Appearing at regular intervals in YFile, Open Your Mind is a series of articles offering insight into the different ways York University professors, researchers and graduate students champion fresh ways of thinking in their research and teaching practice. Their approach, grounded in a desire to seek the unexpected, is charting a new course for future generations.
Today, to mark Cancer Awareness Month, the spotlight is on York Faculty of Health psychology Professor Karen Fergus.
Fergus is a professor and clinical psychologist whose research focuses on the coping and adaptation processes of individuals and couples affected by cancer. She uses qualitative methods in order to derive an understanding of intimate relationships and how couples adjust to illness, adversity, and loss. Her clinical practice is based at Sunnybrook Odette Cancer Centre.
Q. Please describe your field of current research.
A. I specialize in the field of psychosocial oncology and study the impact of cancer on intimate relationships. More broadly, I have an interest in resiliency and resilience as it is expressed in couples. I primarily adopt a qualitative orientation in how I approach the study of relationships but, as a psychologist, I also develop and test interventions to support couple coping and adaptation to illness.
Q. What inspired you to pursue this line of research? Who or what sparked your interest in this line of inquiry?
A. I was intrigued by the question of why it was that some couples seem to grow stronger in the face of a hardship like cancer, whereas other couples seem to falter. What processesaccount for this difference?
Q. How would you describe the significance of your research in lay terms?
A. The relationship is so much greater than any particular adversity. When couples lose sight of that fact, it is indicative of the adversity, or in this case, the illness, overtaking the relationship. As with any significant hardship, the illness will shape the contours of the relationship, becoming part of the couple’s shared life experience and history; but, it should not be the defining feature of the relationship. Resilient couples are able to stickhandle the challenges of cancer without losing sight of who they are as a pair, as a ‘we’ they are continuously, sometimes masterfully, working together as a team.
Q. How are you approaching this field in a different, unexpected or unusual way?
A. I always start with the premise that the relationship is much greater than the sum of its parts – or as others have said, 1+1=3. It is common in psychosocial oncology to think in terms of ‘patient’ and ‘caregiver’ roles, but this is too reductive in my view. Relationships are so much more than our respective roles and responsibilities, or exchanges of support. Yes, these shift and must be accommodated, but that is only one part of the story. So, for as odd as it sounds, I don’t make cancer the focus of my work with couples facing the illness. For example, I developed an online program for young couples affected by breast cancer called ‘Couplelinks’. The theoretical basis for the intervention was to enhance the relationship bond – that is, to improve communication, relationship awareness, mutual empathy and perspective-taking skills. Adaptive couple coping, in my view, is a byproduct of good overall relationship functioning; fine-tune the relationship and the ‘coping and adjustment’ will take care of itself.
Q. How does your approach to the subject benefit the field?
A. A lot of the work my students and I do combines psychological intervention with technological outreach. I initially assumed that online approaches would be inferior to face-to-face modes of intervention. We have come to discover, however, that the online modality has its own unique benefits beyond the obvious advantages of convenience and accessibility – as well as particular challenges. I regularly share our learnings with the broader academic community.
Q. What findings have surprised and excited you? (I.e. tell us about the most interesting finding, person and/or place you encountered while pursuing this line of inquiry.)
A. Resilient relationships are like muscles; they actually become stronger because of, not despite, stress. But like muscles, our closest relationships require care and attention, without which, they will tear under strain. So it is through this continual interplay between ‘injury’ and ‘repair’, or stress and care that the foundation for resilience is laid. Resilience does not just spring up one day in response to a particular crisis; it is the culmination of an ongoing process of daily nurturance and “resilient reintegrations” (a term coined by Glenn Richardson). I find this knowledge encouraging because it means that the choices partners make on a day-to-day basis will determine how well they fair in times of extreme duress, when they have less control.
Q. Every researcher encounters roadblocks and challenges during the process of inquiry, can you highlight some of those challenges and how you overcame them?
A. Recruiting couples is twice as hard as recruiting individuals! And then that much more so with couples who are in the midst of a stressful life event, and for an intervention that is unfamiliar to them. Couplelinks is professionally facilitated, but not quite counselling; it is like an online course, but also very tailored. Consequently, my team and I have spent extensive amounts of time and energy educating healthcare professionals and patients across Canada about the intervention and what, exactly, it is.
Q. How has this research opened your mind to new possibilities or new directions?
A. When I first embarked on the Couplelinks project, there was very little in the way of online support for couples within or outside of oncology. We can now confidently say that this form of support is feasible, and perceived as valuable to the couples who have used it. There is certainly the potential to adapt the program for other populations. On a more theoretical level, I am excited to continue employing qualitative methods to further understanding of couple intersubjectivity, shared memory, and meaning construction as it applies to resilient coping processes in intimate relationships.
Q. Are there interdisciplinary aspects to your research? If so, what are they?
A. Cancer spans all aspects of the individual, from the physiological through to the familial and social, and beyond that to the broader community and health care system. So my research necessarily entails interdisciplinary collaborations including nursing, medicine, and social work. By the same token, I am always happy to represent psychology and provide psychological input on studies with a medical focus because cancer as a phenomenon is not confined to the disciplinary boxes we have constructed. The more interprofessional input and exchange, the better for everyone, I think.
Q. Did you ever consider other fields of research?
A. I haven’t really. For one, I’m too busy! But seriously, I love what I do and I have never felt constrained within psychology because it is such a far-reaching and cross-cutting discipline.
A. I taught an applied, fundamental psychotherapy skills course and an introductory qualitative methods course. I sometimes forget how long I have been working as a clinician and scientist in the field, so it is nice to have an opportunity to reflect on the various aspects of my work, and share what I’ve learned (often the hard way) with students. I find their perceptiveness and genuine curiosity so revitalizing.
Q. What advice would you give to students embarking on a research project for the first time?
A. Whatever that saying is about inspiration and perspiration applies to research. It is 10 per cent inspiration and 90 per cent perspiration in my experience. It can take a few hours to dream up a great idea and then months, sometimes years, to execute that idea in real time. Choose your focus (and later, your mentors and collaborators) well.
Tell us a bit about yourself:
Q. How long have you been a researcher?
A. Since I was a graduate student in the ’90s.
Q. What books, recordings or films have influenced your life and/or work?
A. I am very impressionable intellectually so there have been many. But in terms of my work in psychosocial oncology, I would say that Arthur Frank’s At the Will of the Body would be it. It is the first book I read back in 1998 when I began working as a clinician in oncology. His framing of a cancer diagnosis as a ‘loss of innocence’ in how it challenges so many deeply engrained assumptions has always stayed with me.
Q. What are you reading and/or watching right now?
A. I have two books currently on the go: The Art of Fermentation by Sandor Katz is such a fascinating examination of fermentation as a ‘co-evolutionary process’ from a biological, cultural, historical and ‘how-to’ perspective. The other book, Far from the Tree by Andrew Solomon has to do with children who bear ‘horizontal’ identities relative to their parents’ hopes, expectations or implicit assumptions about what their child ‘should’ be. It is a book about resiliency in the face of being challenged – in both directions. One of my mentors and esteemed colleagues, Professor David Reid, once said to me, “We think we raise our children, but they also raise us.” Far from the Tree is a book about just that.
Q. If you could have dinner with any one person, dead or alive, who would you select and why?
A. It would be the narrative gerontologist, Bill Randall. His study of aging ‘from the inside’ is so much more hopeful and inspiring than the customary focus on aging ‘from the outside’ and attendant deficit-based narrative.
Q. What do you do for fun?
A. Cooking, karate, and (weather and location permitting) canoeing and kayaking. Cooking is a functionally creative outlet for me, and I love to do so for and with the people who are close to me.