Therapy at the End of Life

Therapy at Life's End

Placing your trust in a therapist during the transition into one’s end-of-life is profoundly vulnerable, and very brave. Some people reach the end of life when they are in their older age, and others become ill before they are ready to face their own death. This blog is a discussion of using therapy to receive support in facing an early death, specifically when diagnosed with cancer. As a therapist, I’ve had the privilege of supporting someone through this process, and I will always be grateful in being trusted to help support them.

Receiving a diagnosis of cancer can trigger so many things. In discovering this diagnosis, it’s normal to feel afraid, as it expedites your own contemplation of the end of your life. People often feel terrified, numb, hopeful, devastated, and they find themselves facing so many unknowns. Being sick introduces the possibility of death. Many people with a late stage or potentially terminal cancer diagnosis experience extreme grief, humility, gratitude, love, and a profound shift in perspective.

The loneliness of being very ill and of approaching death often compels individuals to conceal their anxieties and grief from their family, especially before all have accepted that there is no longer a chance to recover. Sharing hope becomes a delicate balance, given the reluctance to uplift loved ones only to potentially disappoint them. As a therapist to someone in this position, I’ve realized that therapy can function to provide a neutral space for someone to process their own hope, loss of hope, exhaustion, fear, and mitigate their reactions to their loved ones as they deeper understand their own illness and their timeline for the end of their life.

One of the hardest parts of being sick is navigating the uncertainty of one's remaining time to live. Similar to the stages of grief experienced after a loss, those facing the end of their life undergo denial, bargaining, anger, grief, and acceptance. Some people may be in denial about the reality that they are dying up until the end. Others may feel angry that this is happening to them. Some people are lucky enough to process their own grief of their upcoming transition into afterlife, and they may reach acceptance before they pass. However, time constraints may hinder the completion of this emotional journey before the final transition.

The pressures accompanying this transition are overwhelming. People find themselves organizing their affairs, preparing themselves, work, and loved ones for the inevitable goodbyes. This process often plunges individuals into extreme emotional pain, arguably one of the most challenging aspects of the human experience. Families, unprepared to bid farewell, grapple with stages of grief, including bargaining (which generally shows up in hoping that their loved one can still receive treatment) to profound anger at the impending loss.

As the body weakens, simple tasks become difficult, and the vulnerability of seeking assistance becomes a major pressure for someone who is ill. It’s very hard to ask for help, and as one becomes more and more sick, they lose their autonomy and ability to function. It can be embarrassing to ask others for simple things that you’ve been able to do your entire life. The loss of agency begins to creep in and its devastating. Maintaining a facade of cheerfulness becomes impossible to somebody who is in that much physical pain. Approaching the end triggers an alternate state of mind, maybe mimicking a younger state, sometimes resembling a more psychedelic experience. Reality undergoes a profound transformation, often accompanied by the acceptance of pain medication and cannabis to help with pain and appetites.

Approaching death requires a spiritual critical point of reflection. Afterlife remains an enigma. We know many things, but with no one can predict what happens in the moments before and after death, we still don’t know what that experience is like, and where we “go”. While some perceive death as final, others, like the Buddhists, term it "Continuation," believing that we continue on after we pass. Society's drive for certainty clashes with the inherent unknowns of life's conclusion, urging individuals to confront their fears and grapple with the uncertainties of the afterlife. A part of approaching your own passing is preparing yourself with your own spiritual belief of what will happen to you.

My experience as a therapist in this context shifted the conventional boundaries of the “standard” therapist-client relationship . I was transparent in a way that I’ve never needed to be. I found myself openly discussing my life, sharing my emotions, and cried alongside my client as we grieved their transition. This work touched me deeply and evoked a profound appreciation for my own life's simple moments. I was gifted many lessons of why life is worth living as I was allowed into processing with my client around what they were saying goodbye to. With this perspective, I was able to evaluate what relationships were meaningful, and prompting farewells to relationships that no longer served a purpose. I got to re-evaluate how I wanted to live my life and spend my time. In processing death, trivial concerns lost their significance, emphasizing the importance of every second.

As the transition from life to afterlife unfolded, my role as a therapist changed, and I stepped in to help facilitate the process of leaving this world. My role became more active as I engaged with family, nurses, and hospice to offer support and help the transition feel comfortable. At the end, I grieved. And I still remember them, because people we care about never truly depart from our lives.