Have you prepared the most important questions from Block 4 Unit 4 for IGNOU MAPC MPCE013 Exam? Don't miss this chance to score good marks - start NOW!

Block 4

Unit 4 Psychotherapy in Terminal Illnesses (AIDS, Cancer)

1) Explain psychotherapy with dying persons.

Psychotherapy with dying persons shares many features with other types of psychotherapy, but it also has unique aspects due to the patient's life-threatening condition and limited time. It is a supportive relationship where the individual can explore personal concerns. The label "dying patient" creates profound changes in the emotional, social, and spiritual climate of therapy. This unique situation requires some adjustments to typical psychotherapeutic attitudes and strategies. The focus of therapy is on communication, education, expressing fears, and discussing needs.

2) Differentiate between typical therapy and therapy with dying persons.

There are key differences between typical therapy and therapy with dying individuals:

• Time-limited and Time-focused: Therapy with dying patients is more time-limited, with a sense of urgency due to the patient's limited lifespan. Time is a more pressing issue than in typical therapy.
• Modest Goals: The goals of therapy with dying patients are often more modest, recognizing the limits of possible change due to time, disability, and the patient's condition.
• Coordination with Other Professionals: Treatment of dying patients often requires careful coordination with medical, nursing, and religious professionals. The patient's physical condition, medical treatments, and institutional settings affect the therapy process.

3) What are the goals of therapy with dying persons?

The primary goals of therapy with dying persons include:

• Open communication: To allow open communication about their conditions and provide honest, factual information.
• Emotional expression: To facilitate the expression of emotions and help patients manage them.
• Supportive relationship: To provide a supportive relationship as patients confront death.
• Intervention: To intervene between patients and significant people like family and medical staff.

4) Describe psychodynamic approach with dying persons.

The psychodynamic approach focuses on the emotional conflicts and defence mechanisms of the dying individual. It aims to resolve the psychic crisis by addressing issues of conflict and defense that arise in the dying person. It recognises dying as the ultimate crisis of ego development, associated with intense intra-psychic turmoil. The goal is to help the person recognise, confront, and replace defenses that hinder an emotionally healthy attitude toward death. While insight is a goal, the therapy is more focused on short-term changes, rather than long-term personality changes.

5) What is humanistic approach? How is used in dying persons?

The humanistic approach integrates a philosophy of human nature where death plays an essential role. It is influenced by existentialism, where confronting death helps clarify values and purpose in life. The goal is to help the dying patient live as full a life as possible, encouraging self-expression and growth. It emphasises building a strong, supportive, and empathic relationship, allowing the client to set the pace of treatment and enabling active participation in the process of dying. The focus is on living rather than dying.

6) Describe the behavioural approach with dying persons.

The behavioural approach focuses on teaching coping skills to deal with the death crisis. It acknowledges that impending death causes stress and extreme emotional reactions like anxiety and depression. The therapy aims to manage these symptoms through techniques such as relaxation training, desensitisation, biofeedback, and self-hypnosis. Stress inoculation training is used to help manage pain, teaching the patient cognitive and behavioural skills for preparing for and managing pain. The goal is to reduce discomfort and provide a sense of control over life.

7) How do we help persons dying with family approach?

The family approach sees the entire family as the recipient of therapy, not just the dying person. It helps families deal with the crisis of a family member's impending death, recognising that each member is affected. The approach facilitates open and productive communication, especially in families with past conflicts. It encourages the expression of emotions like anger, guilt, fear, and depression, and helps family members accept the situation and work together to improve the quality of life for the dying person.

8) What are the five stages of dying?

The five stages of dying, according to Kubler-Ross, are:

• Denial: Disbelief in the seriousness of the illness.
• Anger: Expressing anger, resentment, and hostility at the injustice of dying.
• Bargaining: Attempting to "make deals" to prolong life.
• Depression: Experiencing feelings of loss, hopelessness, shame, and guilt.
• Acceptance: Coming to terms with death with a sense of readiness.

9) What are the four stages of dying according to Weisman?

Weisman proposes four flexible stages of dying:

• Existential Plight: Experiencing emotional shock at the awareness of one's mortality.
• Mitigation and Accommodation: Attempting to resume a normal life after learning of the terminal nature of the illness.
• Decline and Deterioration: When illness and its treatment begin to take control of one's life.
• Pre-Terminality and Terminality: The very end of life when treatment is no longer helpful.

10) Describe the three emotional reactions to dying.

The three core emotional reactions to dying are:

• Depression: Feelings of hopelessness and powerlessness are common among dying people, often combined with a sense of alienation and withdrawal.
• Anxiety: A wide range of anxieties, including fear, dread, and panic are commonly experienced. The anxieties may be related to the physical aspects of dying, the unknown, or spiritual concerns.
• Anger: The dying person can feel frustrated, resentful, and hostile, sometimes directing it towards others or turning it inward.

11) Name the six hurdles which are associated with psychosocial adjustment to cancer?

The six hurdles associated with psychosocial adjustment to cancer are:

• Managing uncertainty about the future.
• Searching for meaning.
• Dealing with a loss of control.
• Having a need for openness.
• Needs for emotional support.
• Needs for medical support.

12) What are three potential negative results of countertransference in therapy with a dying person?

Three potential negative results of countertransference in therapy with a dying person are:

• The therapist may unwittingly support the patient's denial of death by avoiding the issue.
• The therapist may regress to a helpless position.
• The therapist may engage in anxious avoidance of the patient and their concerns.

13) Discuss in detail how the major therapeutic approaches have been modified to the unique needs of dying persons?

The main therapeutic approaches (psychodynamic, humanistic, behavioural, and family) are modified to fit the unique needs of dying persons:

• Psychodynamic: Focuses on resolving the psychic crisis associated with dying by addressing emotional conflicts and defence mechanisms, with more emphasis on short term changes.
• Humanistic: Aims to help the patient live as full a life as possible, encouraging self-expression and growth while accepting death.
• Behavioural: Emphasises teaching specific coping skills and strategies for pain and stress management, with techniques like relaxation, desensitisation, and self-hypnosis.
• Family: Treats the entire family unit, not just the dying individual, to facilitate communication and cope with the situation.

14) Discuss the psychology of the dying person?

The psychology of the dying person is complex, with common emotional reactions like depression, anxiety, and anger. According to Kubler-Ross, a dying person may go through five stages, while Weisman proposes four flexible stages. Dying persons may have existential concerns, question the meaning of their life, and grapple with the prospect of death. Therapists often take an eclectic approach, choosing ideas from various theories to address the patient’s needs.

15) Describe the core emotional reactions of a dying person?

The core emotional reactions of a dying person are:

• Depression: Characterised by feelings of hopelessness, powerlessness, and withdrawal.
• Anxiety: Manifests as fear, dread, and panic related to various concerns, including the unknown.
• Anger: Can be directed toward others or turned inward, often a diffuse, untargeted feeling related to the unfairness of death.

16) Write about the psychosocial morbidity related to cancer? Discuss the therapy approaches with cancer patients?

Psychosocial morbidity related to cancer involves:

• Managing uncertainty about the future.
• Searching for meaning.
• Dealing with loss of control.
• The need for openness.
• The need for emotional support.
• The need for medical support.
• The distress that follows diagnosis.
• The physical and psychological side-effects of treatment.
• Increased vulnerability to future psychosocial problems.

Therapeutic approaches for cancer patients:

• Problem-focused psychotherapies: Psychoeducational and cognitive behavioural interventions to reduce distress by fostering control and regulating affective responses.
• Supportive expressive therapies: Group therapies to enable the expression of all emotions and 'detoxify death,' and are better suited for advanced cancer patients.
• Integrative approaches: combine cognitive, supportive, and existential elements in group therapy, emphasizing the management of uncertainty and mortality.

17) Write about the issues and therapy with persons with AIDS?

People with AIDS face issues including:

• Loss of control over their bodies and lives.
• The impact of physical and mental deterioration on themselves and their loved ones.
• The need for planning for hospitalizations and illnesses.
• The importance of the clinician raising difficult and painful issues long before any apparent need.

Therapy for persons with AIDS:

• Interpersonal therapy: Is useful for HIV patients, relating mood changes to environmental events and social roles, helping them address the interpersonal problem areas of grief, role dispute, role transition or interpersonal deficits.
• Exploratory psychodynamic treatments and psychoanalysis: Can help patients grapple with life-threatening issues.