Counseling for loved ones with terminal illnesses

Coping with illness — and the grief, frustration, anger and other emotions that

accompany it — is one of the reasons people seek mental health counseling.

Professionals undergo years of education to learn methods for counseling

individuals with an illness. These strategies become more specialized and

necessary when a diagnosis is terminal. Not only do these clients need help

addressing their courses of treatment, they also need help confronting mortality,

expressing their fears and preparing as best they can.

When certain aggressive forms of cancer or Alzheimer’s disease strikes, the

client is the person who most directly is affected by the disease. However, the

emotional and mental health needs created by a terminal illness do not end with

the client; these needs extend to family, friends and other loved ones. Dealing

with prolonged grief in these situations is a complicated process, one of

wrestling with difficult, seemingly unacceptable realities and making peace with

them. Death, and the specter of it, can conjure complex emotions — as the

terminal illness is learned, as the client goes through it, even after they have

passed and loved ones learn how to adjust to the loss.

End-of-life counseling for family members with a sick loved one entails taking

a comprehensive, if delicate, perspective. This may mean working with a team

of professionals to ensure the individual’s wishes are met. However, loved ones

will progress through their own coping process, sometimes in different ways, at

different rates and to different degrees, but providing a unifying presence can

help instill in the client and his or her family and friends the tools and guidance

to process emotional needs due to death. Following are some strategies for

delivering quality mental health counseling to the loved ones of a client living

with a terminal illness.

Encourage information gathering on the illness

A terminal illness is defined by the American Cancer Society (ACS) as an

“irreversible illness that in the near future will result in death or a state of

permanent unconsciousness from which the person is unlikely to recover.” A

terminal prognosis may also be made from a chronic condition. Interpretation,

in the legal sense, can vary by state, but organ failures, advanced cancers, heart

disease and brain damage often qualify. At the same time, however, counselors

can encourage family members, and clients if they can, to learn more about the

disease or condition. This suggestion isn’t meant to create unrealistic

expectations of recovery: Knowing how the disease will progress and at what

time the issue of hospice might need to be raised is important for both client and

family

Gaining an understanding of the illness also will offer patients and their families

a stark representation of what to expect. Deterioration and loss of abilities that

were once second-nature (remembering faces, remembering names, holding a

spoon) can lead to extreme reactions. Declines in ability and functionality

cannot be avoided in many cases, but can be mitigated somewhat by knowing

exactly what the disease or condition leads to and planning for those changes.

Counselors help clients and family members visualize and prepare for these

futures. (It is not a “duty”

Address the practical steps

As unpleasant as death is, certain steps and actions are required in trying times

that require levelheaded thinking and initiative. Though the ACS notes that

some states define terminal illnesses as those from which an individual will die

regardless of treatment, many individuals do pursue some measure of treatment,

many times, symptom relief. Researching the costs of such options and

expectations is central to planning for the mid-term. (what, exam?) Yet, the

eventuality of a terminal illness can consider on clients and their loved ones,

who may be delayed in disbelief or simply not able to imagine completing the

steps necessary for an end of life as desired by the person with the illness.

Counselors can help people cope with their feelings and reactions to a terminal

prognosis so that the patient is afforded the best end-of life care.

If an older adult learns he or she has dementia, a condition that worsens over

time, arranging legal affairs like powers of attorney, living wills and estate

planning before his or her cognitive abilities deteriorate is important to

everyone in the family. Avoidance of such responsibilities is understandable,

and counselors want to project empathy in these cases. Gathering a family to

discuss these matters may provoke engagement with the realities at hand and

help them work through processes together.

Respect the individual

Having family sessions is a benefit at certain junctures along the stages of

coping with a terminal illness, but what needs to be remembered throughout the

counseling is that the client is an individual with the rights to make decisions

about their own end of life. Counselors sometimes have to act as mediators in

these scenarios. For instance, if someone diagnosed with cancer wants to travel

while he or she can, but a relative is upset this would supersede time with

family, that relative could then blame the client for being selfish. Tensions

could flare further near the end of life, but mental health professionals need to

counsel clients and their family alike about how they communicate and express

themselves in ways that don’t exacerbate matters but make good use of the time

left.

Getting family to understand that they cannot control the individual will help

them later accept the ultimate realization that they cannot influence death.

Ceding control is not easy, but discussion can help make progress toward it.

Psychologist Ellen Pulleyblank Coffman wrote for Psychotherapy.net about her

husband, who after living on a ventilator for seven years, had the machine

turned off. She recounted the “conversations with family members, ethicists,

psychotherapists and spiritual teachers” over the months it took to make a

decision and had advice for structuring these conversations with family:

“Inviting families to include conversations about death and dying can be

helpful, but often [they] resist this fiercely as they hold onto life. Sometimes
these conversations work better not all together but separately, with different

family members at first and then leading to a wider discussion.”

Offer productive activities

Living with a terminal illness means the client is alive and able to share

memories with family and friends. Reminiscence therapy is a powerful tool in

helping provide families and clients something to balance out knowing only the

unknowable lies ahead. However, they may have trouble finding appropriate

mediums of expression. Counselors can recommend a few options that can be

enjoyed and be productive in helping individuals cope with terminal illness,

including the following activities:

 Videos to remember loved ones by. Clients can create specific

testimonials and recount to particular family or friends certain

experiences, and even record a greeting to a child not born yet. Audio

recordings can produce a finished product just as useful and treasured.

 Scrapbooks with letters and photos. Holding writing sessions and having

participants read aloud their letters before pasting them in a scrapbook

can be a cathartic exercise that helps the individual process final

emotions. Adding old or new photos provide an added activity and a

token that will last past death.

  Music therapy (and other activity-based therapies). Counselors should

recommend quality palliative care for terminal clients that is not

intrusive. Music therapy has been shown to positively affect “pain,

physical comfort, fatigue and energy, anxiety and relaxation, time and

duration of treatment, mood, spirituality and quality of life,” according to

Evidence-Based Complementary and Alternative Medicine, which

reviewed studies of music therapy.

Connecting clients and family with resources

Death is an intensely personal experience, but one that also is shared by many

individuals. Counselors can put clients and their families in contact with support

systems — or other groups of people who have gone or are going through

similar processes of grief and coping — that can provide a release and a source

of empathy.

Cancers that develop in children are arduous circumstances to live through, and

many online forums and social groups exist to offer resources and safe spaces to

help parents come to terms with the death of their children. Likewise, support

systems exist for clients. These groups can connect them with others living

through similar illnesses, helping clients better understand their disease or

process emotion. Attending such meetings has the added benefit of encouraging

socialization.
Bradley University can help mental health counselors

Everyone reacts to death and dying in their own ways. When counseling the

family of a terminally ill client, this notion becomes apparent. Counselors need

to have the skills and knowledge base to address and serve these mental health

needs. Counselors looking to improve their understanding of human emotions

and coping strategies should consider Bradley University’s online Master of

Arts in Counseling program.