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Prostate Cancer and Narrative Therapy

In this article, I want to discuss Narrative Therapy (NT) and prostate cancer. I was given an article by a colleague who knows I write for The article is called ‘Utilizing a Narrative Approach to Increasing Intimacy After Prostate Cancer.’1 She knows me so well. After digesting the article, I figured it could be of some assistance to those who are looking for a different form of sexual therapy related to issues caused by prostate cancer. Well, let’s take a peek inside this article.

What is Narrative Therapy?

While using this form of therapy, the counselor uses a person’s ‘problem’ found through their personal stories to reveal how this ‘problem’ can be reevaluated in social, cultural, and political contexts.2 Therefore, healing and recovery is not defined by solving problems, but instead “on thickening the life stories so the stories not longer support the problem.”1 Because of this ‘thickening,’ people can develop new and healthy variations of their story with brand new possibilities for their future.3 Phew!!

In this article, the authors focused their narrative therapy questions on five themes related to sexual health and prostate cancer.

Themes of sexual health and prostate cancer

The 5 themes are as follows: sexual intimacy, masculinity, self-esteem, role change, and communication. I’ll try to break down these questions into smaller nuggets so you can get the gist of what these researchers are doing.

Sexual Intimacy

Depending on the type of treatment or surgery for prostate cancer, sexual functioning and general satisfaction can be severely impacted. Plus, satisfaction with your sex life can affect overall life satisfaction, for both partners in most cases.1,4 So, one of the early narrative questions could be something like, “How did having prostate cancer alter your sense of connection and intimacy?” A later question may look something like, “How will others in your life be able to tell that your sense of connection and intimacy is stronger than ever?”1


Because of the change in sexual functioning, many men report a negative impact on their self-esteem.5 The women in their lives reported a decrease in their self-esteem as well.6 The women reported they did not miss the act of sex itself but missed the affection.7 So, any early question looking at self-esteem may look something like, “If the problem that is stealing your self-worth, security, and self-esteem had a name, what would it be?” A later question might look like, “Who would have predicted that you would have gained a stronger sense of self and unity after cancer?”1

Sense of Masculinity

Men also report a decreased sense of self-confidence, self-definition, and self-worth, which is all related to sexual capability.8 Their partners also reported changes due to their partner’s sense of masculinity, including hormonal changes and a negative impact on their self-esteem.1 Therefore, some of the narrative questions may sound like, “How do you and your partner’s culture or society define what it means to be masculine?” A later question may ask, “If you were to continue on the new path, how would you predict your sense of masculinity would change you both for the better?”1

Role Change

After or during an illness, the change of role to becoming the caregiver of one’s partner has been reported to cause a sense of isolation, emotional distress, and reveal problems of maintaining the household.9 To explain, the wives reported they were often the go-between for her husband and the healthcare system while mentioning the emotional toll the change in role put them through.10,11 So, early questions may look like, “Since prostate cancer has come into your life, how have your gender roles or marital roles changed?” A later question may ask, “As you continue to redefine your roles to your relationship, how will you continue to show others how these new roles have positively affected your relationship?”1


Doctors also noted how miscommunication and decreased communication in couples with prostate cancer.12 One study found that in couples dealing with a chronic illness, the healthy partner kept their feeling inside in order to protect their partner from any more pain.13 Therefore, some of the early questions in NT might include a question like, “How has communication affected your relationship and sexual intimacy?” A question near the end of NT may sound something like, “When you talk to each other now, how do you know that she/he is really listening?”1

Applying Narrative Therapy

This is a lot of information and the original article was over 20 pages! There is plenty of material on this topic which I will explore in greater depth soon. I think the authors are onto something with Narrative Therapy. I’d like to know if they accounted for the type of therapy or surgery when it comes to NT. I still think Selfless Sex is a good alternative too.

Thank you.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. McCoy, M., Stinson, M.A, et al. (2013). Utilizing a narrative approach to increasing intimacy after prostate cancer. Journal of Creativity in Mental Health, 8, 48-69.
  2. Freedman, J. & Combs, G. (1996). Narrative Therapy: The social construction of preferred realities. New York, NY: W.W. Norton & Company Inc.
  3. Morgan, A. (2000). What is Narrative Therapy? An easy-to-read introduction. Adelaide, South Australia; Dulwich, Centre Publications.
  4. Mallis, D., Moisidis, K, et al. (2006). Moderate and severe erectile dysfunction equally effects life satisfaction. Journal of Sexual Medicine, 3, 442-449.
  5. Rivers, B., August, E., et al. (2011). Psychological issues related to sexual functioning among African-American prostate cancer survivors and their spouses. Psycho-Oncology, 20 (1), 106.
  6. Sanders, S., Pedro, L., et al. (2006) Couples surviving prostate cancer: Long-term intimacy needs and concerns following treatment. Clinical Journal of Oncology Nursing, 10, 502-508.
  7. Harden, J., Schafenacker, A., et al. (2002). Couples’ experiences with prostate cancer: Focus group research. Oncology Nursing Forum, 4, 701-709.
  8. Bokhour, B., Clark, J., et al. (2001). Sexuality after treatment for early prostate cancer. Journal of General Internal Medicine, 16, 649-655.
  9. Danhoski, M., Pais, S.P. (2007). What’s love got to do with it? Couples illness, and MFT. Journal of Couple & Relationship Therapy, 6, 31-43.
  10. Gray, R., Fitch, M., et al. (2002). Hegemonic masculinity and the experience of prostate cancer: A narrative approach. Journal of Aging and Identity, 7, 43-62.
  11. Heyman E. & Rosner, T. (1996). Prostate Cancer: An intimate view from patients and wives. Urologic Nursing, 16, 37-44.
  12. Badr. H & Taylor, C. (2009). Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psycho-Onocolgy, 18, 735-746.
  13. Rook, K., A, August, E., et al. (2011). When does spousal social control provoke negative reactions in the context of chronic illness? The pivotal role of patients’ expectations. Journal of Social and Personal Relationships, 28, 772-789.


  • kenneth1955
    2 months ago

    Nick. I just got done reading the articles that you wrote. And I find them interesting.

    With most of the treatments that they have most of the time your sex life is over as you know it. This is not good for any man or his partner. The change can do more they change there sex life. This can also end a marriage.

    When a man does a treatment he is most of the time talked into it by his doctors but most cancer are slow growing and there are only 5 % that should be addressed right away.

    That is why it is good to have a doctor that cares enough about you and your life not to force into anything. You need to have all the test so you know what you are dealing with.

    One of my friends was 48 at the time they found cancer in his prostate. 2 out of 16 samples. The doctor told him that he needed it out that it was best. The doctor kept calling him every week to have the surgery. He ever got a hold of his wife to do the same thing to him.

    After 8 week he said yes after 3 months all he wanted to do is die. He tried once to kill him self. He could not get a erection after even with pills. At a year the doctor told him to try the injections. they work but he could not have a orgasm. When he did he took him 2 hours and he told me that it was not the same and not worth it.

    After a few years his wife left him. The only thing he lives for now are his 2 little girls. He told me that if he had to do it again he would not have listen to the doctor and just wanted and lived his life. He went back to the oncologist to get some information and he found out that his cancer was slow and they told him that he could have gone for 5 to 10 years before he had to do anything.

    He doctor told him not much.

    We men are all different and we all have different concerns. I for one would never have anything done to my prostate if I get cancer. I will not let any doctor take away my erection or my ejaculations.

    They may save your life with getting rid of the cancer but why should I have to give up something for it. This is not right.

    Your other article on Selfless Sex. Been there done that.

    I was married for 22 years have 3 great kids with working and other thing I was not in the mood all the time. My wife was 6 years younger then I she was in the mood all the time. There were times that I took care of her. Oral was the only way she would have a orgasm. After she was done I just went to sleep as long as she was happy.

    But I do not agree with Diane that society thing to much about sex. We don’t but that is part of our life just because we get older are they just suppose to put us out to pasture like they do to the old studs.

    When the kids are gone and we have the time this is when we should be able to enjoy life with each other. I did not like what you said if you still have the desire. Men never lose that this is just the way men are.

    I’m on another site. This man the first procedure he had was HIFU for his cancer. No more sex life. He still had a problem could not go to the bathroom He had a PAE. Same problem At the first part of the year he had a Turp. This has been in the last 3 years

    Now he wrote me last month he got a erection and was able to have sex with his wife and what surprised him he had a ejaculation. He is 78 years old and he cried when this happen It took 5 years for him to have something happen. Men are not giving up.

    Well I think this is enough. I have said to much but this is my opinion

    I wish all of you good heath and a good year.


  • Dennis Golden moderator
    2 months ago

    The sex thing is tricky. Some men and spouses are not impacted by it while others find it is the only thing on their minds.

    We invite both men and their partners to our education and support groups and it always is interesting to see the number of questions women ask questions vs the men who are about to undergo surgery.

    I was recently contacted by a man from Florida who said his wife wanted a divorce because as she put it “he would no longer be able to fulfill his part of the marriage contract”

    We chatted a number of times over a few months and he decided it was best to go on a solo vacation to a health spa for a few weeks. The much needed break gave them both an opportunity to get over the rough spots. Things are apparently going along smoothly now.

    Personally my wife and I have grown closer as a result of the cancer.

    We are all different and it can take some time to adjust to changes in your life. … Dennis ( Team)

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