Interview with Marianna Dutton

How psychological support can promote the therapy of lymphoedema and lipoedema

The influence of mental strength

The diagnosis lymphoedema or lipoedema doesn’t just change a person's life in physical ways. These chronic diseases also present a great mental challenge for the patient. Encouragement and support, especially from the patient’s social environment, are of great significance here. If such help is missing, there are various possibilities for getting professional assistance. Marianna Dutton knows the worries and fears of lymphoedema and lipoedema patients. She is the leading psychological therapist at the Földiklinik, a specialist clinic for lymphology in Baden-Württemberg, Germany. This interview makes it clear that the psychological care of patients is becoming an increasingly important part of therapy.

Ms. Dutton, what are the most frequent subjects your patients bring up with you?

Many patients feel misunderstood by their surroundings. For some, it is difficult to accept that a chronic disorder can considerably affect their daily routine. This can lead to fears and loss of confidence in one’s own body. Primary lymphoedema patients often have problems with a sense of shame or suffer from depression, adiposity and eating disorders.

Secondary lymphoedema patients are frequently tumour patients. We know from research that about a third of all cancer patients have psychological problems. Sleep disturbances are also common symptoms. For cancer patients, the visibility of the oedema is especially distressing, because it continually reminds them of their disease. 

How many patients do you attend to each year?

We are three colleagues and currently look after between 250 and 300 patients a year. 

As a rule, how long is psychological treatment necessary?

The patients usually remain with us in the clinic for three to four weeks and participate in about three to eight sessions during this period. A session is 50 minutes long and takes place once or twice a week.

How high is the inhibition threshold for patients before seeking psychological help?

For our patients, this inhibition threshold is rare. They have already decided on therapy and some have also been on the waiting list. The awareness of the therapeutic need of patients with lipoedema and lymphoedema has grown. Today we have three times as many patients as we had fifteen years ago.

What do the results and successes of psychological care look like?

Depression and fear levels clearly improve and the patients return home more content with their lives. Their self-esteem is increased and they can deal better with stress, are more attentive to their own needs and accept their body more positively. Unfortunately, there are too few practice-based psychotherapists or psycho-oncologists. A follow-up treatment is therefore not always available to everyone. 

What can patients with psychological problems do for themselves?

At first, they should seek information from their physician, from an information centre or also in the internet, in order to find out whether it is appropriate for them to make use of professional help in their individual situation, for instance for clinical depression. Possibly a self-help group can also be sufficient. Psychological self-help books are likewise recommended for practical advice.

It is important that patients do not feel left alone with their problems. Group activities such as walking, swimming, dancing, yoga or stress-reduction courses can help. Patients should learn to lovingly accept their bodies, instead of always putting themselves under pressure. The quality of life is not decided alone by the extent of the oedema, but the primary factor is rather the subjective feeling of the patients. We are always very generous with other people's looks, but with our own body we say: “I look awful, my arm or my leg is much too fat.” It is wrong to only reduce oneself to one part of the body.

How should one fundamentally deal with patients who are depressive, disappointed or unmotivated?

Therapists develop a close relationship with their patients, whom they regularly attend to over the course of several years. Initially, the therapist-patient contact is important to ensure that the patient feels understood and cherished. The therapist should attempt to view the illness from the viewpoint of the patient, without smothering him or her with advice. Because, behind almost every compliance problem lies fear. If I understand this, I can motivate the patients. If the patient is angry or exasperated, I give him sufficient space to calm down. We can also ask the patient: “If you were a therapist, what would you advise a lymphoedema patient?” This way one can quickly obtain a good access to patients.

Ms. Dutton, thank you for this interview.

Here you will find more information about lymph therapy.