Counselling Dilemma: A Terminally-ill Client
You are working with a 65-year-old female client, Mary, who has been coming to see you for six months as she had grief and loss issues around having lost her only sibling, her brother and her husband in a space of a month apart (a year ago). She has a daughter and son who are both married and have two children each. They live in Sydney whilst she is in Brisbane. She has three close girlfriends whom she sees regularly.
Mary has just been diagnosed with terminal pancreatic cancer and has stated that although she is OK to undergo treatment, she is not prepared to take it to level where she is unable to be in a conscious state of mind. She says it is important that she is aware of who she is and what she feels because being in control of her own decisions is crucial.
How would you, as the therapist, support this client?
Grieving is a personal and individual experience. How someone grieves depends on various factors; their personality and coping style as well as their life experiences, faith/beliefs and the nature of the loss. The process of healing grieving takes time and happens gradually. It can take weeks or months. Either way it is important to inform Mary about this process and the various stages involved in grief and loss recovery. There are also various physical symptoms involved with processing grief and I would ensure that Mary is offered some tools and strategies (how to deal with any triggers i.e. holidays/birthdays ahead of time) and is informed about the importance of self-care and looking after her physical and emotional needs to get through this difficult time. The grief is hers and not for anyone to push her “out of/through” (including herself and her inner critic).
I would also have a conversation with Mary around the importance of having support around her and whether she feels that she can confide in her friends and express the intense feelings of shock, anger, fear and sadness that commonly accompany grief. She may also already have a spiritual practice of some sort in place or involved in any activities or groups that she can connect with or feel connected to. The good thing is that Mary is already attending counselling and can look at many of these points during our sessions. Also good to inform/refer Mary to any group work or organisations close by that support individuals diagnosed with cancer and/or grief and loss. By exploring at all of the above mentioned, I feel Mary will be in a more empowering position to make decisions around what is best for her.
I would first empathise with Mary as she has gone through quite a lot in such a short period of time, and see what it is that she wants to talk about, or what it is she wants to gain from her time with me. After this we could start working on whatever issues she wishes to discuss, and whether there is a need to prioritise any of them. An example of what we may wish to talk about/work through is her brother and husband’s death, and how this has impacted her and her wellbeing. I would then perhaps discuss the options that Mary may have in regards to her treatment, alongside how she feels about her need to be “in control” and what it is that she means by the importance of her “being aware of who she is”. This is Mary’s journey and one in which I would be there to support her and to help facilitate any changes she may wish to make. Depending on how well we work as a team, will dictate whether or not I may need to refer her on to someone who specialises in grief and loss, or someone who specialises psychosomatic therapy, if this is something she would be interested in.
To begin with I would express my empathy for her having to face such a difficult decision and wanting to retain her conscious state of mind and control of her own life. I would then encourage her to talk about her feelings around her illness and to open up about her feelings of grief for so many losses in her life, including her own health. I would allow her to explore her feelings fully and help to normalize these feelings for her. I would also ask if she has discussed her health issue and decision for her treatment with her own family. I would then explore how they responded and what impact this had on her or how she feels they will respond and how she may be affected. I would also discuss my moral dilemma of doing no harm to clients and the concept of beneficence and how I would be able to best uphold these concepts with her in future sessions. I would be open about this so we could both be completely honest with each other and discuss how these issues could impact unconsciously on my work with her. At least this way she may be able to see how her decision impacts those who care about her and how they may go through a range of emotions towards her also.
grieving for the loss of her sibling & her husband who passed away within a short span of time is quite remorseful. we need to empathise with Mary as she barely got anytime to recoup the loss . now she needs to battle with her illness & decide how she would control her life. i gather from the information given that she is a very independent person having a very high self esteem. so it becomes all the more necessary to boost her confidence & encourage her to share her thoughts , fears , doubts so that she can sail through the treatment of her illness with courage. since her children live in Brisbane , she could probably move somewhere close to them so that she would get all the care and attention from her siblings.