Reflections from a Psycho-Oncology Practice

I was working at a Palliative Care Center as a Counselling Psychologist run by an Oncologist Family’s Foundation out of a modest corner building of a well-known Hospital in the South of Mumbai. Here’s a moment that has stayed with me, ten years down the line.

I recall sitting across from a 65-year-old caregiver and noticing, Ms. Jasmine, who otherwise looked composed on all the days that she would accompany her 70-year-old husband, Mr. Adi for therapy, feeling exhausted and visibly overwhelmed. The, then existing frameworks in Cancer care allowed me to recognise what caregiver burden and burnout could look like, but what stood out for me in that moment was not the application of one specific intervention of self-care amidst burnout, but the need for my immediate and undivided presence for Ms. Jasmine’s unspoken fears and the mere validation of how exhausting it could be to reside alongside these fears through every cough, every sore throat and every ache that seemed to signal as if the Cancer was progressing, spreading or returning.

This experience highlighted for me how psychological experiences in a Cancer setting are often layered with ambiguity and moral tension in the Indian socio-cultural context – areas that are not fully deconstructed within structured frameworks of care such as ‘protocols’. Cancer patients, survivors, and caregivers alike are often grappling with existential uncertainty surrounding appointments, diagnosis, treatment, logistics, expenses, family care and shifting identities. If this is the level of complexity that an individual client may be navigating, shouldn’t it drive psychologists to move beyond the rigid compliance to models and protocols towards a more sensitive, flexible and context-specific application of psychological skills and approaches?

Psychology, to me, has been an endeavour to understand the human systems so as to be able to alleviate the human distress. While research does provide insights into coping, forms of care and intervention in a Cancer context, the lived reality of patients, survivors and caregivers often extends beyond what researched interests and frameworks can adequately capture. I believe this gap is more pronounced in the Indian context than we’re willing to admit and act upon. The experience and expression of Cancer journeys bring with them rich personal histories and socio-cultural contexts that may create a sense of tension within the therapist between adhering to a model that research advocates and responding to the individual needs of the visibly emotionally overwhelmed client.

My own experiences of discomfort within the engagement with Cancer patients, survivors and caregivers have clearly announced to me that there is a divide. I do admit that theoretical models do provide me with a foundation and a broad direction to steer into, but meaningful change may emerge only through a therapist’s full presence – emptied of all the faculties before entering the therapy room and a sensitive context-specific application. It is this strong discomfort and a felt sense of the divide that drives my interest towards doctoral-level of training to become an independent researcher. I hope to develop the skills necessary and sufficient to contribute to knowledge that is rooted in a more humane approach and lived realities. This seems like my opportunity to finally participate to make psycho-oncology an ever evolving, relevant and impactful practice.

Author Bio:

Pooja A. Pandhe is a counseling psychologist based in Mumbai with over a decade of clinical experience. Her work focuses on grief, trauma, and the psychological dimensions of loss, with particular attention to culturally situated experiences of healing. Drawing from a trauma-informed and client-centered framework, she engages with questions of meaning-making, resilience, and emotional processing in the aftermath of difficult life events.

Her clinical practice has included work in palliative care settings and with individuals navigating complex and traumatic bereavement, including sudden and anticipatory loss. These experiences inform her interest in the intersections of personal narrative, relational contexts, and broader socio-cultural influences on psychological well-being.