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Loss & Grief: Helping a dying client

The term “dying person” refers to a person whose condition is deemed to be life-threatening, who has little to no chance of recovery, and who has a limited amount of time left. End-of-life care is a catch-all phrase encompassing a variety of services that can be provided to terminally ill patients in their final hours. Hospice and palliative care, nursing facility care, and at-home care are typical types of end-of-life care. Client coping is influenced by a variety of characteristics, including age, education level, religion, prior disease experience, social support, personality, and physical considerations like pain. The delivery of news is crucial because it affects how the client interprets it. Informing a client without thought could traumatize them.

State offenders who have been given a death sentence, patients who have been discharged from the hospital with a Do Not Resuscitate order, hospice care patients, those considering assisted suicide, and others may require these services.

Supportive therapeutic interventions, family therapy, group therapy, providing information and educating about the illness and the dying process that address the physical, emotional, social, spiritual, and practical needs can all be used to help the dying person prepare for the reality of death (Davies, Reimer, Brown, & Martens, 1995; Doka, 1997; Parkes et al., 1984; Rando, 2000). A counselor can support a person spiritually, inform them about typical physical, emotional, and social changes, help manage imaging problems, and generally help normalize life during a trying period.

EMOTIONAL SUPPORT

Everyone, including those who are dying, benefits from counseling, because these feelings are both a normal aspect of dying and can be lessened by attentive intervention (Doka, Rando, and Shneidman, 1978). In order to provide emotional support to a dying client, a counselor may employ techniques like dynamic therapy and a behavioral approach.

With the dying, dynamic therapy tries to assist the patient in identifying, confronting, and replacing defenses that are incompatible with an emotionally healthy attitude toward death. Clients are taught coping mechanisms as part of the behavioral therapy method to help them deal with the death issue. They include self-hypnosis, biofeedback, desensitization, relaxation training, and desensitization, which can all reduce anxiety and stress while boosting self-confidence. Counselors provide assistance to clients going through all these.

In addition to providing support to clients who are going through these difficult feelings, counselors can also help them process their feelings by teaching them coping mechanisms.

  1. Kübler-Ross model ( Stages of dying)

Elisabeth Kübler-Ross described the five stages of mourning in her book, “On Death and Dying,” and many of these emotions can be seen in people who are approaching the end of their lives. These emotions include anger, fear, guilt, and grief (Doka, 1997; Rando, 1984). The five stages are: denial; anger; bargaining; depression; and acceptance. Every client is unique, according to Laurie Meyers, and the Kübler-Ross model does not necessarily manifest itself in a linear manner. A client might, for instance, be both depressed and angry at the same time, whilst other people might not live long enough to experience the model’s latter stages.

When given a diagnosis of a fatal illness, a client’s initial response is frequently, “No, not me, it cannot be true. The Kubler-Ross hypothesis of the dying process, which proposed that many terminally ill patients pass through five phases of death, will be used in this discussion.

Stage 1: Denial At first, the response is “No! Not me!” The majority of people react with incredulity at the severity of their sickness, even though the denial is rarely complete.

Stage 2: Anger: At this point, the patient feels angry, resentful, and hostile toward everyone and everything around them. Some may blame the exorbitant cost of healthcare, others the doctors, etc.

Stage 3: Bargaining: The dying person tries to “make agreements” with God or other people to extend their life.

Step 5: Acknowledgement In the last step, one accepts death, perhaps not with joy, but with a sense of readiness to deal with it. The generalizability of Kubler-Ross’ five stages has been questioned by several researchers, who have noted that not all persons who are dying will experience them, and that the theory’s therapeutic ramifications may not be suitable for everyone.

(Viney, 1984) Viney discovered that the emotional condition of the participants in her study of 484 seriously ill clients was affected by the loss or danger of loss of body

Most people experience anxiety when they think about dying. People frequently experience a wide range of worries and related feelings including fear, dread, and panic when confronting death. A study of the dying person’s anxiety reveals several primary worries. Everyone deals with death differently depending on their needs, personalities, cultures, and social contexts, but the majority of those who are dying do so while under a great deal of emotional stress and anxiety. These are some of the characteristics of this anxiety that are common: 

An important cause of anxiety for the client is their physical state. Insecurity, worry, and anxiety in terminally ill patients are greatly influenced by their pain, suffering, and physical debilitation. Moreover, terminally ill patients who get unpleasant or painful medical treatments, such as chemotherapy for cancer patients, may experience conditioned anxiety reactions to the treatment environment as well as anticipatory anxiety about future treatments. The physical changes a dying person experiences can often cause anxiety and embarrassment. The client who adamantly says, “I don’t want anyone to see me like this!” can be expressing a fear of social rejection as a result of the illness’s unacceptably altered bodily appearance. Another crucial difficulty with dying is the social aspect of anxiety. Many people worry about what their illnesses may do to their friends and family.

This anxiety may be equally prominent for those whose social roles are crucial to the welfare of others as self-concern. For instance, a single mother with two small children is quite likely to feel intense dread for her children’s future and safety. The dread of relationship loss and disruption is another facet of social anxiety in the terminally ill. As previously mentioned, social anxiety may be brought on by other circumstances, such as the worry of not being needed or wanted by others, or by expected rejection brought on by physical repulsion. The counselor assists clients in navigating their worries and concerns about their imminent death in order to help them progress to the acceptance stage of Kübler-Ross’ model. Clients frequently experience remorse about passing away and leaving loved ones behind, for instance.

Guilt is also frequently experienced by patients who decide to stop receiving medical care when their agony becomes intolerable. Also, it is typical for clients to feel fear due to the uncertainty surrounding death and the possibility of continuing their agony and suffering. There are several ways to assist clients in overcoming these anxieties, but one-on-one counseling is usually the most effective. In this setting, the counselor helps the client talk about and examine how he or she is experiencing. Counselors assist clients in expressing significant emotions and in learning how to control them as effectively as possible given the circumstances.

Counselors assist clients in navigating their fears and worries about their coming mortality once they have achieved the acceptance stage of Kübler-Ross’ model. Clients frequently experience remorse about passing away and leaving loved ones behind, for instance. Guilt is also frequently experienced by patients who decide to stop receiving medical care when their agony becomes intolerable. Also, it is typical for clients to feel fear due to the uncertainty surrounding death and the possibility of continuing their agony and suffering. There are several ways to assist clients in overcoming these anxieties, but one-on-one counseling is usually the most effective. In this setting, the counsellor helps the client talk about and examine how he or she is experiencing. For instance, if a client is feeling guilty about leaving behind family members, a counselor can arrange family sessions where the client’s concerns are aired and reframed.

SOCIAL SUPPORT 

For instance, if a client is feeling guilty about leaving family members behind, a counselor can arrange for family members to meet with the client and discuss and reframe the sentiments. By allowing time for this introspection and promoting investigation of events that have been witnessed or things that the individual has done, counselors can help the integration of life events and experience to create meaning. People visit the sick because they are unable to leave because of their disease, but friends can come and engage with the patient who, despite awaiting death, requires social interaction just as much as they did prior to the illness (Davies et al., 1995; Parkes et al., 1996).

The ability of friends and family to help the dying person retain a social life despite physical constraints can be facilitated by interventions by a counselor (Davies et. al.; Kubler-Ross, 1969; Rando, 1984; Shneidman, 1978). This social domain includes an important procedure called business completion. Asking forgiveness, reconnecting with lifelong friends, and engaging in meaningful social interactions with significant persons are all crucial for the dying person’s mental health (Davies et al.; Rando; Shneidman). I have attended family gatherings in African culture because the parents want to fix a problem or smooth out parts of their lives that had previously been problematic. To organize their home, dying clients must go through this process immediately.

In order to provide care that is developmentally appropriate, counselors who work with dying children are aware of the specific social needs of children (Stevens & Dunsmore, 1996). Children frequently receive treatment through play therapy, art therapy, peer support, and support groups.

SPIRITUAL SUPPORT 

The International Work Group on Death, Dying, and Bereavement’s Spiritual Care Work Group has described spirituality as being “involved with the transcendental, inspirational, and existential manner to live one’s life as well as, in a fundamental and profound sense, with the person as a human being. The experience of death may heighten one’s spirituality (Doka & Morgan, 1993, p. 11). The client’s perspective on death and life after death can be explored to better understand and assist the client spiritually. The importance of sin and seeking forgiveness is also crucial for the client to feel at peace with themselves and to restore their confidence in God.

encouraging conversation about religion or the spiritual- Judith Bleicher Jackson According to Bleicher, assisting clients in examining their spiritual and theological views on dying may be very gratifying for both clients and family members. Discussions about religion and spirituality frequently assist individuals in finding peace to face the future. Counselors must first establish a solid rapport with clients based on trust and understanding before starting such discussions, and they must be careful to avoid imposing their personal religious, spiritual, or secular ideas on them.

Helping patients find purpose in their lives and in their disease comes first. The integration of life’s experiences, events, and purpose can be sought after when one ages or becomes very ill. Those who fail to find meaning in life may feel that their lives have become empty or meaningless, which can cause them great spiritual suffering.

People want to pass away in a way that is congruent with who they are. Those who have led independent lives could experience severe distress if they are denied any control over how they die. By asking the dying person about their wishes for how they want to pass away, how they want to take care of their body after passing, and how they want to handle their possessions after they pass away, counselors can help ease some of this distress.

Clients may also feel guilty for not always leading a good life, resentment toward God, concern that past misdeeds contributed to their disease, and rage (Parry, 1990). Counselors must also be aware of the possibility of good psychological development, such as a fresh appreciation for others in life, a greater sense of freedom to live, or a fresh elaboration of emotions (Balk, 1999; Davies et al, 1995; Marrone, 1999; Mead & Willemsen, 1995).

The client can find meaning, find emotional consolation, and take control of how their condition is interpreted by using ritual and symbolism to create meaningful experiences. For instance, some clients arrange a ceremonial service before passing away by bringing their loved ones to a gathering where the client’s life is discussed, presents are given, farewells are uttered, and family matters are organized in accordance with the client’s preferences. Family members should discuss matters like asset distribution, financial planning, setting up wills and trusts, and pre-funeral arrangements, but they frequently feel uncomfortable doing so (Rando, 1984).

Additional elements that are helpful in assisting clients with impending death include physical comfort (empowerment and education), interpersonal reconciliation, creating memories, family support, and organizing the home ( unfinished business)

PHYSICAL COMFORT

  • PAIN MANAGEMENT 

It’s challenging to pay attention or even listen when a client is in tremendous agony. It is crucial to initially check to see if the patient with a terminal illness is taking medicine or receiving therapy to ease their suffering if they are in pain. This procedure is designed to aid clients in getting ready for pain: What must I accomplish? “I can create a strategy to deal with it.” Just consider what I need to do. Pain Management and Confrontation: “I can handle the task.” Simply take things one step at a time. Just unwind and take long breaths. Self-Confirming Phrases: Excellent, I completed it. “I took care of that pretty properly,” “I was confident I could overcome it.”Giving the client some coping skills so they can lessen their discomfort and regain some control over their lives is one of the fundamental goals of behavior therapy. The body frequently changes as the illness worsens, either as a natural part of dying or in response to treatment; these changes can impair the body’s integrity and ability to function normally (Viney, 1984). For emotional well-being, it’s crucial to make sense of a person’s identity after losing body parts or having treatment-related changes, such as hair loss (Cook & Oltjenbruns).

  • EDUCATING & EMPOWERING

Most people don’t expect their medical needs to result in a terminal illness when they seek medical attention. So, the news that they might be coping with one might have a significant impact on them. Being able to inform clients on the type of sickness they might be experiencing, its causes, and effective treatment options serves as a good starting point for conversation. At the management level, you investigate possible outcomes that could happen to the condition. One possibility is that you live with the ailment and take medication to treat it, while the other possibility is that you pass away.

It becomes a holistic journey that examines the following areas to equip clients to be ready for the worst while maintaining hope for the best. With this method, it is possible to have frank conversations with customers about their issues and to give them accurate information. Providing clients with information on will writing, its significance, the distribution of assets, and, lastly, obtaining their preferences for their final disposition.

  • Creating memories

The client’s relationship with their loved one, family, and friends matters most near the end of life. The counselor can promote open communication among family members and clients in an effort to support and bond them during this trying period in order to assist the client who is terminally ill and the family (Rando; Shneidman). Help clients recall their lives and make meaning of their life journeys. In telling stories, making relationships with loved ones, articulating suppressed or buried sentiments emphasizing the positive aspects of a person’s life story. They can record future-preserving tapes, historical notebooks, or photo albums of important moments in their lives.

  • Amending relationships and reconciliation 

While facing death, one wishes they had reconciled with whomever they had unresolved differences with because peace is achieved for both parties when this happens. The counselor can help create possibilities to amend relationships between clients and their loved ones. Clients benefit from feeling supported as they face death through this.

The amended relationship might be between clients and other significant persons such as family, friends, and medical staff.

  • Family Approach 

The entire family is in a state of panic when a family member’s death is imminent. For each member of the dying person’s family, death poses a dangerous circumstance. The function of the dying family member, the family’s developmental stage, and the nature of the relationships between family members are only a few of the numerous variables that affect the degree of family disturbance. A family systems approach sees the whole family as in need of therapy, not just the dying individual. This strategy attempts to allow the family unit the opportunity to learn to deal with the catastrophe. Counselors may continue therapy after the patient has passed away and provide bereavement support for the survivors. Although family therapy can be incorporated into many different types of therapies, family therapists are more likely to concentrate on a few specific difficulties. In order to cope with the death crisis, dying patients frequently feel a desire to sense the closeness and support of their relatives. Family therapy can encourage more honest and fruitful communication in families where past disputes have hampered the patient’s interactions with others. In terms of completing any “unfinished business,” this can be advantageous for all parties involved. Family members’ defenses may make it very challenging for the dying.A dying patient may find it extremely difficult to face death due to the family members’ defenses. It frequently occurs for family members to exhibit the same defensive responses as the individual who is dying, such as denial of reality and misplaced rage.

References

Arnette, J. K. (1996). Physiological effects of chronic grief: A biofeedback treatment approach.  Bowers, Jackson, Knight, and LeShan (1964) Counseling the Dying

Cook, A. S., & Oltjenbruns, K. A. (1998). Dying and grieving: Life span and family perspectives (2nd ed., pp. 38-52). New York: Harcourt Brace College Publishers. 

Corless, I., Wald, F., Autton, C. N., Bailey, S., Cosh, R., Cockburn, M., Head, D., DeVeber, B., Death Studies, 20, 59-72. Balk, D. (1999). Bereavement and spiritual change. Death Studies, 23, 485- 493. 

DeVeber, I., Ley, D. C. H., Mauritzen, J., Nichols, J., O’Connor, P., & Saito, T. (1990).

Kubler-Ross, E. (1969). On Death and Dying. New York: Macmillan