THERAPIES FOR TERMINALLY ILL.   Term Paper ID:19196 Click to get this paper

Essay Subject: Treatment theories & strategies for the dying. Stages of dying, hospices, psychodynamics, logotherapy, play therapy, group therapy, art therapy.... More...

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Paper Abstract: Treatment theories & strategies for the dying. Stages of dying, hospices, psychodynamics, logotherapy, play therapy, group therapy, art therapy. Paper Introduction: Introduction Barocas, Reichman and Schwebel (1983) have reported that: Today there is a new openness about death--and indeed a new interest . . . books appear with titles such as . . . Your Dying . . . Terminal patients and their families are interviewed on television. Celebrities give candid details about how their malignancies affect their lives. (p.436) This new openness to death and dying has served as a foundation to both increased research in the area as well as to the development of a number of treatment strategies for dealing with death and dying in terminally ill populations. This paper examines a sampling of the over 350 publications that comprise the current literature on therapeutic intervention for the terminally ill. The emphasis in the reviewed material is upon Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. She states that the primaryfocus is on the coping task, which Dean defined as "determining the meaningof death." Busick notes that Jungian therapy attempts to resolve fear andanger by assisting the patient to access the collective unconscious. (1983). A group desensitization procedure for thereduction of death anxiety. Barocas, H., Reichman, W. Group therapy has often been found to be very successful in work withpatients dying from AIDS. Theattainment of the perspective associated with atonement to the collectiveunconscious is said to go beyond merely helping the patient to cope.Rather, the patient is said to attain a transcendent outlook which isassociated with a sense of deep peace. (3) Bargaining - In the third stage, the individual attempts to makea deal with God, fate, etc. Revue Francaise de Psychanalyse, 51(3), pp. & Stone, D.B. Prophylactic effects ofpsychoanalysis on cancer-prone and coronary heart diseaseprone probands, ascompared with control groups and behavior therapy groups. Regarding how the psychoanalyst facilitates patient coping, Feldman(1987) stated: The psychiatrist, through the use of, and understanding of, psychodynamics, can help . Regarding the hospice strategy, Fieweger (1987) reports that thepatient is assisted to cope with dying through a focus on interpersonalcommunication. 1 5-12 . Introduction Barocas, Reichman and Schwebel (1983) have reported that: Today there is a new openness about death--and indeed a new interest . Michael: An illustrated study of a young manwith cancer. It isone of the most difficult stages for people surrounding the individualbecause of the ferocity of the venting. Confronting human finitude:Group work with people with A (PWAS) . (199 ). [the patient and relevant others] in responding adoptively . Dean, J.C. . The author studied amultifamily group approach focusing on increasing coping by dealing withissues of denial and avoidance. According to Getzel and Mahony (199 ), thesegroups are essentially discussion sessions focusing on the common issues ofloss, separation, and death. One type of therapeutic treatment used with terminally ill patientshas been based on the developmental theory of Erik Erikson. & Mahony, K.F. Adaptive responses to illnessand disability: Healthy denial. Martin's Press. He/she will be "good" in return for continuinglife. This communication centers around facing the issue ofdeath. (1986). This form of intervention is selective in that hospicesaccept only patients diagnosed as having less than six months to live.Therefore, findings regarding the effectiveness of this interventionstrategy need to be restricted to this population. Szwabo and Thale (1983) have examined the use of group therapy forterminally ill elderly patients. . . NY: St. 115-12 .----------------------- 3 Journal of Gay and LesbianPsychotherapy, 1(3), pp. (1981). Paper presented at the Annual Scientific Meeting of theGerontological Society. (1989). Peal, R.L. Your Dying . Specifically, Peal found thatdesensitization was successful when death anxiety was assessed using therevised Livingston and Zimet Death Anxiety Scale. It was found that treatment was maximally effective if the timingand nature of farewell behavior was geared to the nature of the patient'srelationship with the other to whom he/she desired to say goodbye. Fieweger, M.A. Psychosocial variables associated with theexceptional survival of patients with advanced malignant disease.International Journal of Psychiatry in medicine, 16(2), pp. (1989). The multimodal family therapyapproach was found to facilitate communication and to increase the degreeof support family members gave to both the dying individual and to oneanother. . Most researchers and theorists believe that themost accurate description of the psychological reaction to a terminalprognosis has been provided in the work of Elizabeth Kubler-Ross (1969).Specifically, she states that the patient with a terminal prognosis passesthrough five stages. Supporthas been found for the hospice intervention strategy. . Farewells by the dying: Asociological study. Even in this final stage, thepossibility is left open for some cure or last-minute discovery that willremove the illness. Because of this time constraint, Debraybelieves that there is, at best, limited effectiveness for thepsychoanalytic approach to the dying patient. Druss, R.G. For example, Basileand Stone (1987) found a strong positive correlation between hospice workereffectiveness and workers' emotional and interpersonal skills. (1987). (1984). . This state of emergency results incountertransference repercussions which must be dealt with; however,dealing with them also takes time. (1969). It can benoted that while most forms of therapy appear to be associated with somepositive effects, there was little in the way of comparative research.Therefore, whether one form of treatment should be preferred above anothercannot be known on the basis of the existing literature. Findings showed higher survival rates among patients thatreceived less treatment! The authors state that: Group workers help members find solutions that avoid the extremes of denial of AIDS and a morbid preoccupation which dying and disengagement from life's demands . Tate, F.B. & Eysenck, H.J. (1987, February 14-17). Specifically,Dean (1984) states that patients need help to cope with such diverse tasksas: the unknown, the meaning of death, the pain arising both from theillness and the losses that occur at death; the practical arrangements;communicating with others regarding dying; reconciliation conflicts; andchanging priorities as a result of facing death. . He observed the kind ofoptimism and healthy denial described by Druss and Douglas. References Basile, J. With respect to the foregoing, there are indications thatpsychoanalytic treatment strategies may not only fail to help dyingpatients but may, in fact, exert negative effects. There is atendency to believe that the diagnosis is incorrect and to ignore itsimplications. . All measures showed improvement overtime leading the authors to conclude that group therapy was a viable andbeneficial treatment modality for the terminally ill elderly population. Hospice Journal, 2(4), pp. Feldman, A. (1987). On death and dying. Essentially, this stage istypified by feelings of great loss. 937-946. . Psychology: The study of human experience. However, patients' feelingsof rage, injustice, dependency, and alienation repeatedly generatedarguments and bitterness in the family. 113-122. 1 1-1 8. 61-7 . According to Druss and Douglas (1988), some interesting events aretaking place in research and theory on treatment of the terminally ill.More and more research interest has been focused on determining thosecharacteristics and factors that make for maximal functioning in peoplewith terminal illness. He reports thatwhile these strategies have been found to decrease fear of death and toincrease adaptive functioning, they tend to work better with elderlyterminally ill patients than with younger ones. & Douglas, C.J. 67-78. Summary This paper examined diverse treatment models for terminally illpopulations. NY:Harcourt Brace Jovanovich. state that while achievingintegrity allows for a confrontation of death devoid of feelings of fearand loathing, the choice for despair intensifies the fear which can resultin remorse, bitterness, demanding behaviors, and excessive concern over allbodily changes. Barocas,Reichman and Schwebel (1983) report that, according to Erikson, freedomfrom fear of death comes when a person chooses integrity instead ofdespair. . . These stages are: (1) Denial - At this initial stage, the terminally ill patient willnot (or cannot) acknowledge the reality of his or her death. (199 ). Profile of an effective hospiceteam member. One increasingly prevalent intervention for terminally ill patientsis hospice care. International Journal of Family Psychiatry, 4(3), pp. She states that this form of therapy facilitates the patient'sarrival at the acceptance stage by assisting him/her with specific copingtasks that mark the progression from denial to acceptance. Group workers engage members at each substage of the separation process including denial, regression, recapitulation, and flight (Getzel & Mahony, 199 , p.1 5). Typical comments include, "I am ready now," or "I am nolonger afraid." However, Kubler-Ross does point out that in none of thestages is the person fully without hope. In theirstudy of 1 terminally ill cancer patients, coping abilities were said tobe improved by farewell behaviors such as writing letters, informalconversations with family and friends, saying goodbyes, and the giving ofgifts. (1983). Barocas et al. . This paper examines a sampling of the over 35 publicationsthat comprise the current literature on therapeutic intervention for theterminally ill. . (1985). Some forms of treatment focus on only one or two of the coping tasksdelineated by Dean (1984). Terminal patients and their families are interviewed on television. 247-261. Celebrities give candid details about how their malignancies affect their lives. Omega Journal of Death and Dying, 19(4), pp. Family therapy has also been used with terminally ill patients. 275-292. Orstein (1985) has noted that treatment strategies based on Erikson'snotion commonly involve techniques in which patients are required toreminisce and generally review the events of their lives. (San Francisco, CA: November 17 - 22). & Schwebel, A.I. remained confident that they would not die and asserted that these positive expectations were critical to the healing process. Kellehear, A. Journal of Death and Dying, 12(1), pp. IndividualPsychology Journal of Adlerian Theory, Research, and Practice, 4 (4), pp.453-461. Hutzell, R.R. Greaves concluded that instead of death viewed as a horrible end,death can be seen in terms so transcendent that there are overtones ofinvitation. Counseling the terminally ill. Ornstein, R. (1989) Living with cancer: A transpersonal course.Hospice Journal, 5(2), pp. Still another treatment modality used with the terminally ill patientis behavioral; that is, the approach uses behavioral principles andpractices to facilitate patient coping. Symbols in the graphic art of the dying. According to Tate (1989), art allows patients to express theirfeelings by allowing them to create and work with death symbols.Interestingly, Tate reports that created symbols are often universal onessuch as coiled snakes and/or mandalas. The authors stated that the group focusedon issues relevant to conflict resolution and self-actualization usinginsight-oriented techniques such as role-playing in conjunction with theuse of elements of patients' social support networks. Busick, B.S. (p.113) Another treatment modality used with terminally ill patients is arttherapy. (2) Anger - In the second stage, the individual grows angry. Integrity, the authors report, is characterized by depth, a senseof finality, faith and serenity. Arts inPsychotherapy, 16(2), pp. The dying patient. Bodily trauma, somatic disease, and psychicfreedom. Round, P.C. According to Huttzel, more research needs to bedone but preliminary work suggests that logotherapy can be effective inlifting the feeling of despair often felt by dying patients. He reports that thetherapist using this approach successfully needs to be aware not only ofthe attitudes and responses of the patient but also the attitudes andresponses of the patient's family and his primary physician. For example, Busick (1989) discusses the use ofJungian therapy for terminally ill patients. Interpersonal communicationinstruction in the non-traditional context: Teaching communicationstrategies in a hospice setting. Death in the family: A multifamily therapyapproach. NY: Macmillan. Personaladjustment and growth: A life-span approach. However, findings weremixed when other scales were used. Findings by Rudloff (1985) supportTate's contention; that is, Rudloff found that art therapy was instrumentalin helping a 23 year-old man dying of cancer to express feelings of lossand rejection which he could not express before. Death and Dying in Terminally Ill Populations: Treatment Theories and Strategies Before examining specific treatment strategies, it is helpful toprovide a general description of the death and dying issues faced byterminally ill patients. Subjects assumed responsibility for all aspects of their lives, including recovery . Expressive group psychotherapy withthe older adult. During open-ended interviews, patients stated that they fully believed there was adirect relationship between their survival and their psychological states.Round (1987) reported that these individuals: . (p.1 1)As to the nature of the psychodynamics involved with terminally illpatients, Debray (1987) has pointed out that there are certain constraintsplaced on the psychoanalytic work when the patient suffers from a terminalillness, the most crucial of these constraints being that both the patientand the therapist are in a "state of emergency." The therapist is said tobe in a state of emergency because good psychoanalysis demands time and thepatient has little of it. Journal ofBehavior Therapy and Experimental Psychiatry, 21(2), pp. Kellehear and Lewin (1989) discussed the use of "farewell conduct" asa sociobehavioral mode of treatment with terminally ill patients. Feldman (1987) has discussed the psychodynamic treatment approach todeath and dying issues with terminally ill patients. Success of the groupwas operationalized in terms of regular attendance, problem-solvingability, and communication abilities. This type of healthy denial (asopposed to the kind of denial delineated by KublerRoss) has, according toRound (1987) been found to have concrete survival value. Getzel, G.S. Many treatment strategies focus on getting patients to move from thedenial stage in their responses to death to the acceptance stage; thisacceptance stage being believed to be the maximal coping strategy.According to Dean (1987) Adlerian therapy can be used to facilitate thisprocess. & Thale, T.J. For example, Peal (1981) used thebehavioral technique of desensitization (the use of progressive relaxationtechniques geared to allow patients to think about death and dying whilemaintaining a relaxed and calm state) to reduce death anxiety. (1985). Rudloff, L. . In this regard, hospice workers are given intensive training in theareas of: (1) owning feelings; (2) accepting feelings; (3) sharingfeelings; (4) actively listening to both content and relational messages;(5) responding to content and relational messages; and (6) conflictresolution. Survival rates for the groupwere then compared to a comparison-control group of 259 patients who hadreceived less than two years of psychoanalytic therapy for their deathanxiety. . Among the treatment modalities covered were: psychoanalytictherapy, art therapy, group therapy, family therapy, behavioral therapy,and logotherapy. 353-362. General Hospital Psychiatry., 1 (3), pp.163-168. (1988). (4) Depression - The fourth stage, usually associated with aworsening of the condition, is depression. & Lewin, T. Meaning and purpose in life: Assessmenttechniques of logotherapy. (1987). Debray, R. Paper presented at the Annual meeting ofthe Western Speech Communication Association. Another treatment mode that focuses on assisting the patient withattaining meaning has been characterized by Huttzel (1986) as logotherapy.Logotherapy provides an intense focus on patients' feelings that life hasboth meaning and purpose. One of the factors that the authors state to becrucial to effective coping is what they term "healthy denial." Healthydenial is characterized by the persistence of optimism despiteacknowledgement of a terminal prognosis. . Szwabo, P. (p.436)This new openness to death and dying has served as a foundation to bothincreased research in the area as well as to the development of a number oftreatment strategies for dealing with death and dying in terminally illpopulations. American Journal of Art Therapy, 24(2), pp. Consequently both the patient and those inhis/her support group develop defenses that are actually maladaptive withrespect to reducing stress. Kubler-Ross, E. These patients all received psychoanalytictreatment for a period longer than two years. Oftenhe/she will blame others, God, anyone and everyone for the illness. established a physician relationship characterized as trusting, meaningful and healing and indicated an intense desire to stay alive. . Journal of Death and Dying, 17(4), pp. Psychiatrics Clinics ofNorth America, 1 (l), pp. Greaves, C.C. [and] . 37-5 . According to Greaves, denial and avoidancecan cause great anxiety and anguish in both patients and their familymembers. Acceptance of death was facilitated by focusing on conflictresolution concerning those arguments caused by denial and avoidance.Also, it was observed that patients had a strong desire to be positivelyremembered by the members of their families. (1983). Using these communication skills, the hospice worker helps the dyingpatient toward more satisfying relational exchanges with family andfriends, thereby elevating the patient's ability to face death. 49-62. It was pointed out that there is an interesting paradoxin the treatment literature in that while denial is an unproductiveresponse to terminal prognosis and therefore needs to be treated, thephenomenon of "healthy denial" can actually have survival value. The emphasis in the reviewed material is upon how thesevarious theories and strategies assist patient coping. 91-99. Thismode of therapy has been examined by Greaves (1983). books appear with titles such as . (5) Acceptance - In this final stage, the person reaches a stage ofweary resignation. . In this regard,Grossarth and Eysenck (199 ) studied 362 individuals receivingpsychoanalysis for death anxiety related to terminal diagnoses of cancerand coronary heart disease. (1987). Grossarth, M.R. Specifically, Round (1987) studied nine cancer patients diagnosed asterminal but who survived despite the odds. The need forthe therapist's increased awareness with respect to both patient andrelevant others' emotions and cognitions is said to be due to the fact thatthe patient's stress is compounded because those around him/her are poorlyprepared to deal with death. Thisprocess yielded interesting results. There can be refusal to talk about the illness and itsprognosis. 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