Psychology and chocolate: top tips for coping with terminal illness

Jenny Strachan, Clinical Psychologist at the Marie Curie Hospice, Edinburgh explains how psychology can help people at the end of life.

Photo: iStock

Tell us a bit about your role

I offer psychological support to people who are in-patients in the hospice and people who are outpatients in the community. But sadly, because we’re dealing with end of life care, you can never be sure someone is going to be here from one week to the next. You have to ask yourself: what can I do for this person if it’s the only chance I’m going to get to talk to them?

How do you help someone in such a short space of time?

Sometimes what you’re doing is listening. Because I have ‘psychologist’ written on my name tag, people sometimes feel comfortable telling me things that they wouldn’t feel comfortable telling family, or even the nurse or a doctor. It gives them permission to open up.

So you help people to explore their reaction to what’s happening?

Very often I’m trying to help a person understand what’s happening to them, but in the context of what’s happened in their life so far.  You don’t stop being who you are just because you’re coming to the end of your life.

For example, if your approach to problems has always been to try and take control, then it makes sense that this period of your life – where your sense of control is diminished because of your illness – is going to be hard.

I’ll try to help them understand it’s not their faultthat things are hard now,it’s just that they need different coping strategies to the ones they’ve relied on up until now.

What can help to change someone’s perspective?

Well, you help them understand that dying isn’t something that can be fixed. You can feel bad some of the time. You can’t get rid of the distress – it’s about making a space for it.

I recently saw a patient who was feeling terrible, struggling with a lot of difficult emotions: anger, sadness, fear and guilt. And they were quite convinced that in order to be coping they had to be ‘positive’. All the time. Because that was their measure of ‘good’ coping. But aiming for something as unreasonable as that makes things worse.

Can you give examples of ideas you use to help people?

There’s a metaphor I sometimes use to help people: the hard-centred chocolate of feeling rubbish’. It’s the idea that there are losses that you’ve had and are about to have, anger that the world’s not fair, and fear of what’s ahead.

That’s the hard core of distress: normal and appropriate feelings like sadness, fear or sometimes anger that comes at the end of life. That’s all like a hard nut that’s difficult to get rid of. But that’s to be expected.

Then there are messy feelings about feelings. It might be feeling guilty about feeling sad, feeling ashamed of feeling frightened, or feeling frightened of feeling angry. These can make those core feelings even harder to bear. 

Finally, there's the crispy shell of coping – the exterior we develop, making out everything’s fine.  But it can leave us feeling fragile, wondering what will happen if it crumbles and all the mess comes out.

It’s trying to help people see that this makes the distress bigger than it needs to be. There’s that core you can’t get rid of, so don’t put yourself under the pressure of doing that. Let’s leave that mess behind!

Jenny’s top three tips for dealing with difficult thoughts and feelings

1. You don’t stop being you just because you’re coming to the end of your life

Now more than ever, take the time to think about what matters to you. What brings you pleasure? What do you hope for and wish for the people you love? Put that front and centre of every decision you make – big and small. It can feel like the big choices are being taken away from you, but a thousand little ones are there every day,” says Jenny.

2. Make space for the bad stuff

“Don’t add feeling bad about feeling bad to the pile of stuff you’re dealing with. That guilt is almost is entirely what I deal with: “I shouldn’t be so frightened because I’m weak.”, “I shouldn’t be so sad, I’ve had a good life”. I shouldn’t, I shouldn’t, I shouldn’t. There isn’t a right way to be in this situation. Nobody’s ever had your death before,” says Jenny.

3. Don’t compare yourself to other people

People often compare themselves to high-profile people or families. They’ll come in and say: “I’m not coping, I should have been running the London marathon”. But those people are in the news for a reason – they’re unusual. People look about themselves for how to cope. That’s not the best way. Look inwards instead,” says Jenny.