Many social workers are fantastic counselors. And many hospice patients will benefit from good counseling. And some people who need it most will not be at all open to it.
Hospice patients don’t come face-to-face with social workers because they want to receive counseling. They come onto hospice service for end-of-life support, and social service is an optional part. Some decline to meet the social worker, often because they assume counseling is all she’ll offer. When patients and families welcome the social worker, only some will want to talk about anything very personal.
A hospice social worker needs to flexibly adapt to everyone’s needs. Here are some of the different levels of receptiveness towards counseling hospice social workers encounter:
1. Just don’t want counseling.
Some will decline the social worker, stating either “we already have a counselor” or “we are not interested in counseling. In these cases, we can communicate that there are several services that we offer and counseling is only one of them.
“Counseling is only one of several optional services I can provide,” I explain. “There are some other things I might be able to help you with. For example, if there is financial strain or long-term logistical questions, I can be your go-to person.”
When I visit such families, I am very careful NOT to enter into any kind of psychotherapeutic counseling, even when it seems like “they started it.” It is possible to slide gently into it, but once they realize it’s happening, the part of them that strongly objected might give me the boot. Instead, if they start to speak about very tender topics openly, I’ll clarify. I’ll tell them that I’m happy to discuss these topics with them, but wanted to check in first because they told me before that they didn’t need counseling from me.
2. “Our sessions are counseling, but we’ll pretend they’re not.”
Some people want counseling and make good use of it, but just don’t like the idea of counseling. You can find yourself attentively listening as they share intimately personal concerns and responding honestly when they ask for help finding solutions. They may express hope that your supportive visits will continue with regularity. If your schedule forces you to skip one week’s visit, they might greet you after the two-week gap with a comment like “long time no see.”
These same patients or family members may sometimes say things that indicate they would prefer not to think of you as a counselor. They might say it as clearly as “ I’m not the kind of person who needs a counselor.” or after they share some personal thoughts, they respond to your first question with “You sure ask a lot of questions.” Or they might be a retired Army General who really enjoys reflecting on his life, but learns to associate strength with the kind of self-reliance that never seeks professional mental health support.
We can meet these individuals where they are at, as we can with most of the people we serve. Whatever they are proving that they appreciate from us, we keep providing it, with consistency. Whatever ideas they indicate they are not comfortable with, we continue to set aside.
3. “Please be my counselor.”
Some patients or family members will only see you as a counselor and express consistent need for your support. I’ve found that the people in hospice who want counseling turn out to be good at making use of it. They will lead the way in discussions of their emotional challenges, and when there is an opportunity for you to share some suggestions, they will listen very attentively and make real effort to use your suggestions before your next session.
These are often the people who express a great deal of thanks to you, leaving you wondering what you did to deserve it.
With these individuals, it is important to support them through the termination of your relationship. While it might be okay to end your visits to some family members after the death, ensure there are one or more sessions with those you have been counseling. Instead of letting these family members feel abandoned, you can communicate appreciation for letting you accompany them on their journey. And ensure that they know where to receive additional ongoing support, whether that’s in the form of your agency’s bereavement program or a community resource.
And then there’s everyone else…
These categories cover many of the situations you’ll encounter, but not all. The point to adapt your approach to the different needs and mindsets you encounter in the field.
We’ll look at specific counseling techniques in later sections. For now, let’s get started developing our cache of community resources for hospice patients.