Research

The impact of narrative therapy in End of life care

Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C


Every day, there are new interventions to treat the myriad of cancers that impact the people around us. Targeted chemotherapy and radiation, robotic surgery, and newly developed oral medications are just a few of these interventions. Innovation is a constant in the clinical world of treating cancer and doesn’t end with just treating the disease.

Many people, at or nearing the end of life, or their loved one’s life, can and do experience a wide variety of emotions ranging from fear and anger to hope and peace.

New ways to help these individuals reshape their negative experiences include narrative therapy techniques. Narration refers to the ways in which people share their stories based on their experience. Their experience depends on their social construct and ideas of what is going on around them at the time.

Narrative therapy uses words and language with intention to open minds to new interpretations of experiences from the perspective of the storyteller. For many of us, this story teller would be our patients or their families (Etchison & Kleist, 2000).

Narrative Therapy Appropriate for People With Terminal Illness

Narrative therapy is very much  patient-centered and goal-directed. Given that this form of therapy is based on an individual’s experience of his or her condition, it is beneficial to use with those dealing with terminal illness or the families of these individuals.

The goals of this therapy are to help individuals improve their sense of self and their relationship with themselves. It helps to separate problematic experiences individuals have away from their identity. It helps them to see themselves outside of the problems they may be facing.

End of life issues that often come up include internal conflicts with spirituality and religion. Patients or families sometimes decide to revisit their faith if they have been distant from it. A common time is during periods of turmoil and end of life.

Narrative therapy interventions, in this case, can aid patients and their families in their spiritual development. By implementing new ways of constructing the diagnoses, patients and their families – individually or together – can create new meaning of the terminal illness and the end of life experience.

This type of intervention after a traumatic experience, which includes a terminal illness diagnosis, can help bring new meaning to people’s lives when they may have given up having a sense of peace. It also helps bring families together by creating a shared story at the end of their loved one’s life that they can recall and helps to curtail any maladaptive coping mechanisms post-death during grief (De La Lama & De La Lama, 2011).

Quality of Life Impacted by Depression, Anxiety, Pain

Depression and anxiety also rob individuals of quality of life at the end of life with a cancer diagnoses. Lack of hope, fear for the future without them, and worries for their loved ones often consume cancer patients at the end of life.

Narrative therapy helps these individuals change their attitude towards the end of life by first changing the language of their own experience while at the end of life. By changing how cancer patients view themselves in their disease and how they identify outside their disease, the on-going anxiety and depression lessens over time.

Narration helps them reclaim their life and what it means to them at that moment in time regardless of their advanced cancer stage. Their quality of life and, esteem, and overall mental health improves as a result (Sajandian, 2016).

End of life experiences or terminal and chronic illness also come with confounding amounts of physical pain depending on the types of diseases. Some days may be better than other days. However, pain at the end of life puts a huge weight on patients and diminishes feelings of comfort and rest.

Physical pain can sometimes be exacerbated in patients by what is going on around them. In the case with end of life patients, they are especially vulnerable to decreased feelings of quality of life because of  pain.

Narrative therapy offers a unique way to approach pain from the patients’ point of view. Patients can be empowered by hearing two different perspectives of their own story with facilitation of double listening by a therapist.

While the patient shares his story, to minimize physical symptoms of pain as much as possible, the therapist can guide and help move patients by pointing out themes in their stories to promote self-determination and patient-initiated goals.

Patients can reclaim their body and experiences of pain though also identify issues in their life larger and more consuming than pain. By addressing some of these other issues, the experiences of pain patients can lessen and help patients feel more at ease and improve their quality of life (Philips, 2017).

Narrative therapy has profound outcomes that help improve quality of life, lessen adverse mental health issues, and bring patients closer to themselves, families and their faith. Narrative approaches have helped patients have better regulated emotions and helped their overall psychosocial well-being.

Patients and their families can create new meaning and feel more empowered to own the circumstances of their environment and diseases, leaving them feeling more peaceful and hopeful with an enriched new sense of self at the most vulnerable periods in their lives.

References

De La Lama, L. B., & De La Lama, L. (2011). Counseling a terminally ill agnostic seeking to reclaim spirituality: A narrative approach to dying well. Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_103.pdf

Etchison, Mary & Kleist, David. (2000). Review of Narrative Therapy: Research and Utility. The Family Journal. 8. 61-66. 10.1177/1066480700081009.

Phillips, La urel. (2017). A narrative therapy approach to dealing with chronic pain. International Journal of Narrative Therapy & Community Work. 1. 21-30.

Sajandian, A. (2016). Narrative Therapy on Breast Cancer Patients’ Anxiety and Depression. Iranian Quarterly Journal of Breast Disease. 9(2).

Everyone knows that the task of being a Hospice chaplain is harder than any field in professional chaplaincy. Our goal is to train chaplains and prepare them for competent service within the Hospice industry.

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