Facing Life & Facing Death – Counselling for Cancer and other life threatening illness.

1. Facing Life & Facing Death – Counselling for Cancer and other life threatening illness. Presented by Stephen Quinlan And Juliette Kalifa

2. Stages and cycles • Diagnosis • Treatment • Recurrence • Recovery • Palliation • Bereavement

3. DIAGNOSIS: “This could kill me.” • How / when • May be a process • Shock • A line is crossed

4. Diagnosis: Client tasks - Doka • Understanding the disease • Examining / maximising health, lifestyle • Maximising strengths /limiting weaknesses • Developing coping strategies • Exploring effect on self & others • Ventilating fears /feelings • Accepting / incorporating present reality

5. Diagnosis: 3 stages - Holland 1. Denial , Disbelief 2. Turmoil 3. Doing

6. Diagnosis: Therapy aspects • Helping client’s struggle with uncertainty, anxiety, ambiguity. • A problem to be solved. • Explore coping styles. • Identify supports. • Clarify client choices. • Develop strategies for dealing with changed self image / interpersonals.

7. Treatment • For most, there is neither quick recovery nor rapid deterioration. • Struggles with treatments, side effects, daily business of living. • Chronicity – weariness, fatigue • What else is going on...?

8. Treatment – client tasks: Doka • Managing symptoms, side effects • Compliance – medical regimes • Preventing / managing medical crises • Managing stress / coping • S social support, social isolation • Normalising life in face of illness • Finances • Preserving self concept • Redefining relationships • Ventilating feelings / fears • Finding meaning

9. Treatment: Therapy aspects • What can you address? (eg, pain vs psyche) • Strategies, eg, mindfulness; one day at a time; imagery; guided meditation; relaxation exercises; support groups. • Reality testing • ? Surprises • Role play • Sexuality • Being non-judgmental; no assumptions

10. Treatment: Therapy aspects (cont) • Q.’s that help client find meaning in the experience, eg, How has this experience changed you? What have you learned from this experience? • Choices “within” even if not “about”.

11. Treatment: outcome Recovery? Remission? Recurrence?

12. Treatment: Recovery/Remission • Client Tasks - Doka: 1. Dealing with the physical, psychological, social, financial and spiritual residues of illness 2. Coping with fears / anxieties, esp fear of recurrence 3. Reconstructing life 4. Redefining relationships, esp with carergivers

13. Recovery/Remission: Therapy aspects • Grief and loss • Guilts: survivor, behaviours • Fears: commitment, “damaged goods” • Venting • Validation and exploration • Normalising and the “new normal”

14. Recovery/Remission: Therapy aspects (cont) Q’s: - What will you leave behind from this experience? What will you keep of this illness experience? What will you add? • Fear of Recurrence • Extremely prevalent • How to manage: Information/education; mindful distraction; reality acceptance; recognising triggers; explore the fear

15. Treatment - Recurrence • May or may not lead to palliation • Revisiting the land of Malady • “I have done this before – I can do it again.” • The goals of hope change

16. Treatment - Palliation • Change of goals • Client tasks – Doka • Managing physical symptoms • Managing health and institutional procedures • Managing stress ,fears and anxieties • Preparing for death / saying goodbye • Preserving self concept and relationships • Finding meaning in life and death

17. Palliation: Therapy aspects • Conversations about death • Open communication – let the client lead you • The client sets the tone • Remember: “Hope should not expire before the person.” • ? What does a dying person need?