Palliative Counseling

Source: Pixabay, CC0 Public Domain

We tend to valorize an MD who offers an unlikely-to-be-cured patient the option of palliative care: focusing on comfort rather than additional attempts to cure with likely-to-fail, expensive, painful treatments.

Counselors are less likely to be praised for suggesting palliation. Most counselors have been faced with a client whose condition, for example, anxiety or depression, they believe is too unlikely to sufficiently improve to justify the time and cost of more sessions. Yet the counselor may continue to try to help the client improve said condition. Or if the counselor believes that’s too unlikely to be worth the client’s time or money, s/he suggests that sessions be discontinued or makes a referral.

At that point, such counselors might want to add an option: palliation, that is, helping the client make the most of the status quo. For example, the counselor might say something like, “I’m wondering if we shouldn’t focus on making the most of your situation as it is, for example, managing your work and personal life to accommodate your depression, and focusing on more calmly riding out your bad episodes, knowing this too shall pass. What do you think?”

Understandably, the idea of palliative counseling can engender resistance from both counselor and client. It’s hard to give up on trying to improve a client's condition, and the client resistance may be greater in a counseling client than in an MD’s patient. After all, a physician suggesting palliative care can point to solid outcome data from studies of many patients with, for example, stage 4 pancreatic cancer. A counselor can’t as easily point to solid data that suggests poor prospects for a client’s, for example, treatment-resistant anxiety, let alone for a career counselor showing solid evidence that further effort to search for a sustainably better-paying job is too unlikely to bear fruit.

In presenting the palliative option to clients, of course, wording is key. Here’s another example, this one in career counseling, my specialty, but other kinds of counselors also might find such an approach useful:

You've worked hard during and between our ten sessions and I can understand how frustrating it must be to have not gotten close to landing a better job than the one you have. I’m willing to continue to help you tweak, maybe even again radically change. your job-search strategy. Or you may feel you should discontinue our work together and go it alone or with another counselor. But there’s another option I’d like to offer. We could, if you wish, proceed on the assumption that, for now at least, this is the job you’re going to have for a while, and we can focus on making the most of the status quo: making your existing dollars stretch further, finding more ways to make your current job more pleasurable, even, if you wish, helping you find a romantic partner who makes a good income. What do you think?

The takeaway

Neither counselor nor client likes accepting the disease. But sometimes it’s wise to redirect efforts to more promising territory. Country singer Kenny Rogers warned, “You gotta know when to hold ‘em, know when to fold ‘em, know when to walk away.” I’d add, “know when to change the game.”

I read this aloud on YouTube.