Hospice counseling: Forming a therapeutic relationship

Putting it simply, C+B=TR (Connection plus Boundaries equals Therapeutic Relationship).

I recently attended a care-plan meeting for a lonely patient living in a nursing home. I arrived late, walking into a discussion that included the facility’s social worker, the patient’s daughter, and my agency’s nurse case manager and community liaison. Everyone agreed he needed purposeful emotional support that came with boundaries. “I can do that,” I said.

A few minutes later, the patient walked in and sat with us. Let’s call him Joe Nichols. Joe greeted all present and expressed sorrow to his daughter for being difficult to interact with. I watched and listened, and when there was a nice long pause, I asked him, “I knew a Doug Nichols in the Army. Are you related to him?”

He said no, but explained how his father served in the Air Force. His father started out in World War II, and then stayed in and made a career of it.

“Was it called the Army Air Corps back then?” I asked.

“Yes, that’s right,” Joe said, turning towards me.

“So your father was a founding member of the Air Force,” I said, in a congratulatory tone.

“I suppose he was!” Joe said.

Connecting by meeting the patient where he’s at (specifically, talking with food in your mouth)

Joe leaned forward and picked up a brownie from the plate the community liaison brought. He stuffed it into his mouth and started speaking to me unintelligibly.

I did the same. As we mumbled an enthusiastic conversation with our mouths full of brownie, he and everyone else in the room started laughing.

Brownies swallowed, I asked if I could come visit him again.

“Anytime,” he said. “Come talk to me every day if you want.”

And then he picked up a brownie, looked at it intensely and said, ostensibly to me, “I knew I liked you the moment I first saw you.”

“You’ve got a good friendship with that brownie,” I told him. He laughed.

I picked up a cookie, gazed at it and said, “Looks like the beginning of a fine relationship.”

He laughed until tears were coming out of his eyes.

Mean what you say: “Time to go” means “time to go”

“I’d like to come visit soon,” I said. “I’m running a little late for another meeting, so I need to go.”

“No,” he said. “You’re staying.”

“The sooner I go, the sooner I can come back,” I explained.

“Then you better get going!” he exclaimed with a smile.

We said goodbye, but he began to speak to me again as I approached the door. Our interaction had ended. Staying to listen to what he was saying after I left would force me to stay longer than I could. His continuing to engage me in a conversation may have been testing a boundary. My leaving when I said I had to was me maintaining a boundary.

We picked up where we left off the following week when he told me that he knew from our first meeting that he would be able to trust me.

How did I demonstrate my trustworthiness? I did what I said I would. Even leaving when I said I would–despite any efforts to keep me longer than that–showed him that I meant what I said. And then I came back when I said I would.

Take a look around!

A new article will be published next week Sunday, but until then, check out previous articles. There are articles about advanced directives, advocating for resources, helping enrich our patients’ lives, and many more topics.

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3 keys to trusting and comfortable relationships with hospice patients

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