My Story
Apart from my academic and work experiences, my life experience includes travelling, seen amazing places and learning two new languages and several cultures around the world. In my 20’s I worked as babysitter, bartender, housekeeper and translator.
These jobs taught me a lot about how hard it is to be independent, financially and emotionally. These jobs also allowed me to save money for living, travelling and meeting the kindest and genuine friends that I get to keep as my second family.
Between ups and downs, I got to see paradisaic places and the most beautiful phenomena of nature, such as the northern lights and the lava field in Reykjanes (Iceland), camping at the Havasu Falls (USA), experiencing the sunset from the top of the Eiffel Tower (France), cycling around Lake Bled and entering the Postojna Cave by train (Eslovenia), watching the two sides of the Iguaçu Falls (Argentina and Brazil), cycling around the tulip fields of Lisse (Netherlands), kayaking for hours around the Abel Tasman Coast (New Zealand), etc.
Then I stopped moving around countries to be close to my family, friends and to finish university. I graduated in psychology (BR), and for the last two years of the course I worked as an intern (clinical psychologist) at the university’s clinic of psychology and at the university’s hospital. Through these internship experiences I had my first contact with health psychology as a discipline and clinical practice, which aroused my initial interest in psycho-oncology and in palliative care.
After studying the existential approach in psychology, I decided to research the literature on psychological interventions in palliative care, which resulted in my first publication (Melo, Valero, & Menezes, 2013). In the course of my research I came across an article about the quality of end-of-life care across the world (Mayor, 2010), and in a list of 40 countries, the best care was found to be in the United Kingdom, Australia and New Zealand. Then, in 2012 I moved to the United Kingdom (Cambridge) where I experienced working with patients in a hospice. To view my interview at the Arthur Rank Hospice’s magazine, click here.
How I became interested in using mindfulness for those with incurable cancers?
My experience was that patients with advanced cancer would welcome psychological support unless they were in denial or using avoidance regarding their terminal diagnosis. In addition, I saw that the best way forward for patients with a life-threatening disease to cope successfully appeared to be acceptance of their situation: I observed that only after acknowledging their diagnosis could they move on. Then, in the process of coping, they find meaning in their end-of-life experience, an observation supported by the literature (Benzein, Norberg, & Saveman, 2001; Bishop et al., 2004; Rosenfeld, Barry et al., 2016).
During therapy sessions with the hospice clients, I observed that patients with cancer struggled to find answers to their questions, such as “Why me?” or often to identify what was meaningful in their lives, what really mattered to them for their remaining time. They would look for answers from me or my colleagues. Sometimes, however family and friends, and even healthcare professionals hesitate to talk about someone’s advanced cancer or the existential topics that might arise. They may feel that they cannot find the right words, or it is too complicated to discuss the disease consequences and health deterioration, so this subject may be avoided and not talked about at all. This used to create a silence around cancer and the patients.
This kind of situation frequently arose in my work with patients, and it could be devastating for the patient’s family, friends, community and the healthcare team, creating a generalised sorrow and burden around the work place. My observation was that the death could be less traumatic if psychological support was available before the patient reached the last stage of life, and this kind of support should start by understanding the current reality for patients and family members.
My knowledge of mindfulness practice, and the relaxation techniques taught in my psychology undergraduate course, made me realise that those techniques could be useful in helping patients to feel calmer and more relaxed before they could talk about their feelings. Subsequently I taught some basic meditation and mindful breathing techniques in a few sessions of group therapy in a hospice, and received positive feedback from the family members and the patients.
Nonetheless, the mindful coping skills I was familiar with, focusing on the present moment experiences and achieving a calm state of mind, did not address patients’ psychological needs if they were in denial of their diagnosis, or questioning the meaning of their life. I therefore searched for an approach more suited to patients with terminal cancer, especially approaches already tested by research. However, not only did I fail to find suitable interventions, but I discovered there appeared to be limited research on how best to support the psychological needs of patients with advanced cancer.
From my experiences and subsequent reading, I therefore became interested in developing an intervention that would help my patients, one that would assist them to discover meaning in their experience of having cancer, to acknowledge their poor prognosis and possibly feel peaceful, not facing the proximity of their death feeling anxious and with unresolved issues. I wanted the intervention be one that they could use themselves as needed, rather than being reliant on an appointment with a psychologist. Further, I wanted to test the proposed intervention on the target population.
The advanced cancer population requires coping strategies to be able to maintain psychological well-being. My PhD research was focused on providing an intervention where patients with advanced cancer could obtain new coping skills to help them to cope better with the disease course and psychological symptoms while living out the final years or months of their lives, in accordance with what is meaningful for them. In this context, I developed the “Coping with Cancer Mindfully” (CCM) intervention specifically to be used independently by participants at home.
This client-centred intervention placed this group’s needs as central, with the intention of the delivery design to overcome the practical difficulties of providing psychological support to someone with increasingly difficulty attending professional appointments as their illness progresses, and with the intervention being readily available when participants need it.
I have presented a proposal of this project in 2016 at the Health Research Open Day Lecture at the University of Otago, Christchurch. To access the video, click here.
For more details about the CCM intervention and the study’s results, please go to CCM INTERVENTION
Education
- Doctor of Philosophy (Ph.D. in Mindfulness as a psychological intervention) | University of Otago – New Zealand. Oct 2015 – Jun 2019. Dissertation: “Mindfulness, acceptance and meaning in life for adults with advanced cancer”
- Trained in Mindfulness Based Stress Reduction (MBSR) | eMindful – USA. Apr 2016 – Jun 2016.
- BSc Psychology (Hons) | University of Vale do Itajaí – Brazil. Aug 2007 – Dec 2011. Research project: “Psychological interventions in palliative care”