What kind of things do you tell yourself, knowing you are practicing safer sex?



What kind of things do you tell yourself, knowing you are controlling your substance



abuse?

Counseling Terminally Ill Clients

The counseling of ill and dying clients should be supportive and nonconfrontational, addressing

issues relevant to the client's illness at a pace determined by the client. However, clients are not

the only ones to be affected by the approach of death; counselors too may need assistance in

dealing with clients' deaths. This section addresses the issues of denial, planning for death, pain

management, unfinished business, and bereavement. A five-stage bereavement and loss model,

based on Elisabeth K_bler-Ross' book On Death and Dying, also is presented.

Denial

Denial about a client's HIV/AIDS diagnosis can be experienced by both clients and counselors.

Denial is a natural response and should be confronted only if it causes harm; for example, when a

client in denial about his illness delays in making arrangements for medical and nursing care or

procuring assistance with daily living activities. Counseling can play an important role in helping

clients accept their illness and the eventual need for home health or hospice care.

Denial can also affect counselors. For example, because of the advances being made in the

medical treatment of HIV/AIDS, a counselor may be in denial that a client will die of AIDS.

Counselors must recognize and confront their own denial issues so that they are able to discuss

death and dying and realistically explore these issues with their clients. Programs need to have

inservice education and proper supervision for counselors who work with terminally ill clients.

Proper supervision will help the counselor confront her denial and help lessen her stress.

Planning for death

It is often difficult for a counselor to know how or when to talk to a client about planning for

death. It is optimal, if possible, to begin a discussion of the client's future, including death, before

the client is extremely ill. Questions that often lead the counselor into a discussion of death and

dying, and also are centered on contingency planning, include, "if you were to become too ill to

care for yourself any longer, what would you do, who would help, where would you go?" The

counselor and client should also consider where the client would like to die because different

arrangements may be required.

Counselors who will be working with clients at the end stages of AIDS should examine their

own beliefs about death and dying. In addition to this, counselors may need to learn about the

physical and biological process of dying so that it can be explained to clients. It is also important

to keep in mind that clients' perspectives on death and dying are deeply rooted in their personal

histories, religious practices, ethnic customs, family traditions, and community standards.

Many clients fear dying alone or in pain, or of losing control of their bodily functions, and thus

having to rely on others for care. If clients want to talk about this personal and often frightening