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AIDS: The Therapist's Journey

Discussing Death

I have grown increasingly comfortable talking with terminally ill people about impending death, and about the corresponding losses and feelings they experience. It is remarkable to ask someone very near to dying why he still clings to life. Usually the answers I have elicited were extraordinary in their clarity and understanding of an important issue that needed finishing before each person could finally let go.

In the final week of my best friend's Luis's life he was at home and every breath was a struggle. During that time, his lover Dennis repeatedly told Luis it was all right to die and that he loved him very much and thanked him for the wonderful years they had shared. Dennis wisely urged me and others to also tell Luis that it was all right for him to let go. This was the first time I'd ever said this kind of thing to anyone and it was excruciatingly painful. Yet, it was only after we had all given Luis permission to die that his breathing became less labored and he died peacefully the following morning.

I thought of this as I sat at the bedside of my patient Cal and listened to him say how worried he was about his lover Stan. Cal did most of the caretaking in the relationship prior to becoming ill and, even though their roles were now reversed, he worried that Stan would have trouble taking care of himself.

Cal was so ill, that Stan could not understand why he was still alive. I urged him to ask Cal this question and Cal told Stan he was hanging on because he was worried that Stan wouldn't be able to take care of himself. With a laugh Stan reminded him that he had taken good care of himself for the 30 years before they met, and had subsequently learned even better from all of the ways that Cal had nurtured him. "Every time I do one of the things for myself that you used to do for me, I'll think about you and feel you inside of me," he told Cal. "I'll miss you like hell, yet your body is no longer useful to you, and hasn't been for some time. The most loving thing you can do for me and yourself is to stop fighting and move on." Cal died that night, in his bed, at home, surrounded by the people who loved him most.

The therapist's experience of death and dying will shape his work with patients at risk for the same illness as he. Does the therapist believe that death is the end of it all, or does he envision some kind of life following death? If the therapist has not examined his own beliefs and feelings surrounding death, and has not faced his own fears, he will not be able to initiate discussions about this with patients. A therapist's inability to discuss these issues creates a sense of secrecy or shame in the patient who may not have anyone else to talk to about this.

Living with HIV has forced me to face and grapple with many of life's most profound issues. For instance, I have learned how to question clients about some of the most personal areas of their lives. This includes asking patients about their personal faith experiences and how they integrated spirituality into their lives. It is surprising how many people are hungry to talk about this subject once asked. Many people living with AIDS find meaning and comfort in New Age spirituality. Not believing in either New Age teachings nor in an afterlife, I have had to contain my own skepticism and disbelief in order to encourage patients to discuss how meaningful and comforting these beliefs are. Some people do not find that spirituality or traditional religion meet their needs.

While I acknowledge how difficult it can be for any of us, patient or therapist, to face the reality of our own death, being forced to confront this on a daily basis, both in my work and personal life, has helped me demystify death and dying and move these issues from the abstract into the concrete realm.

Disclosing the Therapist's HIV Status?
A Classic Case of Countertransference
Professional Challenges of Psychotherapy with People Living with HIV/AIDS
Avoiding Burnout
Other Articles by Michael Shernoff

Published in A Perilous Calling: The Hazards of Psychotherapy Practice, M. Sussman, Editor, 1994: John Wiley & Sons by Michael Shernoff, MSW
© 1996 Michael Shernoff

Permission is granted to copy or reproduce this article either in full or in part, without prior written authorization of the author on the sole condition that the author is credited and notified of reproduction.

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This article was provided by John Wiley & Sons. It is a part of the publication A Perilous Calling: The Hazards of Psychotherapy Practice.