The psychologist and his intervention in terminal illness: what does he do?
We all know that sooner or later we will die. An accident, a disease or simple old age will end up causing our death. But it is not the same to know that one day we will die than the fact that we are diagnosed with a disease and tell us that we have at most between two months and one year of life .
Unfortunately, this is what happens to a lot of people around the world. And for most it is something hard and painful to assume. In these difficult circumstances, it is easy for a large number of needs to arise on the part of the sick subject who may not even dare to mention his surroundings as a burden, or even on the family members themselves. In this context, a professional of psychology can perform a service of great value. What is the role of the psychologist in terminal illness? We are going to discuss it throughout this article.
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The intervention of the psychologist in terminally ill patients
The concept of terminal illness refers to that illness or disorder in a very advanced stage, in which there is no probability of recovery of the person who suffers it and in which the life expectancy is reduced to a relatively short period (usually of a few months).
The treatment that is used at a medical level with this type of patient is of palliative type, not pretending as a priority objective their recovery but the maintenance during the longest possible time of the highest attainable quality of life and the avoidance of discomfort and suffering.
But medical treatment often requires the contribution of psychologists and psychiatrists that they take charge of the most psychological and emotional needs of the patient, not so much as regards the symptomatology of their illness as such but in the preservation of their dignity and acceptance of the end of life. Likewise, it seeks to increase comfort and serve as an accompaniment, as well as to close the process of life in a positive way and, as far as possible, to supply psychological and spiritual needs.
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The diagnosis
The moment of diagnosis and notification is one of the most sensitive , assuming a hard setback for the person. In this sense, we must also bear in mind that it is possible that the terminal phase is reached after a more or less prolonged period in which the patient has been able to present different symptoms that he knew led to his death, but which is also It is possible that the diagnosis of a specific problem in the terminal phase is something completely unexpected.
In any case, it is common for a period of mourning to appear in the patient himself regarding his relationship with the possible process that will bring him to his end. It is usual that in the first moment disbelief and denial appear, so that later they awaken strong emotions of anger, anger and disbelief. After this, it is not uncommon for stages to arise in which the subject tries to make a kind of negotiation in which he would improve as a person if he were cured, to later be invaded by sadness and finally, to reach a possible acceptance of his condition.
Attitudes and behaviors can vary greatly from one case to another. There will be people who will feel a constant anger that will push them to fight to survive, others who will deny their disease at all times or even convince themselves of it (something that surprisingly in some people can prolong survival as long as they comply with their treatment , given that it can help them not to experience so much stress) and others that will enter a state of hopelessness in which they will refuse any treatment because they consider it useless. Working this attitude is fundamental, since it allows to predict the adherence to the treatment and to favor an increase in the expectation of survival.
Treatment for the terminally ill
The needs of the population with terminal illnesses can be very varied, this variability being something to be taken into account in each case treated. Broadly speaking, as we have said before, it is intended as the main objectives preserve the dignity of the person , to serve as accompaniment in those moments, to provide the maximum possible comfort, to alleviate the psychological and spiritual needs and to try to work the closing of the vital process as long as the person can die in peace.
On a psychological level , an element that must be worked to a great extent with the patient is the perception of lack of control: it is usual for the terminally ill person to be perceived as incapable of facing the threat posed by the disease and the symptoms he suffers, and see yourself as useless. It will be necessary to restructure these types of beliefs and increase their sense of control over the situation. Techniques such as visualization or induced relaxation may also be helpful. Counseling, as a strategy in which the professional adopts a less directive role and facilitates that the patient reaches his own conclusions about his or her concerns, can serve to improve this perception of control.
Another aspect to work is the existence of possible anxious or depressive symptomatology. While it is logical that in such circumstances appear sadness and anxiety, we must control the possible occurrence of syndromes of this type that worsen the patient's discomfort and go beyond the adaptive. It is also necessary to take into account that in some cases suicide attempts may appear .
Also, that the person can express their emotions and thoughts is fundamental, being very frequent that they do not dare to confess their fears and doubts with anyone or with their immediate surroundings due to the will not to cause worry or not to be a burden.
The professional has to explore the fears, try to give emotional support and favor the expression of fears and desires in order to be able to direct and manage emotion towards adaptive goals and not towards despair. Also, information about the situation and what may happen (for example, pain or what may happen to their families after their death) is usually a complicated issue and something that may disturb patients. However, not all patients want to know everything: their wishes should be taken into account in this regard.
If the patient has religious beliefs and this gives him peace, it may be important to contact any authority, clergy or spiritual guide that can work that aspect so relevant to the acceptance of future death. The resolution of problems and the handling of communication and emotions can be very useful.
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The family: role of the psychologist in the acceptance and management of the situation
The existence of a terminal illness is devastating for the person who suffers it and it must be the one in which the intervention focuses the most, but he is not the only person who is going to present a high level of suffering . Your environment, often, will need advice, action guidelines and great emotional support to cope with the situation, both current and future death.
Special mention deserve two phenomena that are more frequent than it seems. First the so-called conspiracy of silence , in which the disease is denied and ignored in such a way that the patient may not know what is happening to him. Although the intention is usually to protect the terminal patient and not cause suffering, the truth is that in prolonged illnesses can cause suffering because the person does not know what is happening and may feel misunderstood.
The other frequent phenomenon is the family claudication, when the environment surrenders and is unable to support the needs of the patient. This is more frequent in a situation in which the terminal illness has a prolonged duration and in which the subject becomes very dependent, and their caregivers may suffer a high level of tension, anxiety, depression and the so-called overload of the caregiver. In this sense it will be necessary to perform psychoeducation and provide ongoing support to the family, as well as linking family members with associations that can help them (for example, residential RESPIR in Catalonia) and possibly contacting associations of relatives of persons with said disease and / or groups of mutual help.
The resolution of problems, cognitive restructuring, training in emotion management or communication, psychoeducation and the treatment of different problems that may arise are some of the employable techniques that have great utility. The acceptance of future loss , the work with the emotions, doubts and fears of the relatives and the adaptation to a future without the sick subject are elements to be treated.
Bibliographic references
- Arranz, P .; Barbero, J .; Barreto, P & Bayés, R. (2004). emotional intervention in palliative care. Model and protocols (2nd ed.). Ariel: Barcelona.
- Clariana, S.M. and de los Rios, P. (2012). Health Psychology. CEDE Preparation Manual PIR, 02. CEDE: Madrid.
