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Melody Griffith, MSW, LMSW, OSW-C
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Pain, Palliative Care and End-of-Life SIG: The Impact of Narrative Therapy in Shaping End-of-Life Experiences
Everyday there are new interventions to treat the myriad cancers that impact 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 patients with cancer and it does not end with just treating the disease. Many at or nearing the end of their life or their loved one’s life can 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.
What is Narrative Therapy?
Narrative therapy refers to the ways people share their stories based on their experience, which depends on their social construct and ideas of what is going on around them. It uses words and language with the intention to open minds to new interpretations of experiences from the perspective of the story teller. For many of us, this story teller would be our patients or their families (Etchison & Kleist, 2000).
Narrative therapy is very much patient-centered and goal-directed. Given that this form of therapy is based on an individual’s experience of their condition, it is beneficial to use with those dealing with terminal illness and/or their families. The goals of this form of therapy are to help individuals improve their sense of self and their relationship with themselves. It helps to separate problematic experiences individuals have from their identity and see themselves outside of the problems they may be facing.
Internal conflicts with spirituality and religion often come up. Patients and/or families sometimes decide to revisit their faith during times of turmoil, and end of life is a common time. Narrative therapy interventions 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 such as a terminal illness diagnosis, can help bring new meaning to peoples’ 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).
Depression and anxiety. These two emotions can rob individuals of quality of life at the end of their lives. Lack of hope, fear for the future without them and worries for their loved ones often consume patients with cancer at this time. Narrative therapy helps these individuals change their attitude toward the end of life by first changing the language of their own experience. By changing how they view themselves in their disease and how they identify outside their disease, the ongoing depression and depression lessen 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, self-esteem and overall mental health improve (Sajandian, 2016).
Physical pain. End-of-life experiences or terminal and chronic illness also come with confounding amounts of physical pain, depending on the types of disease. Some days may be better than others; pain at the end of life, however, puts a huge weight on patients and diminishes feelings of comfort and rest. For patients at the end of their lives, physical pain can be exacerbated by what is going on around them; these patients are especially vulnerable to decreased feelings of quality of life. Narrative therapy offers a unique way to approach pain from the patient’s 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 patients share their story, to minimize physical symptoms of pain as much as possible, the therapist can guide and help by pointing out themes in their stories to promote self-determination and patient-initiated goals. Patients can reclaim their body and experiences of pain while also identifying issues in their life larger and more consuming than pain. By addressing some of these other issues, the experience of pain 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. It has helped patients regulate their emotions and improve their overall psychosocial well-being. Narrative approaches have helped patients and their families create new meaning and feel more empowered to own the circumstances of their environment and disease, leaving them feeling more peaceful and hopeful with an enriched new sense of self at the most vulnerable period in their lives.
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, M., & Kleist, D. (2000). Review of narrative therapy: Research and utility. The Family Journal, 8, 61-66. doi: 10.1177/1066480700081009.
Phillips, L. (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).
About the Author
Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-CBayada Home Health Care
Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-CBayada Home Health Care
ArticlesPain, Palliative Care and End-of-Life SIG: The Impact of Narrative Therapy in Shaping End-of-Life Experiences