The psychologist and his intervention in terminal illness: what does he do?

The psychologist dedicated to terminal illness cases must face tough situations.

We all know that sooner or later we are going to die. An accident, an illness or simple old age will eventually lead to our demise. But knowing that one day we will die is not the same as being diagnosed with an illness and being told that we have a long time to live. and told that we have at most two months to a year to live, but it is not the same thing to know that one day we will die..

Sadly, this is what happens to a great many people around the world. And for most, it is hard and painful to take. In these difficult circumstances it is easy for a large number of needs to arise on the part of the sick person that he or she may not even dare to mention to those around them because they consider themselves a burden, or even in their own family members. In this context, a psychology professional can perform a valuable service. What is the role of the psychologist in terminal illness? Let's discuss it throughout this article.

The psychologist's intervention in terminally ill patients

The concept of terminal illness refers to that disease or disorder in very advanced phase, in which there does not exist probability of recovery of the person who suffers it and in which and in which life expectancy is reduced to a relatively short period of time (generally a few months).

The treatment used at the medical level with this type of patient is palliative, not aiming primarily at recovery but at maintaining the highest possible quality of life for as long as possible and avoiding discomfort and suffering.

But the medical treatment often requires the contribution of psychologists and psychiatrists to take care of the more psychological and emotional needs of the patient, not so much in terms of the symptoms of the disease itself, but in the preservation of their dignity and acceptance of the end of life. Likewise, the aim is to increase comfort and provide support, as well as to close the life process in a positive way and, as far as possible, to meet psychological and spiritual needs.

Diagnosis

The moment of diagnosis and notification is one of the most delicate ones.It is a hard setback for the person. In this regard, it should also be taken into account that it is possible that the terminal phase is reached after a more or less prolonged period in which the patient may have presented different symptoms that he/she knew were leading to his/her death, but it is also 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 arise in the patient himself with respect to his relationship with the possible process that will lead to his end. It is common for disbelief and denial to appear at first, only to be followed by strong emotions of rage, 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 arrive at a possible acceptance of his condition.

Attitudes and behaviors can vary enormously from case to case. from one case to another. There will be people who will feel a constant rage that will push them to fight to survive, others who will deny their illness 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, since it can help them not to experience so much stress) and others who will enter a state of hopelessness in which they will refuse any treatment because they consider it useless. Working on this attitude is fundamental, since it allows predicting treatment adherence and favoring an increase in survival expectancy.

Treatment of the terminally ill

The needs of the terminally ill population can vary greatly, and this variability must be taken into account in each case treated. Broadly speaking, as mentioned above, the main objectives are as follows to preserve the dignity of the personThe main objectives are to preserve the person's dignity, to serve as a companion at this time, to provide the maximum possible comfort, to alleviate psychological and spiritual needs, and to try to work towards the closure of the vital process so that the person can die in peace.

At the psychological levelOne element that needs to be worked on to a great extent with the patient is the perception of lack of control: it is common for the terminally ill person to perceive him/herself as incapable of facing the threat posed by the disease and the symptoms he/she is suffering, and to see him/herself as useless. It will be necessary to restructure this type of beliefs and increase their sense of control over the situation. Techniques such as visualization or induced relaxation may also help. Counseling, as a strategy in which the professional adopts a less directive role and facilitates the patient to reach his own conclusions about his concerns, can help to improve this perception of control.

Another aspect to work on is the existence of possible anxious or depressive symptomatology. Although it is logical that in such circumstances sadness and anxiety appear, it is necessary to control the possible appearance of syndromes of this type that worsen the patient's discomfort and go beyond what is adaptive. It is also necessary to take into account that in some cases suicide attempts may appear.

Likewise, it is essential that the person can express his emotions and thoughts, being very frequent that he does not dare to confess his fears and doubts to anyone or to his close environment due to the desire not to cause concern or not to be a burden.

The professional has to explore the fears, try to give emotional support and encourage the expression of fears and doubts. and encourage 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 (e.g. grief or what may happen to their families after their death) is often a complicated topic and something that may worry patients. However, not all patients want to know everything: their wishes in this regard should be taken into account.

If the patient has religious beliefs and this brings peace, it may be important to contact an authority figure, clergy or spiritual guide who can work on this important aspect of acceptance of future death. Problem solving and the management of communication and emotions can be very useful.

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 from it and this should be the main focus of the intervention, but it is also a very important factor for the family. is not the only person who is going to present a high level of suffering.. Their environment will often need advice, guidelines and a great deal of emotional support to be able to cope with the situation, both the current one and that of the future death.

Two phenomena deserve special mention, which are more frequent than it seems. Firstly, the so-called conspiracy of silence the so-called conspiracy of silencein which the disease is denied and ignored in such a way that the patient may not know what is happening to him or her. Although the intention is usually to protect the terminal patient and not to cause suffering, the truth is that in prolonged illnesses it can cause suffering because the person does not know what is happening to him or her and may feel misunderstood.

The other frequent phenomenon is family withdrawal, when the family gives up and is unable to support the patient's needs. This is more frequent in situations in which the terminal illness has a prolonged duration and in which the subject becomes very dependent, and the caregivers may suffer a high level of stress, anxiety, depression and the so-called caregiver overload. In this sense, psychoeducation psychoeducation will be necessary and provide ongoing support to the family, as well as linking family members with associations that can help them (for example, the residential RESPIR in Catalonia) and possibly contact associations of relatives of people with the disease and/or mutual aid groups.

Problem solving, cognitive restructuring, training in emotion management or communication, psychoeducation and treatment of the different problems they may present are some of the useful techniques that can be used. Acceptance of the future lossThe work with the emotions, doubts and fears of the relatives and the adaptation to a future without the sick person are elements to be dealt with.

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. & de los Rios, P. (2012). Psicología de la Salud. Manual CEDE de Preparación PIR, 02. CEDE: Madrid.