Death and Dying Psychotherapy: A Time for Contemplation
By: Dr. Denise Renye
Death and dying are inevitable, but also can be deeply profound and peaceful. I’ve seen firsthand in my work with aging and dying populations. I’ve witnessed people release their grip on the material world and it’s a miracle, like birth.
Talking with someone near the end of their embodied life has the potential to be fruitful in a myriad of ways. Death and dying psychotherapy can provide an opportunity for the person to process their death in a way that’s no longer something abstract or distant. It’s concrete and near. Doing so allows them the chance to deepen their sense of self, purpose, and presence. It’s a fertile time for going deeper into the internal landscape. As death approaches, a person can know themselves more deeply, which is a gift.
Because so much gets stored in the body (like trauma), engaging in death and dying psychotherapy can free the feelings and emotions that have lived for so long in the soma, or body. Because the mental and the physical are intertwined, there is a multi-layered freedom that one can experience. The releasing of the emotions and feelings from the soma create a release in the psyche and vice versa, depending on the somatic psychotherapy techniques used. This psychic liberation can have a ripple effect and potentially free the folx connected to the dying person as well.
What often happens is as a person approaches death, they start to review their life. This can happen informally or formally. If formally, a trained professional will ask questions like, “Are there particular things that you feel still need to be said to your loved ones?” or “Are there things that you would want to take the time to say once again?”
As Dr. Elisabeth Kübler-Ross wrote in her seminal book On Death and Dying, “We are always amazed how one session can relieve a patient of a tremendous burden […] it often requires nothing more but an open question.”
Those open questions are thoughtful ones that encourage a dying person to dig into their life. They return to past memories and mine for meaning and emotional resolution. They seek to make sense of the past in the light of present day. For instance, the divorce that was so crushing made room for someone new to step in. Or the major car accident they experienced helped them clear out monetary debt. Whatever it is, re-examining the past in an intentional way can bring a sense of closure or completion.
That’s not to say difficult emotions won’t come up while undergoing this process because they often do. In fact, it’s not uncommon for a dying person to feel angry – angry about their illness, angry about the unfairness of the world, angry that this is happening now, etc. It’s important to allow that anger and express it safely, like in a journal or by screaming into a pillow. Having outlets that allow for the body and the mind to work together in this expression is key. Psychotherapy is a place to have an embodied learning through a relational experience to express one’s feelings. Doing so welcomes in peace.
After expressing all the emotions that arise, be it anger, sorrow, disappointment, etc., the dying person may start to have acceptance that death is happening. It’s not something theoretical in the far, distant future, but instead here, now. The person isn’t “giving up,” but rather giving in or surrendering, accepting the inevitable, the natural order of life. Life is not possible without death just like light is not possible without shadow.
Speaking of shadow, during death and dying psychotherapy, a person is given the opportunity to examine their thoughts, beliefs, and actions. They may have a new perspective; for instance, a new sense of empowerment or ownership regarding their life. They come to understand how they showed up (or didn’t) in their lives. They start to come to terms with what they did and did not do.
This process makes space for forgiveness. The person is able to not only claim ownership for their actions, but also be in a position to choose to let go of hurt and resentment. (Or not. That also happens. Not letting go is certainly a fine option if that’s right for the person.) They may start to forgive themselves but also the end of life is when folx will seek out forgiveness from others because they want to leave this Earth with a clear conscience. They also may choose this time to forgive others for their wrongdoings.
After going through this process, a dying person often feels grateful for their life. Grateful for the people in it, the experiences they had, and the life they led in general. The feeling may also be expressed to friends and family.
This sort of life review can help a person increase their spiritual well-being and diminish psychological distress. It’s a poignant time that I am privileged to be a part of. Because of the nature of the therapy, I have space for just one death and dying psychotherapy patient at a time. It’s an honor to shepherd someone from this world into wherever they go next.
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References
Jenko, Mimi; Gonzalez, Leah; Seymour, Mary Jane. “Life Review With the Terminally Ill.” Journal Of Hospice And Palliative Nursing. May/June 2007, vol. 9: 3, pp. 159-167. https://www.yourstory.utah.edu/images/pdfs-doc/pdfs-forms/LifeReviewwithTerminally_Ill.pdf
Kübler-Ross, Dr. Elisabeth. On Death and Dying. London: Routledge, 1969.
Morrow, Angela. “Reviewing and Reconciling Your Life Before You Die.” Verywell Health. February 6, 2020. https://www.verywellhealth.com/the-five-stages-of-life-review-1132503