Breast Cancer Resource Center Savannah, GA USA


Since breast cancer affects patients both physically and emotionally, we've partnered with Dr. Elisabeth Counselman-Carpenter, PhD, LCSW, Adelphi University, to investigate patient views on both the psychosocial implications of a diagnosis and mental health support. Our goal is to educate patients, providers, clinicians, and community members with IRB research studies and to further programs based on peer-reviewed research.

Title: Recommendations for Physicians about the content of mental health referrals during breast cancer treatment, Supportive Care in Cancer

Title: Factors and coping styles related to breast cancer patients’ preferences about referrals to psychotherapy

Authors: Dr. Elisabeth Counselman-Carpenter, PhD, LCSW, Adelphi University, Joyce T Williams, Keepers of the Flame Foundation, Eun Kyung Lee, Doctoral Candidate

Objective: The purpose of this study was to examine what factors may influence emotional suppression and emotional expression in breast cancer patients and how coping styles relate to beliefs about physician-driven referrals to therapy during the cancer treatment process. 


Methods: Using the Courtauld Emotional Control Scale, this mixed methods study surveyed 69 participants. Based on the median score of 52.5, participants were divided into categories of Expressers and Suppressors. Twenty-seven participants opted into a Phase II semi-structured interview to further discuss their personal views on therapy during breast cancer treatment, beliefs about physician-driven referrals and experiences of coping throughout cancer treatment.


Results: Demographic variables including age, marital status, income, and experience of psychotherapy prior to breast cancer diagnosis are statically significant factors that influence CECS scores. Thematic narrative analysis of the Phase II interview revealed both Expressers and Suppressors recounted experiencing the ‘Elsa effect’, a term coined to describe emotional concealment as a form of emotionally protecting self and others and reported that that a physician driven referral to therapy would have been helpful in terms with coping.


Conclusions: Overwhelmingly, participants who fell into either category of emotional suppressor or emotional expresser believed that there should be physician driven referrals to therapy during the breast cancer treatment process. Both those identified as suppressors and expressers indicated high rates of concealing one’s true emotional experience. This highlights the need for psychological therapy referrals to be integrated as a best practice, regardless of patient’s identified coping style or demographic identities. 

  • Recommendations of trauma informed care for clinicians based on the content and concerns of breast cancer patients. Anticipated submission, October 2023
  • New Study (surveying and analyzing data on: Understanding the impact of empowerment photography on the mental well-being of breast cancer patients and the corresponding impact it has on the perception of beauty in the community)

Learn More

Dr. Counselman-Carpenter, PhD, LCSW

Primary Investigator,

Associate Professor at Adelphi University,

Joyce T. Williams,

Lead Researcher

Founder & President of Keepers of the Flame Foundation