’Why Mutilate Me Before I Die’: An Emotion-Focused Conceptualization of Breast Cancer Clients’ Experiences of Anxiety and Depression

ABSTRACT The study set out to study the experienced distress of clients with breast cancer who also meet criteria for comorbid anxiety and depression (CAD) from the perspective of emotion-focused case conceptualization. A theoretically informed qualitative case analysis of 15 recorded psychotherapy sessions across three women was conducted using an emotion-focused case conceptualization as domains of inquiry and an interpretative framework. Experiences of mastectomy-related shame appeared to be maintained by cancer side effects, whereas social identities relating to gender and class triggered self-blame for cancer and shame at not functioning as well as expected. Existential fear, worry, and hypervigilance were indicative of cancer as an ongoing trauma. Unmet needs for safety were related to unclear communication with the medical team during treatment, while triggers relating to childhood adversity and insecure attachments perpetuated present-day distress. The findings suggest that emotion-focused treatments in psycho-oncology include a trauma-informed lens that allows for greater processing and integration of past trauma. Future research should explore breast cancer distress in women across different social identities for a broader and more inclusive understanding of distress presentations.