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Sep 27, 2013

Death, dying, and working with grief with older adults and their families

As counselors, we encounter challenges not only on a daily basis, but often from moment to moment as we work with our clients on issues that disrupt the client’s entire life – sometimes even shake their sense of self. While each symptom or issue is weighed differently within the lives of clients, the issue of death and dying seems to weigh heavily universally with those dealing with death or dying. Even in our personal lives, dealing with death of loved ones or knowing how to respond to someone who lost a loved one is difficult to navigate. However, as a professional counselor, death and dying is a reality that counselors across all domains and working with every population will encounter. In working with older adults, issues of death and dying arise quite often and present themselves in numerous ways.

Firstly, there is the loss of loved ones, which increases as individuals age. Lifelong friends, siblings, cousins, and significant others pass away. Often times, I have clients who have multiple loved ones die within one year. The impact of losing just one loved one is tremendously difficult, while the weight of multiple losses can feel life ending. As a counselor, we have all taken courses, workshops, and professional development seminars on grief counseling. Grief counseling has a long history of research and development throughout various domains of psychology and counseling. My own sense of traditional grief counseling in that of helping individuals understand the grief process, often presented in stages in which the final “goal” is that of closure and learning to live without the lost loved one. As I have continued my own professional development, I have learned more about a more modern approach to grief counseling in the realm of re-membering conversations. Re-membering conversations have grown out of aspects of narrative therapy and social constructivism theories in dealing with death and loss from an entirely different angle than traditional grief counseling. Re-membering conversations appealed to me as a counselor because I struggled with the idea that when a loved one dies, individuals must learn to find a way to end their relationships with that person and reach this finite closure. However, with re-membering conversations, the focus is not on closure rather than gaining an understanding of the client’s relationship with that loved one while they were living and helping them to now discover the ways in which their lost loved one can still fit in their lives. In essence, a re-developing of the client’s relationship with that lost loved one now that they are no longer physically present. In a workshop I attended, the speaker said something regarding loss that really stayed with me. To paraphrase, they expressed the idea that while a loved one’s physical body may be gone, our relationship with them continues to live on, which I believe is the source of grief for many individuals. So a few questions arise when using re-membering conversations – What was my relationship with this loved one, and how can I find a way to incorporate this lost loved one in my life even after their death? There seems to be no simple answer for these questions, but through re-membering conversations with the client, counselors can help to explore the living relationship between the client and their deceased loved one.

A second presentation of the issue of death and dying I have encountered in my work with older adults involves the death of the client. Working with clients who are in the process of dying can be unbelievably heavy on all involved. In my own experiences, I have worked with a wide variety of reactions to the idea of one’s own death – from individuals who want to take advantage of every moment to those who appear to shut down and push everyone away. With such a range of reactions, it is difficult to find a common approach to working with dying individuals. There is, however, one theme I have come to personally view as an important aspect when interacting with the dying individual. When I first had clients who had been given a terminal diagnosis, I observed family and friends engaging with the client by expressing they would “get better soon” and “the doctors don’t always know everything.” In my own personal experiences with dying loved ones, I too have said similar things. Whether it be for the sake of the dying individual or for our own peace of mind, taking on an optimistic attitude seems to provide some sense of comfort – if even for that moment. However in my one on one time with the dying clients, I found that they expressed a desire for realness when interacting with people. I couldn’t believe it at first, as a young counselor, hearing multiple clients (all with terminal illnesses) saying to me that they wished people would just acknowledge that they are going to die. I began to get this sense that the “tip-toeing” around the client’s death added another burden to their own emotional journey. Furthermore, I believe family counseling sessions can be very beneficial when a client is near the end of life. Having the family or loved ones present provides the counselor an opportunity to ask the client up front how they want to be remembered or what is it they wish for their loved ones when they are gone. This time can be incredibly healing for the family and friends in my experiences because it provides a basis for transition into the re-membering conversations as they grieve the death of their loved one. There is a great deal of literature on re-membering conversations during the grief process that I have found interesting and useful. If you would like any resources feel free to email me, and as always please share your own wisdom, ideas, and experiences on this topic! Thanks for reading –
Lee Kehoe is a counselor working with the older adult population. It is her passion to serve the older adult population through counseling, research, and advocacy efforts, with the hope of raising awareness to the growing needs of older adults and their families.

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