basics of how to do hospice social work

Counseling in hospice: Comfort comes first, breakthroughs come on occasion

Happy New Year! Welcome to a series of articles about how to be an excellent counselor to your hospice patients and their families.

Hospice requires a different approach to counseling for several reasons. One difference that is grief requires comfort and affirmation far more than motivation to take action or learn emotional self-regulation. Another reason is that counseling usually doesn’t result from a hospice patient’s request. Usually, someone else–a colleague, family member, or you–will perceive a need.

When an individual asks you for counseling for depression or anxiety or support with relationships, part of your job may be to encourage them to step out of their comfort zone and take healthy risks. This seldom applies in hospice, where the focus is comfort, not healing or personal development.

There are only a handful of situations where it’s appropriate or necessary for a hospice social worker to recommend a patient or family member step out of their comfort zone.

Exception to prioritizing comfort #1: End-of-life preparations

It’s our job to facilitate comfort down the road by having uncomfortable conversations now. DNRs and funeral home plans can make for hard conversations, but they facilitate peace of mind down the road as the patient transitions.

Exception #2: Advocating for the patient or the designated decision-maker

Sometimes the patient will have family members or friends who will very lovingly take over or interfere with a patient’s wishes. Some will take over as a coping mechanism. Many will forget that the patient’s wishes usually trump their sensible thinking. Some won’t know they need to step back to support the proxy in making calls. Many designated proxies won’t know that the patient still makes her own decisions until she no longer can or wants to.

Advocating for the patient’s wishes in these situations can require some participants to learn some new things that go against their instincts.

Exception #3: When patients or family members ask for it

The most rewarding of opportunities to help patients or family members outside of their comfort areas are when they ask for our help in doing so. Patients will request support in reconciling with estranged family members or communicating uncomfortable messages to their supportive family members. On rare occasions, they’ll ask for help resolving some anxiety they’ve carried around their entire lives. But this will more likely happen if you first establish yourself as someone who respects their wishes.

Don’t force patients to resolve their emotional challenges

A cancer patient living on the rural outskirts of Austin showed indicators of depression but asserted she was appropriately processing her emotions. She also communicated quite emphatically that she didn’t want to talk about issues that were on her mind, and I accepted that.

Unfortunately, a nurse pressured her to talk about her feelings. She warned her how unhealthy it would be for her to bottle them up. And the patient banned the nurse from her home.

Let’s not tell hospice patients that they have to deal with their feelings and they can’t keep them bottled up. As far as we’re concerned, they don’t have to deal if they don’t want to and bottling is their prerogative. Releasing pent-up emotions can promote a person’s long-term healing and personal growth, and such aims are quite optional.

To read more about counseling in hospice

The next article gives an example of how you can begin forming therapeutic relationships in hospice. Click here to read on!

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Hospice counseling: Forming a therapeutic relationship

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