Why there are so many kinds of helpers
Cancer affects nearly every part of life at once: feelings, relationships, finances, faith, work and sense of the future. It makes sense that no single profession covers all of it. The National Cancer Institute (NCI) lists psychologists, psychiatrists, social workers, palliative care specialists and religious counselors among the specialists people can talk with when they are having trouble coping.
The NCCN patient guide on distress notes that the work of mental health providers overlaps but their expertise varies, and that a license shows a provider has met the education and training requirements to give care. Knowing the broad differences can make a referral feel less confusing and help you ask for the kind of help you actually want.
Who does what
Oncology social worker
NCCN describes social workers as experts in helping people overcome life challenges, and oncology social workers as those who focus on people affected by cancer. They often help with practical concerns such as treatment costs, insurance and leave forms, transportation, child care and connecting you to community resources. Many also provide counseling, lead support groups and advocate for patients and families. Clinical social workers have specialized training to provide mental health care. If your cancer center has a social worker, they are often the easiest first call.
Psychologist
NCCN describes psychologists as experts in how people think, feel and behave, and lists clinical, counseling and health psychologists among those who provide clinical services. A licensed clinical psychologist can evaluate what you are experiencing and offer psychotherapy, a structured conversation aimed at understanding your reactions, coping with them, and working through the effects on relationships and identity. Psychotherapy can continue over weeks or months, and it can address both the cancer and the older history that cancer sometimes stirs up.
Psychiatrist
NCCN describes psychiatrists as medical doctors who specialize in mental health and are licensed to prescribe medication. NCCN notes that psychiatrists can become certified in particular areas, such as consultation-liaison or geriatric psychiatry. A psychiatrist can be especially helpful when symptoms are severe, when depression or anxiety is not easing, or when medication questions are complicated by cancer treatment.
Chaplain
NCCN describes a chaplain as a trained professional who provides spiritual support in secular places like hospitals, and notes that many chaplains are board certified. NCI adds that many hospitals have chaplains trained to support people of different faiths, as well as people who are not religious. Chaplains can help with questions of meaning, conflict between beliefs and treatment, fear of death, prayer and ritual, and they can refer you to other kinds of care.
Others you may meet
NCCN also lists psychiatric-mental health advanced practice nurses, licensed mental health counselors and marriage and family therapists. Palliative care teams, which NCI describes as working alongside the oncology team to improve quality of life, may include psychologists, social workers and chaplains as well as doctors and nurses.
In practice, these roles often work side by side. A person in treatment might see the oncology social worker about a disability application, meet the hospital chaplain during a long infusion day, and talk weekly with a psychologist about fear and family tension, while the oncologist or a psychiatrist manages any medication for sleep or mood. A caregiver might use an entirely different mix. Nobody needs every kind of help at once, and the mix can change as treatment, recovery or survivorship moves along. What matters is that each person knows enough about the others to avoid gaps, which is one reason to tell each professional who else is involved.
A note about medication
Medication for anxiety, depression or sleep is prescribed by physicians, such as a psychiatrist, an oncologist or a primary care doctor, and by certain other licensed prescribers. NCCN notes that your cancer care team may itself prescribe medicines to relieve distress symptoms. Psychotherapy with a psychologist is a separate, talk-based form of support. If you are seeing a psychologist and wonder whether medication might help, the next step is a conversation with one of your doctors. Never start or stop a medication without talking with the prescriber, especially during cancer treatment.
How to decide where to start
There is no wrong door, and one professional can usually point you to another. As a rough guide:
- Bills, insurance, rides, child care or forms: start with an oncology social worker or patient navigator.
- Questions of faith, meaning or what happens after death: ask about a chaplain or your own faith leader.
- Ongoing fear, sadness, relationship strain or old wounds resurfacing: consider a psychologist or other licensed therapist.
- Severe or worsening symptoms, or questions about medication: talk with your doctor about a psychiatrist.
- Physical symptoms tangled up with emotional ones: ask your oncology team, and about palliative care.
The American Cancer Society suggests asking your cancer care team which kind of counselor fits your needs if you are unsure, and looking for someone with experience working with people who have cancer. If your care team screens you for distress, answering honestly is one of the simplest ways to be connected to the right person, and How to Talk With Your Oncology Team About How You Feel has ideas for starting that conversation. If you are weighing a group against one-on-one help, see Cancer Support Groups vs. Individual Therapy.
Where a private-practice psychologist fits
Some people prefer to talk with someone outside the hospital, with sessions that are not tied to treatment days. Dr. Lehmann is a licensed clinical psychologist in Franklin, Michigan, with an insight-oriented, integrative approach that looks at your history, relationships and current circumstances alongside practical coping skills. She does not prescribe medication or give medical advice. With your written permission, a psychologist can coordinate with your physicians when that would help. Learn more about cancer-related emotional support.