END OF LIFE

When the reality of death becomes inevitable, hard decisions must be made. Individuals and family members often face a range of strong and difficult emotions, such as anxiety, fear, uncertainty and sadness. The process of dying engenders feelings of powerlessness and loss of control. Often, patients and families have difficulty initiating discussions about this process. Counseling can help facilitate dialogues about end of life practicalities, spirituality and physical concerns and fears. Through these discussions the patient and family are able to make choices, have a sense of control and empowerment, and allow this transition to have richness and meaning.

End of life counseling differs from traditional psychotherapy. The therapist serves as an advocate focusing on quality of care, education about the death process and facilitation of communication between the dying individual and his or her family. Counseling may occur in non-traditional settings (e.g., the home, the hospital, nursing homes, etc.). The focus may be less insight-oriented, (although that can occur), and more on decision-making, emotional support, means of coping and existential concerns.

Counseling addresses:

• Preparing for the last phase of life-choosing where to die and discussion about wishes for the last phase of life.
• Spirituality at the end of life-discussion of spiritual concerns about the meaning and purpose of life. This might be a dynamic process of turning inward to reflect on life, but at the same time turning outward to seek that, which is beyond daily experience.
• What to expect in the last days of life