dianne Cooper_Byram
If it's a person that has sought counseling because of the diagnosis, there are steps that have to be taken to develop a relationship.
00:11:07
Dianne Cooper_Byram
where you can be with the patient.
00:11:11
Dianne Cooper_Byram
But the first step is always listening to the client and figuring out the client's journey. Like anything else, it's like a roadmap.
00:11:23
Dianne Cooper_Byram
So the client needs to gather enough information
00:11:34
Dianne Cooper_Byram
to know what they're dealing with.
00:11:39
Dianne Cooper_Byram
Let me see. it Okay, stop this for a minute because I'm rambling. I have so much information in front of me. Did I answer your question?
00:11:51
Dustin Mesick_ RDN
Yeah, that did.
00:11:53
colinyourbluff
Yeah, I think it it's a not that one size fits all and being responsive to the where the patient is coming in with their understanding and their strengths. You know had mentioned just like even their support.
00:12:05
colinyourbluff
um Can you tell me or tell us ah how you incorporate their support system into your treatment?
00:12:13
Dianne Cooper_Byram
Well, the support system is so important to the patient in that if there is a spouse, if there's children, if there's parents, we have to balance what the patient needs and we have to balance what the support system needs.
00:12:42
Dianne Cooper_Byram
because sometimes they're different. of Remember the thought of ah loved one having cancer and just the word cancer.
00:12:55
Dianne Cooper_Byram
Before it's even staged, people have an image of what cancer means. And for so many people, cancer means ultimate crisis.
00:13:11
Dianne Cooper_Byram
rather than knowing that in 2023 we've been able to find many treatments that are less intrusive and give longevity after diagnosis that we didn't have 10 or 20 years ago so i do try to after the patient has been diagnosed and I encourage the patient always to have a relationship with their healthcare care team, know what questions to ask, to get all the information, and have one member from their support system to be sort of like a navigator.
00:14:07
Dianne Cooper_Byram
Many cancer programs now have what's called a nurse navigator, which will be with the patient as they begin to gather more and more information as their treatment, whatever it may be, surgery, chemotherapy, radiation, ah how they're going to tolerate it.
00:14:30
Dianne Cooper_Byram
yeah. Sometimes the support system is so much more difficult to handle because their fear or their loss of control ah this loved one is more than they can tolerate.
00:14:47
Dianne Cooper_Byram
and And it depends on their mental health and what psychiatric diagnostic impressions they might have. So that's how we integrate. If there are young people,
00:15:01
Dianne Cooper_Byram
children adolescents they need to be counseled teenagers have this struggle and they also have this sense of this narcissism and unconsciously they believe if they become dysfunctional the parent have to get better because they have to help them or fix them.
00:15:31
Dianne Cooper_Byram
and When I started my career, we did home calls. And I remember coming to woman's family where she was taking treatment.
00:15:44
Dianne Cooper_Byram
She was on chemotherapy. And I walked into the house, which was a mess. She had three teenagers, 12, 14, and They were all sitting in the living room, just not doing anything. And as I talked to them, I said, where's your mom? Oh, she doesn't feel good again. She never feels good now.
00:16:08
Dianne Cooper_Byram
And I said, okay, so what's for dinner? I don't know. We're waiting for her to get up to make it. they Their defenses were so strong and their fears were so present.
00:16:23
Dianne Cooper_Byram
that they just couldn't wrap their heads around the fact that their mom was really sick from the treatment.
00:16:29
colinyourbluff
Yeah, there was a change.
00:16:31
Dianne Cooper_Byram
Yeah, there was a change and they weren't going for it. And I think the the most difficult thing for that cancer patient is when their support system becomes so anxious that the patient then has to make the family member feel better.
00:17:01
Dianne Cooper_Byram
The patient is already dealing with their own loss of a sense of control, this new dependency that they have to deal with.
Coping Mechanisms and Denial in Therapy
00:17:14
Dianne Cooper_Byram
Their fears of abandonment, if they don't do what the family members want them to do and how they want them to do it, They're afraid that the family member will leave them.
00:17:26
Dianne Cooper_Byram
oh Patients also start to lose their own identity. So with this loss of identity comes a new behavior that the patient sometimes has to develop.
00:17:40
Dianne Cooper_Byram
um And so we have balance all of this and in a supportive,
00:17:51
Dianne Cooper_Byram
yet directive way
00:17:57
Dianne Cooper_Byram
deal with both the relationship if it's a husband and wife or a husband and husband or a wife and wife we have to deal with that primary relationship so the patient still is able and the partner is able to feel the connection the intimacy If the body is changed because of a surgical process, whether it's a testicular cancer or breast cancer, how is the partner gonna manage it?
00:18:32
Dianne Cooper_Byram
And what I have found, which is really interesting, is so many, I work predominantly with women with breast cancer and men with breast cancer, but the women with breast cancer,
00:18:46
Dianne Cooper_Byram
They start to complain that their husbands don't want anything to do with it or they can't look at it or whatever. And when I talk to the husbands, they say they won't let me look at it.
00:18:57
Dianne Cooper_Byram
They keep telling me it's ugly or it's terrible, don't look. So I finally believe it, which is a very interesting phenomenon.
00:19:08
Dianne Cooper_Byram
is it up to the patient to reassure the partner, up to the partner to reassure the patient?
00:19:16
colinyourbluff
That give and take.
00:19:17
Dianne Cooper_Byram
that give and take. And if there are parents involved with the patient, the parents, and I'm talking about adult patients and older parents, they're just so anxious sometimes. I might get five, six, eight calls,
00:19:39
Dianne Cooper_Byram
a day from a member of the family saying, oh, she's not talking or he's not doing this or he's not, she's not doing that. So the therapist really does have to understand boundaries and help the families understand the boundaries.
00:19:58
Dianne Cooper_Byram
And depending on the seriousness of the diagnosis and what the families recommend. The patient wants a hamburger, fries, and a milkshake, and the families are now feeding them green stuff.
00:20:20
Dianne Cooper_Byram
ah
00:20:21
colinyourbluff
I can relate to that.
00:20:21
Dianne Cooper_Byram
You know, exactly. And it's sort of like, really, we we want cancer patients ah to, at least the research has shown that if they have at least 10 extra pounds on their body, they're able to tolerate treatment better.
00:20:41
Dianne Cooper_Byram
And um so if somebody is having trouble eating, let them eat anything they want. That's just my own personal opinion.
00:20:52
Dianne Cooper_Byram
there are some nutritionists that disagree with me, but sometimes it's normalizing.
00:20:56
colinyourbluff
I would say that there's certainly nutritionist that would agree with you too as well.
00:21:00
Dianne Cooper_Byram
Yeah, it's it's that issue around where can we normalize?
00:21:00
Dustin Mesick_ RDN
No, no, no.
00:21:06
Dianne Cooper_Byram
um And, you know, consistently checking for signs of depression if they're increasing or signs and symptoms of anxiety.
Therapist’s Role in Cancer Journeys
00:21:23
colinyourbluff
Right.
00:21:25
Dianne Cooper_Byram
The depressive signs that I look at is patient isolating, is the pulling back?
00:21:36
colinyourbluff
Mm-hmm.
00:21:38
Dianne Cooper_Byram
They're so wrapped up in the diagnosis that they forget that there's other parts of their lives. um Are they beginning to feel hopeless? And initially the diagnosis causes a certain amount of crisis oriented behavior. So automatically get diagnosed with cancer and the first thing people think about is, am I going to die?
00:22:06
Dianne Cooper_Byram
So we want to help them and check out the level of helplessness and hopelessness. um and I don't know a cancer patient that doesn't start having sleep issues.
00:22:22
Dianne Cooper_Byram
They're either sleeping too much or sleeping not enough.
00:22:24
colinyourbluff
Thank you.
00:22:26
Dianne Cooper_Byram
So there's a behavior change when our sleep patterns change. energy levels will change with or without treatment incidentally. So we have to be able to assess that as a therapist.
00:22:39
Dianne Cooper_Byram
Are they overeating? Are they under eating?
00:22:44
Dianne Cooper_Byram
Are they suddenly concentrating on every mistake they ever made in their lives? What did I do wrong? How did i And for many, they start to believe that they're being punished. They get this disease because they're being punished.
00:23:01
Dianne Cooper_Byram
And it's how do we let them talk and how do we listen to what they're saying and begin to encourage a path past here and now.
00:23:23
Dianne Cooper_Byram
And this is where we start to take a look at the power of now. to lower those anxiety symptoms. They do say that if we're constantly dealing with depression, sadness, what we did or didn't do, we're looking at the past pretty consistently.
00:23:50
Dianne Cooper_Byram
If we start to become excessively worried about everything, if we get muscle tension, if we get headaches, if we get irrational feelings,
00:24:01
Dianne Cooper_Byram
fears. That means we're just so focused on the future that we can't get a grip. So consequently, we want to bring people back to the present.
00:24:14
Dianne Cooper_Byram
What are we dealing with? What's the reality? And where is the hopeful process? i I am a positive psychologist.
00:24:28
Dianne Cooper_Byram
I do work in the realm of humor and healing and finding things that feel good, that make us laugh.
00:24:41
Dianne Cooper_Byram
I had one patient, he had lost, he had prostate cancer and he lost his ability to get or maintain an erection or have an ejaculation and he became obsessed with pornography.
Family Dynamics and Communication
00:25:00
Dianne Cooper_Byram
And his family was just overwhelmed by this.
00:25:08
Dianne Cooper_Byram
And as I talked to him, he said, it's really fun watching. It's really fun remembering. And I'm hoping that I'll get this thing to work one day.
00:25:19
Dianne Cooper_Byram
So he wanted to stay in the now and think about what he might be able to do with enough time mental stimulation.
00:25:34
colinyourbluff
Sounds like there's lots of ah systemic work that you like to incorporate, you know, and and having all these ah
00:25:37
Dianne Cooper_Byram
Oh, there is.
00:25:42
colinyourbluff
relationships explored and and really looking at, you know, is it a burden on others? then Then have the role then changed or then having that adjustment to whatever comes up with the diagnosis or treatment.
00:26:03
colinyourbluff
And I certainly like what you said about having a a point person, because i think that is something that's pretty like a common, I would say, and and having i you know a partner point person then be able to communicate to the rest of the family or to then even have be a a voice box for the patient when they're not feeling well or just having that ah sense of an individual you know navigator rather than the nurse navigator.
00:26:12
Dianne Cooper_Byram
who
00:26:34
Dianne Cooper_Byram
Well, the most interesting thing I've seen in families over and over again is the issue around control so there if there's like two or three siblings or parents they start fighting amongst themselves for who's going to be that point person and they forget to ask the patient which person do they think they want to be the point person and it's a they're well yeah it's the role of the therapist
00:27:05
colinyourbluff
They're playing favorites.
00:27:10
Dianne Cooper_Byram
I've had many patients say, could you figure out a way to get my my older sister to be my point person and tell my younger sister and my mother to just shut the fuck up?
00:27:14
Dustin Mesick_ RDN
Thank
00:27:23
Dianne Cooper_Byram
Excuse my language. ah And I'm picturing this woman and she said, my mother won't let anybody come to appointments except her.
00:27:36
Dianne Cooper_Byram
And then she doesn't stop talking. So it's the role of the therapist to be able to say to the family member, you know, Carolyn needs
00:27:54
Dianne Cooper_Byram
Denise to be her point person because Denise has the most logical way of interpreting information. And then they get angry with the therapist, but they kind of get back because the therapist said so.
00:28:12
Dianne Cooper_Byram
That's where the therapist plays a really important role sometimes in speaking for the patient when the patient asks for that.
00:28:25
colinyourbluff
Yeah, having that advocacy or even triangulation, really.
00:28:28
colinyourbluff
All right, well, I'll relieve this pressure here.
00:28:29
Dianne Cooper_Byram
ah Oh, absolutely.
00:28:30
Dianne Cooper_Byram
Any dysfunctional family. Okay. yeah okay
00:28:38
Dustin Mesick_ RDN
Well, Dr. D, you've already shared so much, but i did want to ask, could you elaborate ah maybe a little bit more on the assessment of how you work?
00:28:49
Dianne Cooper_Byram
Well, I assess when I'm working with the patient, I will give them
Assessing Mental Health in Cancer Patients
00:28:54
Dianne Cooper_Byram
a basic ah depressive injur inventory, the Beck depressive inventory and the Beck anxiety inventory because they're easy to, know,
00:29:08
Dianne Cooper_Byram
administer and it's ah it's a good way of being able to because there's state tests how they're feeling today so I can do that once every three or four weeks to see where things are improving and where things are beginning to be compensate so I'll use the PLC checklist to see if in fact as the patient recovers, will there be a tendency towards PTSD and how we can intercede and maybe prevent that from happening later.
00:29:53
Dianne Cooper_Byram
um I also assess just patient read response, what they're saying, what they're doing.
00:30:05
Dianne Cooper_Byram
um I will assess coping skills. There's a coping questionnaire that tells me how people cope, what defense mechanisms they use.
00:30:17
Dianne Cooper_Byram
And I look for healthy defense mechanisms. I look for that defense mechanism of humor or denial. Denial is a really good defense mechanism and we never want to take denial seriously.
00:30:31
Dianne Cooper_Byram
away from the patient until the patient has something to replace it with. So I will take a look at that and I will revisit it with the patient frequently.
00:30:43
Dianne Cooper_Byram
I will also evaluate if patients are dreaming or having um doing what's what's called narrative therapy, having them make up stories, I will tend to relax them by using metaphors to deal with slow and deep relaxation.
00:31:13
Dianne Cooper_Byram
So they can allow themselves to feel their life energy.
00:31:20
Dustin Mesick_ RDN
Wow.
00:31:20
Dianne Cooper_Byram
I've
00:31:21
Dustin Mesick_ RDN
Well, was going to, I was going to say, I thought it was really fascinating where you said that you should never take denial away from a patient until you have something to replace it with.
00:31:22
Dianne Cooper_Byram
ah
00:31:35
Dustin Mesick_ RDN
feel like that's like, that could be like the first line and in your, in your next book.
00:31:35
Dianne Cooper_Byram
Absolutely.
00:31:41
Dianne Cooper_Byram
Absolutely. Denial really is a healthy defense mechanism unless it becomes um not healthy.
00:31:53
Dustin Mesick_ RDN
Mm-hmm.
00:31:55
Dianne Cooper_Byram
But we have to use denial in order to make a plan. If we automatically go to catastrophic without something in the middle a patient does tend to become emotionally disabled right
00:32:16
Dustin Mesick_ RDN
Yeah, like they're spiraling. So it's like the denials that kind of in between. You mentioned that you wouldn't want to take it away until they replaced it. Well, what could they replace it with?
00:32:29
Dianne Cooper_Byram
well what they replace it with is ah the reality of the diagnosis. They would and I try to get people to stop going online to look up statistics.
00:32:44
Dustin Mesick_ RDN
Hmm.
00:32:45
Dianne Cooper_Byram
ah But you can't take their computer away from them. So um they will replace it with some concrete factual information.
00:32:57
Dianne Cooper_Byram
This is what you have. This is the stage. And this is the option in treatment. And now because of social media, we are finding that people are coming up with treatments that they saw online and maybe that can work.
00:33:22
Dianne Cooper_Byram
And the oncologist tries so hard two
00:33:30
Dianne Cooper_Byram
do what they know how to do best. And then when people say, you know, I don't want to do that. yeah I want to just eat watermelon and that's going to cure my cancer.
00:33:47
Dianne Cooper_Byram
That's when denial becomes dangerous. However,
00:33:55
Dianne Cooper_Byram
We have to assess if the patient is going to become extreme or their family members come up with extreme, they say concrete information.
00:34:10
Dianne Cooper_Byram
ah
00:34:13
Dianne Cooper_Byram
Are we as therapists
00:34:17
Dianne Cooper_Byram
supposed to decide what's right and wrong? And that goes back to the journey of the patient and listening to the patient. I have worked with many women with breast cancer that decided that they were going to use imagery to heal themselves and then got really surprised when the cancer metastasized. or we get spiritual leaders that come in
00:34:52
Dianne Cooper_Byram
that talk about
00:34:56
Dianne Cooper_Byram
it's God's will. And then the patient has to go through all of the issues around, am I being punished for the sins of my father? Am I being punished because I did this or that?
00:35:16
Dianne Cooper_Byram
So we replace it with concrete information.
00:35:23
Dustin Mesick_ RDN
I like that concrete factual information. What's ah one more question on that? Like what what kind of process do you usually
Integrating Philosophies in Patient Acceptance
00:35:32
Dustin Mesick_ RDN
like? How do you get them to that stage? Because if they're like in denial and they're like, that's a defense mechanism, right? They're like, oh, no.
00:35:41
Dustin Mesick_ RDN
Like, how do you?
00:35:41
colinyourbluff
Well, you can lead a horse to water. That's the what I'll often say.
00:35:43
Dianne Cooper_Byram
hide it right
00:35:44
colinyourbluff
i mean, with this ah conversation on acceptance.
00:35:48
Dustin Mesick_ RDN
Okay.
00:35:50
Dianne Cooper_Byram
Okay, so as as I sit with the patient, I have them imagine using Ericksonian techniques. And i Erickson was a very, very skilled psychiatrist that talked about getting to the unconscious through using metaphors and many times I will stand with that patient near the water and ask them to imagine what it would feel like if they got close to the water as
00:36:17
Dustin Mesick_ RDN
Mm-hmm.
00:36:35
Dianne Cooper_Byram
as the child plays in a waiting pool and then the child gets in the waiting pool and then we take the patient on a metaphorical journey and before long the unconscious is most psychodynamic and analytic therapists will tell you this the unconscious is is so literal and will fight to stay alive.
00:37:07
Dianne Cooper_Byram
And most people are able to fight for their life if in fact they trust the person that they're on the journey with and that's the transference and
00:37:31
Dianne Cooper_Byram
they become a student
00:37:37
Dianne Cooper_Byram
of what science has to offer them, both Eastern medicine and Western medicine. They work together.
00:37:53
Dianne Cooper_Byram
And usually it's the Eastern philosophy of mindfulness, Patience, sometimes acceptance, that will allow Western medicine to balance, especially in the new data that's coming out with targeted therapies and other therapies that are so new.
00:38:24
Dianne Cooper_Byram
So this is a constantly changing field, and it's true with any kind of catastrophic illness. person has to make their decisions on their own and one way to do it.
00:38:41
colinyourbluff
and Kind of finding that virtue of wisdom.
00:38:42
Dianne Cooper_Byram
there was a It's a virtual of wisdom that each person has themselves. So we never want to forget the spiritual side, the quiet side.
Approach to Death and Dying
00:38:56
Dianne Cooper_Byram
And if the disease is progressing to the point where somebody is not going to survive,
00:39:09
Dianne Cooper_Byram
as the therapist and as the patient, it's important that that comes with a certain amount of acceptance.
00:39:24
Dianne Cooper_Byram
And Have we gotten there yet about the death and dying? Can I go on with that?
00:39:34
Dianne Cooper_Byram
I'm asking you, Colin.
00:39:38
colinyourbluff
Yeah, that's absolutely fine. you know i didn' I know that we wanted to specifically talk about your your approach there and and kind of your experience. ah So go right ahead if you would like to speak on that.
00:39:49
Dianne Cooper_Byram
Well, okay. I will tell you, um Oh, I wish I could recall the name of the person that is micro dosing with Cetalpheilin.
00:40:04
Dianne Cooper_Byram
i Hospice patients who are so anxious about the about dying that they they can't hold on to life as they have it in that day.
00:40:21
Dianne Cooper_Byram
And what they're discovering in this micro dosing is that it's a new reality. And that's how they're equating
00:40:34
Dianne Cooper_Byram
dying is a new reality because nobody really knows what's going to happen. There's many religious beliefs on what happens when we die.
00:40:47
colinyourbluff
Mm-hmm.
00:40:47
Dianne Cooper_Byram
But this is giving the patient an experience of a new reality. and
00:40:56
Dianne Cooper_Byram
equating it to death so death can become interesting, so death can become welcomed so perks curiosity so to speak.
00:41:09
Dianne Cooper_Byram
It's really fascinating. They're doing a lot with psychedelics in treating patients today that I'm not nearly as experienced and know about but it my new learning curve and because these issues on, on death and dying has so many facets.
00:41:35
Dianne Cooper_Byram
It's got the support system facet. It's got the patient facet. It's got the therapist. How does the therapist go from having healthy transference with the patient that the patient sees them as maybe wise or,
00:41:53
Dianne Cooper_Byram
ah support to the countertransference of the therapist to begins to believe that the patient is going to be okay.
00:42:05
Dianne Cooper_Byram
like yeah It's really field that if you work directly with patients, there's about a 10-year ability toleration. That's the last research I read.
00:42:23
Dianne Cooper_Byram
And then there's this burnout that begins ah because you thought, okay, it used to be in the 70s, you know, people felt like if they thought positively, they would heal.
00:42:37
Dianne Cooper_Byram
Symington and Broodjoy and some of those early higher consciousness people, you know, told cancer patients, if you think positively, if you read positively, you will get better.
00:42:55
Dianne Cooper_Byram
And is that denial? Well, people did that and they didn't get better and then couldn't understand it. Well, the therapist's mind over matter exactly.
00:43:02
colinyourbluff
Literally mind over matter, right?
00:43:06
Dianne Cooper_Byram
Well, in the mid 80s, there was Seligman did a whole thing on mostly with women with breast cancer that they were responsible for their own cancer.
00:43:20
Dianne Cooper_Byram
They were too nurturing or they were too this or that or throat cancer because they didn't say what they were going to say what they needed to say, et cetera.
00:43:30
Dianne Cooper_Byram
We now know that stress has something to do with cancer, but the research is showing that there's got to be already cancer brewing somewhere and the stress can just perpetuate it, but the stress isn't going to cause it.
00:43:49
Dianne Cooper_Byram
At least that's what the current research is talking about.
00:43:49
colinyourbluff
and internet
00:43:52
colinyourbluff
Maybe an accelerant.
00:43:53
Dianne Cooper_Byram
Exactly. It's an accelerant. Exactly. But it's got to already be there.
00:44:01
Dianne Cooper_Byram
So working with this death and dying process, of many years ago, I was fortunate enough to work with Elizabeth Kubler-Ross, who was the first to talk about death and and dying in a more concrete way. She had padded rooms in hospitals where people could throw themselves against the wall and scream and yell and cry and carry on until they could go through those five stages of denial and acceptance and what went on in the middle.
00:44:38
Dianne Cooper_Byram
um And now there's so many other theories that people will look at as to
00:44:54
Dianne Cooper_Byram
what is death. And we have religions. I, for many years, I taught courses on issues of death and dying.
00:45:05
Dianne Cooper_Byram
And i had each person in the class write down what their religious background taught them about death and dying.
00:45:17
Dianne Cooper_Byram
You know, turns out to be an American Indian seemed to be the healthiest way of of looking at death.
00:45:25
Dianne Cooper_Byram
Some people believe, you know, when you die, you die. Some people believe in an afterlife and everything in between. So I think it's really important that we get what each person's philosophy is on death and dying.
00:45:44
Dianne Cooper_Byram
And sometimes in the early part of treatment, See if we can kind of in engage people in just what their philosophy is and see if that helps them in coping.
00:46:03
Dianne Cooper_Byram
So on i I watch people, they say people want to die at home.
00:46:14
Dianne Cooper_Byram
Some do, some don't. That's an individual's journey. Some people want to be in the hospital. They want to feel like everything is being done for them.
00:46:30
Dianne Cooper_Byram
It really does just depend on each person's philosophy and their support system.
00:46:44
Dianne Cooper_Byram
Today with hospice, People are are in the home. They're being taken care of in the home.
Legacy and Storytelling
00:46:54
Dianne Cooper_Byram
who's Who's there besides the hospice nurse? What family members are there?
00:47:00
Dianne Cooper_Byram
Who can tolerate this loss? And sometimes it's not healthy for the patient to be at home.
00:47:10
Dianne Cooper_Byram
um Because the family is so agitated.
00:47:20
Dianne Cooper_Byram
i
00:47:22
Dustin Mesick_ RDN
You know what you're sharing?
00:47:23
Dianne Cooper_Byram
I don't know what more I want to say about it.
00:47:25
Dustin Mesick_ RDN
Well, what you're sharing right now is making me actually want to share something.
00:47:25
Dianne Cooper_Byram
Yes.
00:47:28
Dustin Mesick_ RDN
i don i don't know. We may or may not edit it out. ah um But actually, um
00:47:36
Dustin Mesick_ RDN
actually, I had an experience in hospice. i used to volunteer in hospice with terminally ill patients. And um there was this patient that I had who had, they didn't have cancer actually, but you know, there are people in hospice that do have cancer or can are terminally ill cancer patients.
00:47:51
Dianne Cooper_Byram
Uh-huh.
00:47:54
Dustin Mesick_ RDN
ah They actually, their diagnosis was actually Parkinson's. And um you know, when you are a cancer survivor and you think you might not survive, you might be open to some Eastern stuff that other people might say, oh, that's not, that's pseudoscience.
00:47:59
Dianne Cooper_Byram
Uh-huh.
00:48:05
Dianne Cooper_Byram
Hmm.
00:48:11
Dustin Mesick_ RDN
So at the time I started practicing Reiki for chronic pain because I had some other family friend who said that it really helped her. So I would share that as a service and hospice.
00:48:20
Dianne Cooper_Byram
Right.
00:48:23
Dustin Mesick_ RDN
And um I went I it actually was interesting because I went originally to do the Reiki on this patient. But it it turned out that they were kind of scared of the Reiki. So all I did is go and read to them.
00:48:37
Dustin Mesick_ RDN
And I was reading there there their favorite book. Their favorite book was the Book of Mormon. So every week i would go and read them their favorite book.
00:48:42
Dianne Cooper_Byram
Mm-hmm.
00:48:44
Dustin Mesick_ RDN
I learned a lot. I was like this guy named Nephi. Some other character, interesting names, reading them.
00:48:49
colinyourbluff
Nephi. nephi
00:48:50
Dustin Mesick_ RDN
Nehemi. Okay. And then pretty soon, it was actually pretty soon after that, they they were they thought I was a missionary. They're like, the missionary is here to see you. And I was like, yeah I'm not a missionary at all.
00:48:59
Dianne Cooper_Byram
Mm-hmm.
00:49:02
Dianne Cooper_Byram
i
00:49:02
Dustin Mesick_ RDN
I'm i'm just reading her favorite book. And i actually like called the daughter multiple times, asking her. And then actually... um Not long after that, and maybe it was probably six months or three months, three to six months I was seeing this patient.
00:49:16
Dustin Mesick_ RDN
She actually got better in hospice care and she actually got to return back to home. So and I and and her daughter says it was because you were seeing her. You were going to read read to her.
00:49:28
Dustin Mesick_ RDN
And it just made me wonder, like, oh, I wonder if that was all she needed.
00:49:33
Dianne Cooper_Byram
Well, what's interesting it's so true. Sometimes what's really needed is someone to be there with them, whether it's reading their favorite book, like a personal experience.
00:49:50
Dianne Cooper_Byram
My sister in in her processes of dying, people would bring
End-of-Life Experiences and Emotional Support
00:49:58
Dianne Cooper_Byram
her all these these positive thinking books and
00:50:01
Dustin Mesick_ RDN
Mm-hmm.
00:50:03
Dianne Cooper_Byram
I walked in one day and she had the cover of, I think it was Simington at the time, you know, power positive thinking or whatever. And inside she was reading some mystery novel.
00:50:16
Dianne Cooper_Byram
And she said, you know what? I can't get them to shut up about I should be reading these things and listening to these things.
00:50:21
colinyourbluff
Oh, that's so funny.
00:50:23
Dianne Cooper_Byram
So I said to her, i you know, I won't blow your cover. Whatever you need, whatever you want.
00:50:30
colinyourbluff
The old classic switcheroo, right?
00:50:33
Dianne Cooper_Byram
Exactly. But, you know, it it's so important that, you know, people, the patient is left with the responsibility of taking care of the loved ones.
00:50:47
Dustin Mesick_ RDN
Yeah.
00:50:48
Dianne Cooper_Byram
So, you know, it
00:50:51
colinyourbluff
Oh, role reversal for sure.
00:50:52
Dianne Cooper_Byram
yeah it is very much a role reversal because we do, we have to let the patient be whatever they want to be.
00:51:04
Dianne Cooper_Byram
And I do a i do a
00:51:13
Dianne Cooper_Byram
a thing where I have the patient get into a relaxed state. I do a deep, relaxed muscle thing. And then i I have them imagine they're turning their head and looking behind them so they can see their life.
00:51:32
Dianne Cooper_Byram
They can see those that they love, those that they hate it, those that they do. have them come to a life lived.
00:51:44
Dianne Cooper_Byram
And it's been so meaningful for so many. Yet I had one one man that he was very business-wise successful. He was a billionaire.
00:51:58
Dianne Cooper_Byram
and very powerful, blah, blah. blah And I had him do this exercise. And he kept doing it. And I kept saying, him what do you see? And he kept looking.
00:52:11
Dianne Cooper_Byram
And he turned around and he looked at me and he had tears running down his face.
00:52:14
Dustin Mesick_ RDN
Thank you.
00:52:15
Dianne Cooper_Byram
He says, all I see is a burnt out forest.
00:52:20
Dianne Cooper_Byram
And this is the first.
00:52:21
colinyourbluff
Wow, what a powerful image.
00:52:23
Dianne Cooper_Byram
And i it i said I told him, i said, my goodness,
00:52:25
colinyourbluff
Scorched Earth.
00:52:27
Dianne Cooper_Byram
that took my breath away. You must be so sad. And he said, it's the first time I've been able to say, I've accomplished so much for everyone else, but what I didn't accomplish for me is to feel that somebody cared about me.
00:52:50
Dianne Cooper_Byram
And that was his, And I just, I said, my gosh, you must be feeling so sad.
00:52:59
colinyourbluff
Thank you.
00:53:01
Dianne Cooper_Byram
and he said, I really am. I didn't expect that response from you, but that's really what I'm feeling. I'm just really sad. I said, I think you're pretty terrific guy.
00:53:13
Dianne Cooper_Byram
You've entertained me for the past four months. I know your disease has progressed and know you have more pain. I also do pain management.
00:53:25
Dianne Cooper_Byram
with imagery, it allows people just to break for a certain amount of time.
00:53:31
colinyourbluff
Right.
00:53:32
Dianne Cooper_Byram
And that's where the role of a therapist can be very instrumental. Because many times it's the therapist that the last person they person talks to before they take their last breath.
00:53:52
Dianne Cooper_Byram
If the therapist follows the patient
00:53:53
Dustin Mesick_ RDN
Thank you.
00:53:55
Dianne Cooper_Byram
thrill That's why we have to be so careful of our counter transference. Because many times the family member can't sit as the patient is taking those last breaths.
00:54:08
Dianne Cooper_Byram
They'll go get something to drink or they'll leave because they can't be there. It's too painful.
00:54:16
colinyourbluff
Yeah.
00:54:18
Dianne Cooper_Byram
And I've been fortunate enough assist many people including very close family members to cross over. That's just my own belief.
00:54:31
Dianne Cooper_Byram
I don't put that on them.
00:54:31
colinyourbluff
yeah
00:54:33
Dianne Cooper_Byram
But to just cross over, I think the spirit lives on.
Importance of Personal Legacy and Family History
00:54:38
Dianne Cooper_Byram
Again, my own belief. I don't put that on my patients. I let my patients have their beliefs, whatever they are.
00:54:47
Dianne Cooper_Byram
And it's usually I'm going to see my, I'm going to see the people i that have passed before me
00:54:47
colinyourbluff
but sorry
00:54:53
Dianne Cooper_Byram
which makes it a more joyful experience. I had one man say, i can't wait to die because I want to see my dogs. I missed them.
00:55:03
colinyourbluff
Yeah.
00:55:05
Dianne Cooper_Byram
So people are very naked.
00:55:06
colinyourbluff
Well, Dr. D, you know, I know we, uh,
00:55:08
Dianne Cooper_Byram
Yes.
00:55:12
colinyourbluff
had wanted to ask a question about your role at the American Cancer Society. But I wonder if it is maybe it more important just to kind of stick with a what we're talking about now and and continue with the conversation on death and dying.
00:55:27
Dianne Cooper_Byram
Whatever. I am forever grateful to the Cancer Society for allowing me to have such a fruitful career.
00:55:38
Dianne Cooper_Byram
i remained a volunteer for many years. I was at one time I was their youngest volunteer ah so many years ago.
00:55:49
Dianne Cooper_Byram
um But Yeah, it's changed so much over the years, but it's still the number one voluntary run organization in the world.
00:56:02
Dianne Cooper_Byram
And their pie still looks pretty good that so many donations go for patient services
00:56:08
colinyourbluff
yeah
00:56:11
Dianne Cooper_Byram
compared to other organizations where more of the donations are going for administrative costs.
00:56:25
Dianne Cooper_Byram
oh
00:56:28
colinyourbluff
I'm just curious if there's anything else you wanted to speak to on the topic of death and dying and and and that and working with terminal patients.
00:56:37
Dianne Cooper_Byram
um hi The only thing I'd really want to offer any therapist or a paraprofessional, this is one area that you don't have to be licensed to be a a volunteer in sitting and reading with the patient, reading anything the patient wants to hear. The family members want them to talk.
00:57:09
Dianne Cooper_Byram
I do recommend for families, incidentally, if a patient is diagnosed and has a terminal diagnosis where they can see that the lifespan will be more limited I do encourage patients to, ah used to be, use a tape recorder, now we can just use our phones, to record their life story.
00:57:41
Dianne Cooper_Byram
It seems to really help the patient feel like they won't be forgotten. I have many, many patients that have recorded their life and,
00:57:54
Dianne Cooper_Byram
oh Hans Salyer, who wrote Stress Without Distress, Positive and Negative Stress, he claims he lived four years longer than he was supposed to because he wasn't finished with his life story.
00:58:05
colinyourbluff
think
00:58:09
Dianne Cooper_Byram
So, you know, I think everybody should leave a legacy, positive or negative. Never too late to say I'm sorry.
00:58:23
colinyourbluff
Yeah, and having that part of a perhaps narrative therapy.
00:58:23
Dianne Cooper_Byram
Never, know.
00:58:27
Dianne Cooper_Byram
Exactly. And you know narrative therapy is part of dealing with medical issues.
00:58:38
Dianne Cooper_Byram
So I think, yeah, I would truly say that I would encourage any person to leave a life story for those that come after them.
00:58:57
Dianne Cooper_Byram
You know, we've gotten so involved in knowing our ancestors and knowing where we've come from. and so many genetic cancer genes have come from i our ancestors who, in essence, you know,
00:59:20
Dianne Cooper_Byram
just stayed together in a ghetto type living style where they ran out of people they weren't related to to marry. And that's where a lot of our genetic issues have come from.
00:59:34
Dianne Cooper_Byram
So leaving stories for your spouse, for your children, for your grandchildren of who you were.
00:59:47
Dianne Cooper_Byram
i know I have told my children What I want to say my gravestone, I just didn't want to say she's beloved mother, grandmother, or aunt, whatever.
01:00:01
Dianne Cooper_Byram
I wanted something that much more significant, which I don't need to share, but my kids are saying, okay.
01:00:09
colinyourbluff
Right.
01:00:15
Dianne Cooper_Byram
Because people are aging and we don't know. i come from a background of sudden death and that's a very different kind of death for a person to manage than a death where you can do anticipatory grieving.
01:00:26
colinyourbluff
right
01:00:34
Dianne Cooper_Byram
sudden te death usually does take longer to go through the grieving process for the family members.
01:00:42
colinyourbluff
more questions perhaps.
01:00:43
Dianne Cooper_Byram
more questions and I should have could have would have.
01:00:45
colinyourbluff
ponder Yeah.
01:00:47
Dianne Cooper_Byram
Yeah.
01:00:48
colinyourbluff
You know, as you were talking about just, uh, you know leaving a legacy, I was just thinking, ah silly joke.
01:00:48
Dianne Cooper_Byram
oh
01:00:54
colinyourbluff
i'm like, that's exactly why i have social media accounts so that, you know, so everyone can know that I make poor jokes and post silly pictures.
01:00:57
Dianne Cooper_Byram
Exactly.
01:01:05
Dianne Cooper_Byram
Well, that's positive part of that positive psychology. That's part of living in the now. ah I got, you know, I obviously I have a web page or I have a Facebook page, but I don't put anything on it basically because
01:01:27
Dianne Cooper_Byram
I don't want to.
01:01:30
Dianne Cooper_Byram
I knew there was going to be a ah pro prophetic reason why I don't do it, but i i I just don't want to. I want to read it. I don't want to do it.
01:01:42
Dianne Cooper_Byram
but So, I think it's really important for all of us to remember that if we're going to be part of a family system, of a religious system, of a connected system, we have some responsibilities that those that come after us for us to be, if they choose to, take us as role models.
01:02:14
Dianne Cooper_Byram
um If we can give them something to hold on to. i was fortunate enough to have great aunts that were powerful women weren't
Conclusion and Gratitude
01:02:28
Dianne Cooper_Byram
afraid.
01:02:31
Dianne Cooper_Byram
So consequently, and of loving men that
01:02:37
Dianne Cooper_Byram
were so supportive of anything I did. And that's what I tried to model for those that come. after me.
01:02:46
colinyourbluff
Beautifully said. know, I wanted to just take this opportunity to to thank you, Dr. D, for and you know being here with us and and having this conversation, you know, on lots of different things. I think we talked about quite a bit of different things to today, but wanted to then just thank you for your time.
01:03:06
Dianne Cooper_Byram
Oh, i I so enjoyed it. Thank you both.