The Impact on the Family Therapist of a Focus on Death, Dying, and Bereavement
Becvar, Dorothy S., Journal of Marital and Family Therapy
Recognizing the growing numbers of family therapists who are choosing a focus on death, dying, and bereavement, this article addresses the nature of the commitment required-as well as the gifts and challenges presented by work in this area. Particular attention is given to therapists' vulnerability to compassion fatigue and/or vicarious traumatization, both of which are described and discussed. A variety of strategies for individuals and institutions, aimed at supporting professionals and preventing problems, are considered. It is concluded that as family therapists focus on self-care as well as client care, they have the potential to increase not only their effectiveness but also to enhance their own well-being. Implications for training and for research on this topic also are considered.
"For there is nothing heavier than compassion. Not even one's own pain weighs so heavy as the pain one feels with someone, for someone, a pain intensified by the imagination and prolonged by a hundred echoes." (Kundera, 1999, p. 31)
As the field of family therapy was coming of age in the late 1960s and early 1970s (Becvar & Becvar, 2003), this highly volatile era in our social history also saw a great growth in awareness of, as well as responses to, the previously unmet needs of those who were dying (Vachon, 1999). Accordingly, the concepts of hospice and palliative care, pioneered in England by Saunders (1959), and of thanatology, pioneered in the U.S. by Kubler-Ross (1969), emerged, signaling the birth of a new movement. For example, in 1974, the first meeting of what later would be called the International Work Group on Death, Dying and Bereavement was held (Vachon, 1999). In 1976, the Forum for Death Education and Counseling, subsequently renamed the Association for Death Education and Counseling, was created in response to the needs of a growing number of professionals involved in this work (Crase & Leviton, 1987).
Despite this shift in attitude toward death and dying and its on-going evolution in the professional arena, in the larger realm of society, denial, described many years ago by Becker (1973), and fear, noted by Foos-Graber (1989), generally have continued to be the norm (Byock, 1997; Kuhl, 2002). Indeed, at various points in the not-so-distant past, perceptions of death have been so negative that it has been construed both as a social disease (Shneidman, 1980) and as a less acceptable topic of conversation than sexual activity (Gorer, 1980). More recently, Stiller (2001) indicates that conversations related to this topic remain taboo and that "cultures take extraordinary measures to eliminate reminders of our impending death" (p. 2). Such efforts at denial undoubtedly are related to fears about death, a concept and an experience about which there always will remain more questions than answers.
The form of such fears has been explained in many ways. In terms of the avoidance of conversations about death, Kuhl (2002, p. xv) suggests that "We are afraid that talking about death beckons it," that is, if we ignore it perhaps it will go away. According to Neale (1973), tears about death arise from concerns about the dying process, about what will happen the moment after death occurs, and about the loss of one's only life. Fears also may be related to awareness of a lack of meaning in one's life, to negative associations around the decay of one's body, to apprehension about judgment, and to dread of the unknown (Stiller, 2001). Yet another source of fear is described as follows:
Our greatest fear is that when we die we will become nothing. Many of us believe that our entire existence is only a life span beginning the moment we are born or conceived and ending the moment we die. We believe that we are born from nothing and so we are filled with fear of annihilation. (Hanh, 2002, p. 4)
Thus, even when permission is granted to talk about the subject, dialogues about death generally are conducted in a serious, solemn, and subdued manner (Hainer, 1997). …