How Can.I Fix My Anxiety And Deal Like An Adult Death and Dying and the Therapeutic Relationship

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Death and Dying and the Therapeutic Relationship

Our society has developed the belief that death and disease are to be avoided and feared. Denying that death is real and can happen causes people to view illness and death as something that happens to them, rather than as a natural process that can be accepted without anxiety and suffering. Our thoughts and perspective on death and illness are based on fear rather than as a possible opening to an experience that can offer new learning, challenges, growth and a positive outlook on our existence and ourselves. Denying that death is real and can happen causes people to view illness and death as something that happens to them, rather than as a natural process that can be accepted without anxiety and suffering.

Upon realizing a terminal illness, Kübler-Ross outlines various stages the patient goes through in response to this new knowledge. Often these defense and/or coping mechanisms help the patient cope with the stress of facing his own mortality. These phases include the first stage, denial and isolation; the second stage, anger; the third stage, negotiation; the fourth stage, depression; and the fifth stage, acceptance (1969). The stages are defined as sequential in which hope is usually present in one form or another. In the last stage of admission, there is no longer any hope of finding a cure, and the patient may not want any more visitors. One will have completed their unfinished business and feel that the patient has reached a sense of peace (Kubler-Ross, 1969). Another indicator of the final stage is the role of hope. Once hope is gone, the patient is often close to death.

Steven Levine, who has also worked extensively with dying people, took the stages outlined by Kübler-Ross a step further, noting that these stages are actually more about changes in the mind. “These stages, rather than being absorbed whole as an absolute reality, can rather be used as a means of focus, a way of encouraging recognition of the impermanence of all things, so that one can go beyond seeing others as such, what they are becoming and instead to experience them as they are. To touch the living truth of their being, to share the reality that transcends death” (Levine, 1982, p. 234). Many people have outlined the various stages that people go through when they face their ultimate fate of death. In facing death, Levine (1982) defined the mind as a roller coaster that changes thoughts in a day. During the evaluation process, the stages are revised more than once.

Levine adds a spiritual dynamic to his view of the stages of dying outlined by Kübler-Ross. He refers to its stages as psychologically based, related to thoughts, feelings and emotions. He adds, “The difference between the psychological and the spiritual is that the spiritual is not only about the content, but also about the space in which that content unfolds. The five stages deal with death as if it were beyond us. Perhaps true acceptance is the first time we accept death within us. Where death is not an enemy, but instead becomes the great teacher who guides us to our fear and encourages us to relate to it instead of to it. The teaching of death is to treat life as a whole and not as some fractured reality from which you want to escape.” (Levine, 1982, p. 242) Spirituality is often woven into the dying process, regardless of previous spiritual development.

As I have seen in my office, a person can feel stable in a particular belief system, and with a diagnosis or when an opportunity arises to explore death, many beliefs are immediately reevaluated. I have had the opportunity to work as a chaplain in a community hospital and have worked extensively with people who have recently been diagnosed with a life-threatening illness and/or know someone close to them who is going through this process. I believe everyone has a different answer to their particular life circumstances. The therapeutic process can be very helpful, supportive and helpful in feeling and working through emotions as they arise. Therapy can also be a place to process what may remain unfinished.

As a therapist, my job is to hold space for another’s process, rather than to fix, heal, and/or deny someone’s experience. Through all the feelings of grief, anger, shock, denial and acceptance, I hold the space of choice in the midst of challenging circumstances. Sitting with another human being in this process is humbling, powerful, and reminds me of how the role of choice happens until our last breath.

sources:

Levine, S. (1997). A Year to Live: How to Live This Year Like It’s Your Last. New York: Belfry.

Levine, S. (1982). Who Dies: Exploring Conscious Living and Conscious Dying. New York: Anchor Books.

Kubler-Ross, E. (1969). On Death and Dying: What Dying Doctors, Nurses, Clergy, and Their Own Families Need to Learn. London: The Macmillan Company.

Kubler-Ross, E. (1974). Questions and answers about death and dying. New York: Simon & Schuster.

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