Counseling Terminally Ill Counseling the Terminally Ill

Counseling Terminally Ill Counseling the Terminally Ill Working as a counselor in a medical setting comes inbuilt with a wide array of ethical challenges, practical obstacles and emotional trials. In this context, it is incumbent upon the counselor to possess certain sensitivities, sensibilities and intuition with respect to the needs of clients. This imperative is only magnified when this clientele is facing terminal illness.

Counseling patients suffering from terminal illness carries its own spectrum of complexities and only the combination of training, experience and psychological suitability for the job are sufficient to provide one with skills to perform it well. As the discussion hereafter will show, patients with terminal illness are in a unique disposition within the context of medical treatment and must therefore be shown a unique form of counsel.

This will be reflected in the values demonstrated and responsibilities assumed by the attending counselor both in this discussion and in the video compiled to accompany it. Values and Responsibilities of the Counselor: The responsibilities of the counselor can fall within a wide range of permutations depending on the patient's specific needs. But a common role taken on by the counselor of the terminally ill, reports Daneker (2006) is participation in strategies designed to help reduce physical pain in the patient.

Daneker reports that "pain management is one of the most important concerns of hospice care (National Hospice Foundation, 2001). In addition to pain medication, the use of traditional psychological interventions such as biofeedback, hypnosis, relaxation and imagery techniques are used to provide skills that increase the client's awareness and control of pain." (Danaker, p. 1) This indicates that the counselor will be responsible for bringing a host of holistic and homeopathic strategies for healing into the therapeutic relationship.

Thus, the value system of the counselor of the terminally ill patient should perhaps even more so than other medical professionals be a particularly receptive one. In helping the patient to content with pain as well as to find ways of controlling fear and panic symptoms in the body, the counselor can bring a considerable amount of physiological comfort to the subject. Therefore, a willingness to incorporate and integrate myriad non-traditional strategies for pain management will constitute an important supplement to more conventional medicinal and surgical strategies.

Pain management assistance is, of course, only one responsibility of the counselor, and a secondary one relative to the role of providing emotional support to the patient. Terminally ill patients will experience an infinite range of possible emotional, philosophical and practical responses to the various stages of illness and eventual death. The counselor will become a critical support beam as the subject undergoes these stages and said counselor must be possessed in the values of compassion, patience, understanding, calm, empathy and realism, among countless other valuable characteristics.

These values should serve in attending the incredibly difficult responsibility of providing words of comfort to the patient without creating unrealistic expectations, without being patronizing and without losing a certain emotional distance from the subject. And as the text by Daneker indicates, it is absolutely essential that the counselor be capable of maintaining objectivity and equanimity in the face of a torrent of potentially volatile emotions.

It is necessary for the subject to endure these emotions and the counselor's responsibility to function as a static foil for the realization of these emotional stages is essential to helping ease one through this difficult period. According to Daneker, "dying individuals cope with intense emotions such as anger, fear, guilt, and grief. Dying individuals benefit from counseling as much as anyone and these emotions are both a normal part of the process of dying and can be alleviated by sensitive intervention.

Addressing the anticipatory grief of the individual is critical for counselors. Issues of anticipatory grief include helping clients redefine life as it currently is, facilitating communication about feelings of being a burden, supporting clients as they struggle with change, encouraging the search for meaning, and allowing the client to live day-by-day." (Danaker, p. 1) Another key responsibility area for the client will involve the patient's family and support system.

Often as the patient endures the trauma of facing terminal illness, so too must the patient's spouse, parents, children, siblings or close friends. The counselor has a role in ensuring that communication remains fluid and open between the patient and these parties. Likewise, the counselor may provide counsel to a collective support group or individuals such as a spouse or parent attempting to cope with the illness and the expectation of loss of a loved one.

As Daneker indicates, the quality of life during this period of time can be very much dictated by the ability of the terminally ill subject to continue to maintain some semblance of a social life. Therefore, Daneker reports, "the dying individual needs social involvement as much as he or she did before the illness (Davies et al., 1995; Parkes et al., 1996). Interventions by a counselor can facilitate the ability of friends and family to enable the dying individual to maintain a social life in the face of physical limitations " (Daneker, p.

1) Among the values called for in this scenario, the capacity to exhibit warmth, openness, acceptance and mediation all will be essential. Potential Issues and Considerations: Among the potential issues faced by the counselor of the terminally ill is a resistance on either the part of the patient or members of the patient's family to engage openly or honestly with the therapy process.

It is quite typical for the terminally ill patient to experience a number of feelings, emotions and anxieties that are beyond description or articulation, and that prevent success in reaching out to the patient. Moreover, it may even be a necessary part of the patient's strategy for coping wth the realities of his or her illness. According to the Crimson Crier (CC)(2007), "the families of the terminally ill and the patients too, tend to run through the normal stages of grief.

Expect a terminally ill patient to suffer from depression and isolate themselves, usually it does end eventually. When they are isolating themselves, try to make contact, but don't force the issue." (CC, p. 1) In such instances, it is particularly important for the counselor to frequently remind the subject that he or she is available to provide support and comfort when this is needed, but not to impose this support upon the patient.

As the Crimson Crier advises, it is not uncommon that the patient will require some period of depression that is akin to grieving for one's self. At the juncture that the subject is again willing to accept the counselor's support, it is important that the counselor be prepared to provide this. Steps Taken to Address Issues: Truly the only steps that a counselor can take in the event of a patient's decision.