Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality

Abstract

Medical and psychological discourse on end-of-life care has steadily shifted over the years from focusing primarily on symptom control and pain management to incorporating more person-centred approaches to patient care. Such approaches underscore the significance of spirituality and meaning making as important resources for coping with emotional and existential suffering as one nears death. Though existential themes are omnipresent in end-of-life care, little has been written about their foundations or import for palliative care practitioners and patients in need. In this article, we explore the existential foundations of meaning and spirituality in light of terminal illness and palliative care. We discuss existential themes in terms of patients' awareness of death and search for meaning and practitioners' promotion of personal agency and responsibility as patients face life-and-death issues. Viktor Frankl's existential logotherapy is discussed in light of emerging psychotherapeutic interventions. Meaning-centred group therapy is one such novel modality that has successfully integrated themes of meaning and spirituality into end-of-life care. We further explore spiritual and existential themes through this meaning-oriented approach that encourages dying patients to find meaning and purpose in living until their death. (Reprinted with permission from Canadian Journal of Psychiatry 2004; 49:366 -372; full text of article available online at http://ww1.cpa-apc.org:

Psychological resources in spinal cord injury: a systematic literature review

“…[120][121][122][123][124][125][126][127][128][129] Spirituality can be an important component in psychotherapy. [130][131][132] Beneficial effects of meaning making interventions on SE, optimism and self-esteem are reported. 133 The review of the literature suggests that people with SCI who are hopeful and optimistic are also more satisfied and less depressed.…”

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“…Existential matters are prominent in palliative care. The paradoxical nature of human existence with themes of life and death, relation and isolation, hope and despair, meaning and meaninglessness infiltrate end-of-life work (Breitbart, Gibson, Poppito, & Berg, 2004).…”

“…The existential approach emphasizes how humans find meaning in life's paradoxes coupled with our unique ability to take responsibility for our own existence (Breitbart et al, 2004). Existential thinking is well-matched to end-of-life care because it asks deep questions about the nature of humans and the nature of despair, grief, loneliness, anxiety, isolation, and anomie (i.e., personal unrest or alienation; May & Yalom, 1995).…”

“…Existential thinking is well-matched to end-of-life care because it asks deep questions about the nature of humans and the nature of despair, grief, loneliness, anxiety, isolation, and anomie (i.e., personal unrest or alienation; May & Yalom, 1995). As patients explore their life experiences, especially their negative emotions of anxiety and guilt, emotional and spiritual well-being may be achieved as one's life is integrated into a meaningful whole (Breitbart et al, 2004). The most frequently asked questions of hospital chaplains by palliative care patients were generally existential in nature and were about the meaning of life, death and dying, and relationships (Strang & Strang, 2002).…”

Baxter v. Montana: What the Montana Supreme Court said about dying, dignity, and palliative options of last resort

“…Indeed, drawing upon the meaning-centered logotherapy of Victor Frankl, Breitbart has developed meaning-centered interventions for patients with terminal illness (Breitbart et al, 2004). Similarly, Harvey Chochinov has developed what he describes as "dignity-conserving care" for the dying patient (Chochinov, 2002), and Davis Kissane has argued for some time that terminally ill patients who express a desire for a hastened death may not necessarily meet the criteria for clinical depression but may nevertheless be manifesting symptoms of what he labels "demoralization syndrome" (Kissane & Clarke, 2002).…”