Guest blogger and 2018 FHT Training Congress speaker, Jane Duncan Rogers, shares five top tips to enable you to be fully present with clients who are terminally ill.
Ruth, a woman in her late 60s, was having chemotherapy treatment for cancer, but had recently learned that it was now terminal. She had always been interested in holistic healing, and alongside the chemotherapy had used the services of various holistic therapists. She said, ‘I was shocked to discover that some of the therapists seemed to be almost afraid of me; almost as if by touching me, they could catch this ‘disease’ called dying.’
Ruth is not unusual. When working with terminally ill clients, we are inadvertently invited to come face to face with death itself. This means that if we have not taken care of our own feelings about death, about what the needs of a terminally ill client are, and how to respond to those, then we risk being one of those therapists that Ruth referred to.
Here are 5 pointers to enable you to be fully present with clients who are terminally ill:
- Understand the concept of anticipatory grief. Anticipatory grief is when someone grieves for their losses in advance of them happening. It is entirely normal, and many clients will find themselves feelings the myriad of feelings that are normally thought of as happening only after a death. But with anticipatory grief, the terminally ill client may also be feeling these. Given that everyone experiences grief differently, this could be feelings of dread, sadness, rage, denial, depression, distaste, and the impact of loss in all it’s forms (loss of identity, job, purpose in life, physical ability, mental capacities, friendships etc). There are many more feelings attributable to grief, but these are some of the more common ones.
- Ask particular questions. Do not shy away from asking specific questions. Of course this depends on the relationship you have with your client, how long you have known them, and the kind of person they are. But generally speaking, it is much better to be able to say ‘how sick are you?’ or ‘how long do you have, do you think?’ than to skirt around the issue and be left wondering what is going on. By asking these and other specific questions, you will be affirming the trust established between you, affirming your therapeutic alliance, and your ability be fully present for your client.
Listening is also important – it is not unusual for those near the end to find a way to communicate their knowledge of this through a remark or comment that is meaningful only to their personal situation. If you keep your ears open for these, you will likely hear this.
- Be adaptable and flexible in the face of the uncertainty that a terminal diagnosis brings. Structures of safety and routine can become even more important. Your client knowing you are there for them, consistently, at the same time and same day each week or month, may turn out to be crucial. As a fixed certainty in a life of unknowns, this apparently tiny thing can be vital in helping clients feel safe, secure and loved. However, you both have to be able to cope with many changes too. Consider what to do regarding home or hospital visits, changes of appointment and payment issues. Be aware of both verbal and non verbal cues as you agree next steps with your client.
- Face up to your own death. It’s impossible to be around anyone who is terminally ill without coming to terms with the fact that it could be you. If you have not done this in both emotional and practical terms, then you will be inadvertently letting down your client, and bringing yourself unnecessary stress and angst. Facing up to your own death can safely be done when you consider the many practical actions that need to be taken to prepare well for a good ending. While it often appears to be just addressing necessary administration, such as a will and power of attorney, there is, in fact, plenty of provision for you to address any buried feelings about dying, death and grief, when this is done in the wider context of creating a comprehensive end of life plan.
- Saying goodbye. This is an area that is challenging for many. If you are the close family or friends of someone who is actively dying, then you will likely have a place by their bedside (assuming the person conveniently dies when someone is there). But when you are one or more steps removed in terms of a relationship, you may not know when will be the last time you will see that person, where it will be or what will happen. Being aware of this in advance and knowing how you will cope with it are all important.
Jane is delivering a full day course on being with terminally ill clients in Inverness on 5 May. For more information and to book go to: fht.org.uk/fht-hosted-course-how-to-be-with-your-clients-who-are-terminally-ill
Learn more at the 2018 FHT Training Congress
You can learn more about the subject of this blog article at the 2018 FHT Training Congress in the NEC Birmingham:
5 pointers to being with terminally ill clients
With Jane Duncan Rogers
Room 3, Monday 21 May, 2pm – 3pm
When facing end of life, how others behave around you is crucial, especially your therapist. In this talk, Jane introduces you to five essential things to consider with your client, in order to best support them, and facilitate as good an end of life as possible.