The capacity to talk with others openly and sensitively about illness, death, and dying, can lead to a better quality of life, even a ‘good death’. Of course, these are difficult conversations, but they cannot be ignored in palliative care. The tragic circumstances will not go away, but they can be handled with candour and dignity. In many instances, a counsellor may be the catalyst for creative conversations about the things that matter.
There are often strong emotions, which we must live with, such as shock, anger, fear, and distress. What do we do with these emotions? And it’s complicated. In my experience, the patient does not want to upset loved ones; and loved ones do not want to upset the patient. In this situation, a counsellor can gently build bridges by having separate conversations first, and then secondly, by bringing all those conversations together.
In addition, the counsellor can support the family during the dying process and after death in bereavement. Moreover, a counsellor, who is experienced in palliative care, has the knowledge to help with the practical dimensions, like who to ask for clinical help, or what resources and support are available, and what sort of things need to be done?
Good communication is important in all parts of life; however, it is even more important with people approaching end of life. So, there needs to be a fine balance between facing reality, gently supporting, and fostering positivity and hope. This is not a simple linear process, but changeable, even chaotic. often one of chaos and changeability. Communicating well allows patient and families to trust themselves and each other, in their vulnerability, bringing empathy and goodwill to the surface.
There are times when a person outside the family system, like an experienced counsellor, can give the time and space to hold all those important dimensions in creative tension. With empathy and understanding, as well as good verbal and non-verbal skills, counselling can provide a safe space in palliative care to live with these complexities. At times, it means being with someone who can sit with you in silence, that is, being a supportive presence without feeling the need to ‘fix’ the situation.
There is no easy answer, but there are helpful and positive processes. Palliative care then is very much a process for living and dying well.