Psychiatric Palliative Care

Thank you for your question. I do not know that there is anything that is specifically defined as ‘palliative care counseling’ or that would necessarily be qualitatively distinct about this work. However, counseling or various modes of supportive psychotherapy with patients who are dealing with psychological issues related to facing a serious life-threatening illness is a crucial need, is likely underutilized and underprovided, but is essential to good quality palliative care which ought to be multidimensional and multidisciplinary in approach in order to achieve its mission of addressing emotional concerns, social stressors, as well spiritual matters and physical symptoms, all of which are often encountered, and in a very different way than may have been experienced in the past. By and large, these broad issues constitute indications for involving mental health practitioners to offer support when providing palliative care. Indeed, then, it would seem that most people would benefit from such counseling in the context of palliative care to receive emotional support for addressing these matters. These issues are part of the general indications for psychotherapeutic work which is to improve coping and adaptive functioning by gaining a better understanding of anxieties and inhibitions with respect to one’s self and one’s role in the context of life changes. However, like any other area or focus, there are certainly specific themes that uniquely emerge when dealing with such issues, and resultant depressive and anxiety symptoms, for instance, in the palliative care setting. End of life, itself, may be conceived as a phase of development with unique conflicts and challenges, and, indeed, may subsume a period of tremendous growth, particularly when these are satisfactorily addressed. Unique issues most salient during this time are even such that a corresponding framework from which to understand and address them has been established – Existential concerns and psychotherapy, respectively. Indeed, these issues are so universal that they are conceived to apply on some level to anxieties and fears faced at many points in life, and not just at its end when, however, they perhaps most readily and directly apply. These concerns may be subsumed in the domains of “the self”, “free choice”, “meaning”, and “anxiety”. Some major topics distinctly encountered in the approach to the palliative care patient for psychological support include dealing with demoralization, or a loss of meaning, and with lack of dignity. To address such issues, certain psychotherapeutic methods have been established, including the general application of interpersonal psychotherapy, or modified psychodynamic therapy, and various types of existential psychotherapy, such as meaning-centered psychotherapy, as well as dignity therapy. Thank you for your question. I do not know that there is anything that is specifically defined as ‘palliative care counseling’ or that would necessarily be qualitatively distinct about this work. However, counseling or various modes of supportive psychotherapy with patients who are dealing with psychological issues related to facing a serious life-threatening illness is a crucial need, is likely underutilized and underprovided, but is essential to good quality palliative care which ought to be multidimensional and multidisciplinary in approach in order to achieve its mission of addressing emotional concerns, social stressors, as well spiritual matters and physical symptoms, all of which are often encountered, and in a very different way than may have been experienced in the past. By and large, these broad issues constitute indications for involving mental health practitioners to offer support when providing palliative care. Indeed, then, it would seem that most people would benefit from such counseling in the context of palliative care to receive emotional support for addressing these matters. These issues are part of the general indications for psychotherapeutic work which is to improve coping and adaptive functioning by gaining a better understanding of anxieties and inhibitions with respect to one’s self and one’s role in the context of life changes. However, like any other area or focus, there are certainly specific themes that uniquely emerge when dealing with such issues, and resultant depressive and anxiety symptoms, for instance, in the palliative care setting. End of life, itself, may be conceived as a phase of development with unique conflicts and challenges, and, indeed, may subsume a period of tremendous growth, particularly when these are satisfactorily addressed. Unique issues most salient during this time are even such that a corresponding framework from which to understand and address them has been established – Existential concerns and psychotherapy, respectively. Indeed, these issues are so universal that they are conceived to apply on some level to anxieties and fears faced at many points in life, and not just at its end when, however, they perhaps most readily and directly apply. These concerns may be subsumed in the domains of “the self”, “free choice”, “meaning”, and “anxiety”. Some major topics distinctly encountered in the approach to the palliative care patient for psychological support include dealing with demoralization, or a loss of meaning, and with lack of dignity. To address such issues, certain psychotherapeutic methods have been established, including the general application of interpersonal psychotherapy, or modified psychodynamic therapy, and various types of existential psychotherapy, such as meaning-centered psychotherapy, as well as dignity therapy.