Counseling Terminally Ill Patients: Values and Responsibilities

Introduction

Working as a counselor in a medical setting comes 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 clients are 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 role are sufficient to provide the skills needed to perform it well.

As the discussion below demonstrates, patients with terminal illness occupy a unique position within the context of medical treatment and must therefore be offered a unique form of counsel. This is reflected in the values demonstrated and the responsibilities assumed by the attending counselor.

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. One common role taken on by counselors of the terminally ill, as reported by Daneker (2006), is participation in strategies designed to help reduce physical pain. Daneker notes 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" (Daneker, p. 1). This indicates that the counselor is responsible for bringing a host of holistic strategies for healing into the therapeutic relationship. The value system of the counselor of the terminally ill patient should therefore be a particularly receptive one. In helping the patient contend with pain as well as find ways of controlling fear and panic, the counselor can bring considerable physiological comfort. A willingness to incorporate and integrate varied non-traditional strategies for pain management will constitute an important supplement to more conventional medicinal and surgical approaches.

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

As Daneker indicates, it is absolutely essential that the counselor be capable of maintaining objectivity and equanimity in the face of potentially volatile emotions. It is necessary for the patient to endure these emotions, and the counselor's ability to function as a steady presence during their realization is essential to helping ease the patient 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" (Daneker, p. 1).

Another key responsibility area for the counselor involves 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 support to a collective group or to individuals — such as a spouse or parent — who are attempting to cope with the illness and the anticipated loss of a loved one. As Daneker indicates, the quality of life during this period can be greatly influenced by the ability of the terminally ill individual 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 will all be essential.

Potential Issues and Considerations

Among the potential issues faced by the counselor of the terminally ill is 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 feelings, emotions, and anxieties that are difficult to describe or articulate, and that can prevent the counselor from successfully reaching out. Moreover, withdrawal may itself be a necessary part of the patient's strategy for coping with the realities of illness. According to the Crimson Crier (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 patient that support and comfort are available when needed, without imposing that support. As the Crimson Crier advises, it is not uncommon for the patient to require a period of depression that is akin to grieving for oneself. When the patient is again willing to accept the counselor's support, it is important that the counselor be prepared to provide it.

Conclusion

Ultimately, the most important dimension of counseling the terminally ill is recognizing that the goals of treatment have shifted. Where the traditional goals of counseling and medical treatment are the removal of sickness and the return of wellness, neither is possible for the terminally ill. Instead, the provision of comfort, the easing of suffering, and the maintenance of the highest possible quality of life become the primary goals. The counselor is instrumental in achieving these objectives.

Works Cited

Crimson Crier (CC). (2007). Counseling terminally ill patients and their families. Helium.com.

Daneker, D. (2006). Counselors working with the terminally ill. Counseling Outfitters.

Mesothelioma & Asbestos Awareness Center (MAAC). (2010). Counseling for terminally ill patients. MAACenter.org.