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

We all know that sooner or later we will die. An accident, an illness or a simple old age will eventually cause our death. But it is not the same to know that one day we will die because we are diagnosed with an illness and tell us that we have at most between two months and a year of life left.

Unfortunately, this is what happens to a lot of people around the world. And for the most part, it is something difficult and painful to face. In these difficult circumstances, it is easy for a large number of needs to arise on the part of the sick subject that he does not even dare to mention in his environment as a burden, or even in his own parents. In this context, a professional in psychology can render a service of great value. What is the role of the psychologist in terminal illness? We will discuss this throughout this article.

    The intervention of the psychologist in terminally ill patients

    The concept of terminal illness refers to very advanced disease or disorder, in which there is no likelihood of recovery of the person who suffers from it and whose life expectancy is reduced to a relatively short period (usually a few months).

    The treatment dispensed at the medical level with this type of patient is palliative, not aimed primarily at their recovery but at maintaining the best possible quality of life for as long as possible and to avoid discomfort and suffering.

    But medical treatment often requires the contribution of psychologists and psychiatrists that they take care of the most psychological and emotional needs of the patient, not until the symptomatology of his disease in itself but in the preservation of his dignity and the acceptance of the end of the life. It also seeks to increase comfort and serve as support, as well as closing the life process in a positive way and as far as possible to meet psychological and spiritual needs.

      the diagnosis

      The timing of diagnosis and notification is one of the most difficult, Assuming for the person a difficult setback. In this sense, it should also be borne in mind that it is possible to reach the terminal phase after a more or less prolonged period during which the patient may have presented various symptoms which he knew led to his death. death, but it is also possible that the diagnosis of a specific terminal problem could be something completely unexpected.

      Anyway, it is common for a period of mourning to appear in the patient himself as to his relation to the eventual process which will bring him to an end. It is common for disbelief and denial to appear early on, so that later it arouses strong emotions of anger, rage, and disbelief. After that, it is not uncommon for stages to occur in which the subject tries to do some sort of negotiation in which they would improve as a person if they healed, only to then be overcome with sadness and ultimately achieve to a possible acceptance of his condition. .

      Attitudes and behaviors can vary widely from one case to another. There will be people who will feel a constant rage that prompts them to fight for survival, others who will deny their illness at any time or even convince themselves of it (which surprisingly in some people can prolong survival as long as they are comply with their treatment, as it may help them not to feel so much stress) and others who will enter a state of desperation in which they will refuse any treatment to be considered unnecessary. Working on this attitude is essential, as it helps predict treatment affiliation and promote an increase in survival expectancy.

      Treatment of terminally ill patients

      The needs of the terminally ill population can be very varied, this variability having to be taken into account in each case treated. Generally speaking, as we have seen above, it is conceived as the main objectives preserve the dignity of the person, To serve as accompaniment in these moments, to bring him the maximum possible comfort, to alleviate the psychological and spiritual needs and to try to work the closing of the vital process so that the person can die in peace.

      At the psychological levelOne thing that needs to be largely worked on with the patient is the perception of lack of control: it is common for the terminally ill person to be perceived as unable to cope with the threat posed by the disease and the symptoms it presents. suffers, and that he sees himself as useless. It will be necessary to restructure these types of beliefs and increase their sense of control over the situation. Techniques such as visualization or induced relaxation can also be useful. Counseling, as a strategy in which the professional takes a less managerial role and helps the patient to draw their own conclusions about their concerns, can be used to improve this perception of control.

      Another aspect to work on is the existence of possible anxiety or depressive symptoms. While it is logical that under these circumstances sadness and anxiety arise, the possible appearance of such syndromes which aggravate the patient’s discomfort and go beyond adaptive must be controlled. It should also be noted that in some cases suicide attempts may occur.

      In addition, it is essential that the person can express their emotions and thoughts, as it is very common that they do not dare to confess their fears and doubts with anyone or with their immediate environment due to the desire not to not to worry or not to be a burden.

      The professional should explore fears, try to provide emotional support and encourage the expression of fears and desires so that we can direct and manage emotion towards adaptive goals and not towards despair. Additionally, information about the situation and what may happen (for example, pain or what may happen to their family after their death) is often a complicated subject and can 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 them peace, it may be important to contact an authority, clergy or spiritual guide who can work on this aspect so relevant to the acceptance of future death. Problem solving and managing communication and emotions can be very helpful.

        The family: the role of the psychologist in accepting and managing the situation

        The existence of a terminal illness is devastating for the sufferer and this is where the intervention is most focused. he is not the only person with a high level of suffering. Their environment will often need guidance, guidelines for action, and a lot of emotional support in order to be able to withstand the situation, now and in the future.

        Special mention should be made of two more frequent phenomena than they appear. First the so-called conspiracy of silence, In which the disease is denied and ignored so that the patient does not know what is happening to him. While the intention is generally to protect the terminally ill patient and not to cause pain, the truth is that in prolonged illnesses he can cause suffering by not knowing what is happening to him and being able to to feel misunderstood.

        The other common phenomenon is family limp, when the environment surrenders and is unable to support the patient. This is more common in a situation where the terminal illness has a prolonged duration and where the subject becomes very dependent, and their caregivers may suffer from a high level of stress, anxiety, depression and the so-called overload. caregivers. In this way psychoeducation should be carried out and provide ongoing support to the family, as well as putting relatives in touch with associations that can help them (for example, residential RESPIRs in Catalonia) and possibly contact associations of parents of people with this disease and / or support groups.

        Problem solving, cognitive restructuring, training in the management of emotions or communication, psychoeducation and the treatment of the various problems that may arise are some of the employable techniques which they possess a great utility. Acceptance of future loss, Working with the emotions, doubts and fears of loved ones and adapting to a future without the sick subject are elements to be addressed.

        bibliographical references

        • Arranz, P .; Barber, J .; Barreto, P and Bayés, R. (2004). Emotional intervention in palliative care. Model and Protocols (2nd ed.). Ariel: Barcelona.
        • Clariana, SM and dels Rios, P. (2012). Health psychology. CEDE PIR preparation manual, 02. CEDE: Madrid.

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