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Tuesday, January 12, 2010

Psychotherapy and End of Life Talks

In today's New York Times Science section, there's an article entitled "Facing End-of-Life Talks, Doctors Choose to Wait" by Denise Grady (http://www.nytimes.com/2010/01/12/health/12seco.html).

The first sentence of the article is, "It's a conversation that most people dread, doctors and patients alike." The article focuses on how and when doctors handle end-of-life talks with their patients as well as, from the patients' and their families' perspectives, when they might be ready to have these talks about accepting or rejecting further medical treatment, and where the patients want to die.

It's an interesting topic, not only from a medical point of view, but also from a psychological point of view. This particular article focused primarily on medical issues but, at least in my mind, as a psychotherapist, it made me think about psychological aspects about a person accepting (or not) that he is going to die and, aside from being comforted medically and physically, what this person would need to attain a measure of psychological comfort about a death that is imminent.

Most people don't like to think about the fact that we're all going to die one day. It's something that we know but, for most of us, we keep these thoughts in the back of our minds and we remain somewhat in denial about it--unless either we or someone close to us is facing an imminent death. Many people might find this topic to be too morbid for a blog post but, upon reflection, most of us would want our loved ones (and ourselves) to have as peaceful a passing as possible when the time comes. In my opinion, that means not just physical comfort and making sure that health care proxies and wills are "in order," but also a coming to terms with death on a psychological level.

Reading the New York Times article reminded me of a training film that I saw several years ago at a psychotherapy conference. The client in the film, who gave her therapist permission to show the film as part of advanced level training for licensed psychotherapists, was an elderly woman in her mid-70s who was diagnosed with end stage cancer. Unlike most of the doctors that are mentioned in the New York Times article, her doctors told her early on that her cancer was terminal and the best that they could do for her was to provide her with palliative care at the end. When this patient told her husband of over 50 years that she had end-stage cancer and she was probably going to die in 12-18 months, he packed up his things and he left her without even a goodbye. So, not only did she feel betrayed by her own body because of the cancer, she also felt alone and abandoned by the person who was closest to her in her life, her husband.

This was this client's predicament when she began psychotherapy. As I watched this film, I thought to myself that I could hardly imagine there being a more traumatic scenario than being abandoned by your partner of 50 years after you were told that you would die in less than two years. By the time this client came to therapy, she had accepted that her death was imminent. So, the treatment focused on her husband's abandonment. It was truly inspiring to watch this client work through such a tragic loss at this time in her life. Step by step, she made good use of the EMDR treatment to process the loss, which started with the image of her seeing her husband's back as he walked out of the house with his suitcases.

It was a testament to this client's spirit, the skill and empathy of her therapist, and the power of EMDR treatment that she was able to process this terrible loss so that she no longer felt crushed by it. In fact, towards the end of her life, she was helping and providing emotional comfort to other patients in the hospital with terminal cancer. She was an extraordinary woman. And her husband did return a few months later, full of remorse for having abandoned his wife at such a critical time. She forgave him, and they reconciled before she died.

This teaching film was one of the most powerful and compelling examples of the need for people to deal with end- of-life issues before they die. And although it's not a topic that most people like to face, death and dying are a natural part of life. How we reconcile our relationships with our loved ones, and how we come to terms with our own lives is a critical factor in the final days of our lives. If we are fortunate to be well enough and have enough time to avail ourselves of psychotherapy to deal with end-of-life issues, I believe it can make such a difference to our psychological comfort at the end of our lives.

If you're curious about EMDR, you can visit the EMDRIA website: http://www.EMDRIA.org.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist in NYC.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, you can call me at (212) 726-1006.