Only give the counseling that hospice patients and families want

This week’s pointer in a nutshell: don’t give hospice patients and family members counseling that they don’t want.

If you endeavor NEVER to give counseling that PFs don’t want, and ONLY give counseling that PFs indicate that they want, you will increase your chances of maintaining good rapport with them for the duration of service.

This sounds obvious, but this distinction does not always come naturally. The most extreme example I know of is when a colleague believed a patient was depressed and pressured the patient to acknowledge that she felt depressed and to talk about her feelings. The patient responded by insisting that the nurse go away and never return.

It’s valuable to remember that counseling is an optional extra in hospice. People don’t sign up for hospice service for the counseling—it just happens to be something that can come with hospice if the social worker has a counseling orientation. In private therapy practice settings, counselors can go farther with challenging clients’ patterns and beliefs because clients are more invested in the counseling because a desire to change or heal drove them to seek help. And when clients seek counseling, quite often they don’t only want relief: they want you to help them learn about themselves so that they can free themselves from longstanding patterns and even evolve.

Very rarely in hospice settings is counseling seen as an opportunity to developing into a higher-functioning or more self-aware individual. Often the goal is simply relief, usually from painful grieving or stress related to caregiving. Social workers should visit PFs with only the goals of relationship building and ongoing assessing for needs. When a need is perceived, and the PF agrees that there’s such a need, then the social worker can provide an intervention, whether it involves counseling, referral or assistance with planning.

I inform PFs at the start of care that counseling is one of the services I provide, and quite often they will request it either for themselves or for a family member. And even in these cases, I provide counseling on the subjects that they wish to address. An approaching death makes life stressful enough for everyone, and being told that they should live life differently than how they are can make life more stressful.

Once a hospice patient was very clear and specific that she wanted me to help her move past some patterns that had plagued her for 50 years. She had a tendency to keep people at a distance as a reaction to a set of childhood traumas, and she wanted me to help her process the trauma and change her patterns. This was after I made routine visits for six months, consistently listening and stopping myself from becoming directive. I believe that had I given her any unwanted counseling during those first months, she never would have decided to finally open up to me.

Enjoy!

-Michael Giles, LMSW

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