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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. The denial that death is real and can happen has led people to view illness and death as something that happens to them, rather than as a natural process that can be embraced without stress and suffering. Our thoughts and perspective on death and illness are based on fear and not as a possible opening to an experience that can offer new learning, challenges, growth and positive insight into our existence and ourselves. The denial that death is real and can happen has led people to view illness and death as something that happens to them, rather than as a natural process that can be embraced without stress and suffering.

After learning of a terminal illness, Kubler-Ross describes various stages a patient goes through in response to this new knowledge. Often these defense and/or coping mechanisms help a patient manage the stress of dealing with their 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 final stage of admission, there is no longer any hope of finding a cure and the patient may not want any more visitors. A person will have completed their unfinished business and there is a sense that the patient has felt 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.

Stephen Levine, who has also worked extensively with the dying, took the stages described by Kubler-Ross a step further, pointing out that these stages are really more about changes in the mind. “These stages, rather than being swallowed whole as ultimate 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 transcend others as what they are 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 individuals have described the different stages that people go through when faced with the ultimate fate of death. Facing death, Levine (1982) defines the mind as a roller coaster, changing thoughts in a given day. During the evaluation process, the stages are reviewed more than once.

Levine adds a spiritual dynamic to his view of the stages of death described by Kubler-Ross. She refers to her stages as psychologically based, connected to thoughts, feelings and emotions. He adds: “The difference between the psychological and the spiritual is that the spiritual is not only related to the content but to the space in which these contents unfold. The five stages deal with death as if it were outside of ourselves. Perhaps the true acceptance is the first time we take death into us. Where death is not the enemy, but instead becomes the great teacher who directs us toward our fear and encourages us to relate to it instead of it. The teaching of death is to relate to your life as a whole rather than some broken reality that you want to escape from.” (Levine, 1982, p. 242) Spirituality is often woven into the dying process regardless of prior spiritual development.

As I have seen in my office, a person can feel fixed in a particular belief system, and with a diagnosis or when an opportunity to consider death arises, 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 undergoing this procedure. I believe that everyone has a different response to the particular circumstances of their life. The healing process can be very helpful, supportive and beneficial to feeling and moving through the emotions as they arise. Therapy can also be a place to process what may remain unfinished.

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

Sources:

Levine, S. (1997). A year to live: how to live this year as if it were your last. New York: Belfry.

Levine, S. (1982). Who dies: an investigation of conscious life and conscious death. New York: Anchor Books.

Kubler-Ross, E. (1969). On death and dying: what the dying have to teach their doctors, nurses, clergy and families. London: The Macmillan Company.

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

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