Psychotherapy and Terminally Ill Patients

With the demographic bulge of the baby boomers entering early old age, more psychotherapists in outpatient settings are going to find themselves working with patients who are facing end of life issues.

In a presentation made at the 2017 conference of the American Association for Psychoanalysis in Clinical Social Work, Ed Ross, LCSW, BCD, Director, Behavioral Health Services at Lighthouse Guild, drew useful guidance on the aspect of palliative care from the work of Joan Berzoff, EdD, LICSW, professor emerita, Smith College School for Social Work and Maxine Rattner, a palliative care Social Worker at Kensington Hospice in Toronto, in their essay Rethinking Suffering: Allowing for Suffering that is Intrinsic at End of Life (2016). He considered how it relates to psychotherapeutic work with patients who are suffering at the end of life.

Sitting with Suffering

Mr. Ross described Berzoff and Rattner’s concept of “sitting with suffering” that entails recognizing the limits of manualized interventions and not trying to offer solutions to change the subject that have the effect of denying the patient’s experience in facing dying. Accepting that suffering cannot always be relieved is also hard on the clinician, who may feel a sense of failure, helplessness, moral distress and compassion fatigue.

The orientation and training of palliative care clinicians is to alleviate suffering. Palliative care clinicians often face urgency in helping dying patients, frequently under acute stress, with limited time, which may contribute to the pressure to do something to assuage suffering. “Sitting with suffering” signals a shift, as it asks clinicians to rethink their role in being able to relieve some forms of psychosocial suffering intrinsic to dying.

From a relational point of view, the clinician should become aware of personal responses to suffering – fear, sadness, hopelessness – as an empathic bridge to the patient.

Psychotherapists may begin work with patients when unaware of their illness or impending death. Few psychotherapists have broad experience in helping dying patients and their training may be inadequate. That may need to change, as more social workers in settings such as Lighthouse Guild encounter increasing numbers of older patients.