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Issues in psychotherapy with terminally ill patients

Published online by Cambridge University Press:  04 April 2005

S. TZIPORAH COHEN  and
SUSAN BLOCK
S. TZIPORAH COHEN
Affiliation:
Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, Massachusetts
SUSAN BLOCK
Affiliation:
The Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Abstract

Psychotherapy with the terminally ill poses special challenges for clinicians and in return offers unique rewards. As a time limited therapy, acceptance, rather than change is a primary goal; yet, patients can be strongly motivated to change. Patients may need to struggle with how to disengage while also maintaining connection. Unique transference and countertransference issues arise. The psychological tasks of dying include grieving, saying goodbye, constructing a meaningful context to one's life, and letting go. The therapist can serve as a companion and guide to the dying person as she or he negotiates these tasks. Through the use of a case example, these issues are explored from the perspectives of patient and therapist. The therapist must address the following issues: attending to physical suffering, differentiating between grieving and depression, addressing fears, facilitating the life review, and assisting in decision making. A dying patient's need to leave a legacy, complete relationships, grapple with spiritual and religious issues, and attend to his or her family, are often important themes. Therapists must work productively with denial, maintain flexible yet appropriate boundaries, grapple with their own anxiety about death, and grieve the loss of their patients. Psychotherapy with dying patients can help reduce their psychological pain, relieving psychosocial distress and providing opportunities for personal growth in the last stage of life. Such work is often draining yet immensely rewarding for the patient and therapist alike.

Keywords

Palliative carePsychotherapyPsychooncologyTransferenceCountertransference
Type
REVIEW ARTICLES
Information
Palliative & Supportive Care , Volume 2 , Issue 2 , June 2004 , pp. 181 - 189
Copyright
© 2004 Cambridge University Press

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References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association.
Bedell, S.E., Cadenhead, K., & Graboys, T.B. (2001). The doctor's letter of condolence. New England Journal of Medicine, 344, 162–164.Google Scholar
Block, S.D. (2000). Assessing and managing depression in the terminally ill patient. Annals of Internal Medicine, 132, 209–218.Google Scholar
Block, S.D. (2001). Psychological considerations, growth, and transcendence at the end of life: The art of the possible. JAMA, 285, 2898–2905.Google Scholar
Byock, I. (1997). Dying Well. New York: Riverhead Books.
Cassem, E.H. (2000). Care and management of the patient at the end of life. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 13–24. Oxford: Oxford University Press.
Emanuel, E.J. & Emanuel, L.L. (1998). The promise of a good death. Lancet, 352S, 1121–1129.Google Scholar
Greisinger, A.J., Lorimor, R.J., Aday, L.A., et al. (1997). Terminally ill cancer patients: Their most important concerns. Cancer Practice, 5, 147–154.Google Scholar
Hacker, T.A. (1977). Some aspects of transference and countertransference in therapy with dying and non-dying patients. Suicide and Life-Threatening Behavior, 7, 189–198.Google Scholar
Kastenbaum, R. (1977). Death, Society, and Human Experience. St. Louis: Mosby.
Kearney, M. (2000). Spiritual care of the dying patient. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 357–373. Oxford: Oxford University Press.
Kubler-Ross, E. (1969). On Death and Dying. New York: Macmillan Publishing Company.
Lewis, M.I. & Butler, R.N. (1974). Life review therapy. Geriatrics, 29, 165–173.Google Scholar
Maguire, P. (2000). Communication with terminally ill patients and their relatives. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 291–301. Oxford: Oxford University Press.
Osterweis, M., Solomon, F., & Green, M. (eds.). (1984). Bereavement: Reactions, Consequences, and Care. , Washington, DC: National Academy Press.
Pattison, E.M. (1977). The Experience of Dying. Upper Saddle River, NJ: Prentice Hall.
Schneidman, E.S. (1978). Some aspects of psychotherapy with dying patients. In Psychosocial Care of the Dying Patient, Garfield, C. (ed.), pp. 201–218. New York: McGraw Hill Co.
Schwartz, A.M. & Karasu, T.B. (1977). Psychotherapy with the dying patient. American Journal of Psychotherapy, 31, 19–33.Google Scholar
Singer, P.A., Martin, D.K., & Kelner, M. (1999). Quality end-of-life care: Patient's perspectives. JAMA, 281, 163–168.Google Scholar
Stedeford, A. (1979). Psychotherapy of the dying patient. British Journal of Psychiatry, 135, 7–14.Google Scholar
Steinhauser, K.E., Clipp, E.C., McNeilly, M., et al. (2000). In search of a good death: Observations of patient's families, and providers. Annals of Internal Medicine, 132, 825–832.Google Scholar
Viederman, M. (2000). The supportive relationship, the psychodynamic life narrative, and the dying patient. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 215–222. Oxford: Oxford University Press.
Viederman, M. & Perry, S. (1980). Use of a psychodynaminc life narrative in the treatment of depression in the physically ill. General Hospital Psychiatry, 2, 177–185.Google Scholar
Weissman, A. (1972). On Dying and Denying. New York: Behavioral Publications.
Wellisch, D. (2000). Family issues and palliative care. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 275–289. Oxford: Oxford University Press.