The most humbling and profound experiences in my life have been working with and being present for the terminally ill. An uncomfortable ability to “just be” in the presence of someone who is concluding their chapter of physical existence, can’t readily be compared to any other experience. Gaining trust of someone who is preparing to exit this world, with whatever their religious or spiritual belief has to offer as guidance, is the most delicate process that any of us can engage in.

For most people, being diagnosed with a terminal illness brings forth the process of deep grieving. Confusion, panic, fear, anger, depression… hopefully acceptance… Physical, emotional, mental, and spiritual pain- are all involved in that person’s daily existence. The modern culture of what “the process of dying should be like” can create pressure not only for the ill, but for the whole family. Scheduling and dealing with doctors’ and treatment appointments, having to maintain employment, financial and familial obligations… pressure builds daily. All these issues, in addition to harsh treatment reality, inclusive of chemotherapeutic and radiological toxins, take an enormous toll on the body, mind, and spirit. Altered-state experiences, although rarely admitted to, occur in the terminal phases of life. A terminally ill person may be reluctant to talk about these incidents out of fear of being labeled “crazy.” The medical community, and many mental health professionals, view these altered-state experiences as hallucinatory and dismiss them as material undeserving of contemplation or indicative of the disease process.

However, the timeframe prior to physical death is one of utmost receptivity to altered-state realities. Working with the terminally ill within the context of normalizing such experiences is a delicate dialectical matter, requiring fearless openness and sensitivity to uncomfortable and questionable types of information on the part of everyone involved.

To help a terminally ill person with the resolution of the end-of-life personal and interpersonal issues, psychotherapeutic interventions must integrate approaches that will guide a person to bring to light the “unfinished business” and make it more likely to peacefully surrender emotional, mental, and spiritual attachments.