Counselors help clients through an array of difficult circumstances, for example drug addiction, abuse or mental illness. Perhaps one of the most challenging circumstances with which counselors aid clients is a terminal illness diagnosis coupled with the process of receiving end-of-life care.
Before an examination of some effective strategies for counselors helping clients through this complex and difficult journey, it is important first to examine in more detail what it means to receive a terminal diagnosis and end-of-life care.
What is a terminal diagnosis?
As suggested in Good Therapy, a group dedicated to educating the public about positive therapy, a terminal diagnosis, in its most general sense, occurs when a client receives news that his or her illness will, in all likelihood, lead to death. What this process involves can vary, contingent on the nature of the illness that the client is experiencing. For example, clients may receive news that their illness will lead to death imminently and that they must begin preparations for end-of-life care. An example of this type of situation is the diagnosis of certain forms of incurable cancer. Other clients may receive a terminal diagnosis for a condition that will take much longer to progress, such as Parkinson’s disease or HIV/AIDS. Another common circumstance involves clients who receive care with hope for a cure — often for certain cancers — only to find sometime into their journey that the treatment is ineffective and they will eventually die from their illness.
In any case, receiving a terminal diagnosis can elicit a range of emotions from clients, including:
- Anger
- Denial
- Regret
- Sadness
- Fear
- Acceptance
- Relief
Even though counselors can help clients cope with these emotions in the aftermath of their diagnosis, this article takes a closer look at strategies for helping clients through the final stages of their illness, while they are receiving end-of-life care.
What is end-of-life care?
End-of-life care is a general term for several forms of care that can be offered to dying patients in their final days. Common forms of end-of-life care include hospice and palliative care, nursing home care or care received at home.
Hospice and palliative care are particularly common. According to the National Hospice and Palliative Care Organization, hospice care is known as a paradigm of support for the terminally ill that involves medical assistance, emotional help and counseling, and the administration of treatments and drugs that can help alleviate chronic pain. It is understood that hospice care is given to individuals who are experiencing illnesses for which there is no cure. Hospice care is, generally speaking, offered to patients in the final weeks or months of their lives. Palliative care is similar to hospice care because it is designed to help relieve the physical and emotional suffering of someone experiencing a chronic illness. Yet, palliative care is not exclusively offered to the terminally ill: Anyone experiencing a chronic illness, at any point, can receive palliative care.
Strategies for helping clients cope
Counselors helping clients receiving end-of-life care, typically in the form of hospice care, may face some challenging experiences. As explained by the National Association of Social Workers, the goal of counselors (and social workers) assisting clients in their final days should be to help the clients achieve the best possible quality of life during their illness, as well as to come to terms emotionally, spiritually and psychologically with what is about to occur. The Association of Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of the American Counseling Association, also is committed to the consideration of spiritual meaning that people make in their lives. The spiritual competencies from ASERVIC have expanded the practice of professional counseling to include the spiritual aspect of clients’ lives, particularly when facing difficult situations of which a terminal diagnosis is one.
Some effective strategies for counselors include, but are not limited to, the following:
Helping clients process emotions
Individuals nearing the end of their lives likely will experience a range of emotions, many of which can be observed in Elisabeth Kübler-Ross’ model of the five stages of grief, which was outlined in her seminal text, “On Death and Dying.” The five stages are denial, anger, bargaining, depression and acceptance. As Laurie Meyers explains, however, writing in Counseling Today, every client is different, and the Kübler-Ross model does not always present in a linear fashion. For example, a client may experience depression and anger concurrently, while other individuals may not live long enough to experience the final stages of the model. In any case, counselors offer support to clients experiencing these complex emotions and introduce strategies that can help them work through and process their experiences. In addition to working one on one with clients, counselors can help clients navigate these complex emotions by recommending or facilitating care in a number of forms, as suggested by the National Association of Social Workers:
- Information and education about the illness.
- Family therapy.
- Group therapy.
- Mental health assessments.
Working through death anxiety
In an article for Counseling Today, contributor Laurie Meyers interviews several counselors about the ways they help clients face their final days. Interviewee Kerin Groves explained that an effective tactic for helping clients who have reached the acceptance stage of Kübler-Ross’ model is to help them navigate their fears and concerns about their impending death. For example, it is common for clients to feel guilty about dying and leaving loved ones behind. Guilt is also common when clients opt to cease medical treatment when the pain becomes too much to manage. It is also commonplace for clients to experience fear over the unknown nature of death and the potential for further pain and suffering. Helping clients work through these worries can take a number of forms, but it typically involves one-on-one counseling where a counselor helps the client discuss and analyze how he or she is feeling. For example, if a client is experiencing guilt over leaving family members behind, a counselor can facilitate sessions with family members wherein the feelings are discussed and reframed.
Helping clients make sense of their lives
Groves detailed that one effective way to assist clients in their final days is to help them recount their lives and make sense of their life journeys. This approach can take a number of formats, including telling stories, making connections with loved ones, articulating repressed or buried feelings and so on. The process can be emotionally rewarding for the client by emphasizing the positive aspects of a person’s life story.“I have helped clients find meaning in their personal [histories] and accept suffering during the dying process by engaging in life review and reminiscence, with both laughter and tears,” Groves said.
Encouraging spiritual or religious discussion
While not all clients will believe in God or have a religious outlook on issues of death, it is likely that many will, Helen Jackson Bleicher explained in her thesis, “The Experience of Counseling the Terminally Ill and the Best Counseling Practices,” submitted to the University of Nebraska at Omaha. Indeed, Bleicher alluded to statistics indicating that a vast majority of Americans — some 96 percent — believe in a deity. Bleicher explained that helping clients explore their religious and spiritual beliefs surrounding death can be immensely rewarding for both clients and family members. Religious and spiritual discussions often help clients find peace to face what is to come. Before such discussions are initiated, however, counselors must build a strong relationship with clients based on trust and understanding, and must take care not to impose their own religious, spiritual or secular beliefs on clients.
Advocating on behalf of clients
Sometimes, it is important for counselors to take a more active approach to helping clients by advocating on their behalf to medical staff at a hospital or hospice facility, LPC Mary Jones detailed in Meyer’s article for Counseling Today. This kind of advocacy includes requesting new forms of medications and medical assistance. Similarly, Groves noted that this work necessitates that counselors research and learn about the medical side of hospice care in terms of medications routinely used to manage pain and other potential treatment options.
Consider Bradley University’s online counseling program
The above strategies are just some of the many ways that counselors can help clients entering the final days of their lives. If you are interested in becoming a counselor, consider applying to Bradley University’s online Master of Arts in Counseling program, with a specialty in Clinical Mental Health Counseling. Earning your master’s in counseling is an important step in the path to becoming a licensed counseling professional.
Recommended Reading
The Aging Population: End-of-Life Planning and Advanced Directives
Bradley University Online Counseling Program