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Christine’s* friends and family had been pillars of support after her cancer diagnosis. Her community responded quickly and consistently while she underwent treatment – home-delivered meals, child-minding, lifts to medical appointments, even an online fundraiser to help with living costs while she was unable to work.

A year on, Christine was thrilled to share news of remission. But after feeling buoyed by dozens of congratulatory messages and a celebratory group dinner, she felt an abrupt shift within her friendship group. Daily check-ins and offers of help dwindled, replaced by an expectation to “get back to normal”. Christine also felt a shift within herself, noticing she felt flat most days and was increasingly consumed by thoughts of her illness and recollections of treatment and procedures. She felt as if her friends were abandoning her just as she needed them most.

Christine coped well initially following diagnosis, remarking that it must seem odd that she sought therapy after remission. Everyone is different, I assured her, and there is no wrong or right time to seek assistance. In fact, psychological distress after remission or at end of treatment is not unusual; there’s little time for reflection during the blur of appointments and procedures following diagnosis, with many patients unconsciously detaching from psychological aspects of their experience in order to focus on physical health and persevere through necessary medical protocols. It is common to experience a “comedown” after significant life events, whether negative (such as illness or another trauma) or positive (such as getting married, entering retirement or moving to a new home). Given time and space, thoughts and feelings eventually catch up with us.

While her friends expected a seamless return to pre-illness life, Christine felt a sense of limbo between her old and new self. She wanted to move forward, but was conscious of changes to not only her psychological wellbeing, but also physical appearance and functional capacity. Although she had completed treatment, Christine’s life was replete with reminders of her diagnosis, including ongoing medical appointments and daily medication regime. “Scanxiety” (apprehension or fear about undergoing or waiting for medical scan results) was particularly heightened for Christine. This was strongly linked to her fear of cancer recurrence.

Attempts to raise concerns with friends fell on deaf ears. Instead, they had become positivity cheerleaders. They encouraged her to express gratitude for early diagnosis and life-saving treatment. Concerns around the cancer returning were dismissed as unnecessary and unhelpful thinking. Christine was thankful and tried to adopt a positive mindset, but was insightful enough to know that her experience aligned more with post-traumatic stress than the much-fêted post-traumatic growth.

Therapy helped Christine make sense not only of her own psychological reaction following remission, but also of her experiences with her friendship group and support network.

First, Christine recognised the change in her own needs and her friends’ capacity to assist. While they had excelled at pragmatic support, she came to accept their limitations in helping with current emotional concerns. She recognised the need to broaden her support network. In addition to individual therapy, joining a cancer support group helped her connect with like-minded people. Concerns about cancer recurrence and lifestyle changes were normalised by others. Being able to speak freely in therapy sessions and within the support group reduced Christine’s sense of urgency around speaking about her illness with friends.

For Christine, it was important to realise that her friends’ lack of capacity to help was not necessarily reflective of lack of care. This allowed her to enjoy positive aspects of her long-term friendships rather than focus on apparent deficits. It was upsetting for Christine’s friends to see her unwell and a relief to hear of her remission, but their desire to see her better resulted in glossing over or rushing through the realities of Christine’s current experiences. Despite our hopes, treatment for cancer and other illnesses is rarely a panacea; ongoing physical and psychological sequela is the norm rather than exception.

Eager to put others’ bad days behind them, we may hurry to console or cheer others in their darkest moments, encouraging them to look at the bright side and anticipate the future rather than dwell in the past. To people such as Christine who have endured illness, we may say, “You’re better now.” To a miscarried mother, “You can try again.” To a heartbroken teenager, “Plenty more fish in the sea.” To the losing team of a sport final, “There’s always next season.”

It can be difficult to strike the balance between supportive listening and offering encouragement or help with problem-solving. Even experienced therapists struggle with this at times. If in doubt, it can be helpful to ask the person directly about what they want or need from you at that moment. It may be emotional support (listening, empathising) or practical or logistic support (planning, problem-solving). Using open-ended questions and resisting assumptions about the person’s recovery from illness can help encourage conversation. Meeting the person at their actual stage of recovery or wellness – rather than where we think or wish they were – might prove to be a gift as valuable as a home-cooked meal or lift to a medical appointment.

*All clients are fictional amalgams

• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org.

• Dr Bianca Denny is a clinical psychologist based in Melbourne. She is the author of Talk to Me: Lessons from Patients and Their Therapist