May 25, 2024


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Death and Dying and the Therapeutic Relationship

Our society has developed the belief that death and illness should be avoided and feared. The denial that death is real and can happen has caused people to regard illness and death as something that is happening to them, rather than a natural process that can be embraced without anxiety and suffering. Our thoughts and perspective on death and illness are based in fear rather than viewed as a possible opening to an experience that can offer new learning, challenges, growth and positive insight into our existence and ourselves. The denial that death is real and can happen has caused people to regard illness and death as something that is happening to them, rather than a natural process that can be embraced without anxiety and suffering.

Upon awareness of a terminal illness, Kubler-Ross outlines different stages that a patient goes through in response to this new knowledge. Often these defense and/or coping mechanisms help a patient manage with the stresses of facing his or her own mortality. These phases include the first stage, denial and isolation; the second stage, anger; the third stage, bargaining; the fourth stage, depression; and the fifth stage, acceptance (1969). The stages are defined as being consecutive, in which hope is usually present in one form or another. In the final stage of acceptance, there is no more hope in finding a cure and the patient may not want any more visitors. A person will have finished their unfinished business and there is a sense that the patient has reached a feeling of peace (Kubler-Ross, 1969). Another indicator of the final stage is the role of hope. Once hope disappears, often the patient is close to death.

Stephen Levine, who has also worked extensively with dying people, went a step further with the stages outlined by Kubler-Ross, making a point that these stages are really more about changes in the mind. “These stages, instead of being swallowed whole as an absolute reality, can rather be used as a means of focusing, a way of encouraging recognition of the impermanence of all things so that one may go beyond seeing others as what they are becoming and instead experience them as they are. To touch in the living truth of their being, to share in the reality that goes beyond death” (Levine, 1982, p. 234). Many individuals have outlined the different stages that humans’ experience when faced with their ultimate fate of death. In facing death, Levine (1982) defines the mind as a rollercoaster, changing thoughts in one given day. During the evaluation process, stages are revisited more than one time.

Levine adds a spiritual dynamic to his view of the stages of dying that Kubler-Ross outlined. He refers to her stages as psychologically based, connected to thoughts, feelings and emotions. He adds: “The difference between the psychological and the spiritual is that the spiritual relates not only to the contents but to the space in which these contents are unfolding. The five stages deal with death as though it were outside of ourselves. Perhaps real acceptance is the first time we take death within. Where death is not the enemy but instead becomes the great teacher that directs us toward our fear and encourages us to relate to it instead of from it. Death’s teaching is to relate to your life as a whole rather than some fractured reality from which you wish to escape.” (Levine, 1982, p. 242) Spirituality is often interwoven in the dying process regardless of previous spiritual development.

As I have seen in my office, a person can feel stable in a particular belief system and with a diagnosis or when an opportunity to examine death arises, many beliefs are immediately re-evaluated. I have had the opportunity to work as a Chaplain in a Community Hospital, and I have worked extensively with people who have been recently diagnosed with a life threatening illness and/or know someone close to them who are going through the process. I believe that everyone has a different response to his or her particular life circumstances. The therapeutic process can be very helpful, supportive and beneficial to feel and move through emotions as they arise. Therapy can also be a place to process what may remain unfinished.

As a therapist, it is my job to hold space for another’s process rather than to fix, heal and/or deny ones experience. Through all feelings of grief, anger, shock, denial and acceptance, I hold the space for choice in the midst of challenging circumstances. Sitting with another human being in this process is humbling, powerful and reminds me how the role of choice occurs up until our last breath.

Levine, S. (1997). A year to live: how to live this year as if it were your last. New York: Bell Tower.
Levine, S. (1982). Who dies: an investigation of conscious living and conscious dying. New York: Anchor Books.
Kubler-Ross, E. (1969). On death and dying: what the dying have to teach doctors, nurses, clergy and their own families. London: The Macmillan Company.
Kubler-Ross, E. (1974). Questions & answers on death and dying. New York: Simon & Schuster.