Counselor+Interviews

Counselor Interviews
> ** Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death. Denial can be a conscious or unconscious refusal to accept facts, information, or the reality of the situation. Denial is a defense mechanism, and some people can become locked in this stage. ** > ** Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. ** > ** The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just do something to buy more time..." ** > ** During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors, and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed. ** > ** In this last stage, individuals begin to come to terms with their mortality, or that of a loved one, or other tragic event. **
 * We wanted to get a few opinions for the interview, so we contacted a Licensed Clinical Social Worker, Licensed Master Social Worker, and a community counselor. **
 * The community counselor brought up the issue of whether or not Jason’s case should be looked at as suicide. Since he has considered stopping his medications, she compared it to the cancer patient who no longer wants chemotherapy or the diabetic that quits taking insulin. She reiterated that he has the right to decide whether or not he wants to take his medication. She would encourage him to think about this a little longer and try to get him to return for another session before he began traveling. She referenced the Kubler/Ross five stages of death. She believes he has moved past depression and onto acceptance. The Kubler/Ross five stages of death are as follows: **
 * 1) ** **Denial** — "I feel fine."; "This can't be happening, not to me." **
 * 1) ** **Anger** — "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?" **
 * 1) ** **Bargaining** — "I'll do anything for a few more years."; "I will give my life savings if..." **
 * 1) ** **Depression** — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point? "I miss my loved one, why go on?" **
 * 1) ** **Acceptance** — "It's going to be okay."; "I can't fight it, I may as well prepare for it." **


 * The LMSW’s first thought was the client has a right to self determination; although, she would try to get him to come back in a week for one last session (which may or may not end up being the last if he changed his mind). She would discuss the support system he needs during the end of life process. She would make sure he was aware of hospice and palliative care resources if he was interested. She did not note any reason he was not of sound mind to discontinue his treatment; therefore, duty to warn was not a concern. She would encourage him to find supports whether it was friends, a cousin, or uncle that may be able to help him mentally and physically in the end. **


 * The LCSW recommended being very present and empathetic to the HIV/AIDS client and finding them “where they are” in the process. She noted a few red flags in his decision to stop his medications. She questioned if he was taking his anxiety and depression medications, since he was no longer adhering correctly to his HIV medications. She asked, “Is this Jason talking or is it the anxiety/depression talking? Does he really want to take a drug holiday, or is he so consumed with anxiety he thinks it is his only option?” She wanted to make sure he was making a rational decision. If Jason will sign a records release, she suggested talking with his doctors and taking a “team approach.” Since he may not agree at this point, signing the release up front could have been considered. She cautioned against recommending to the client whether or not he should stop taking his medications. **


 * The common thread throughout the interview was once it is determined Jason is in a sound state of mind, he has the right to make his own decision regarding his treatment. However, each counselor did have a slightly different focus. The community counselor addressed his grieving process, while the LMSW wanted to make sure the end of his life was comfortable. The LCSW suggested speaking to his other doctors for more collaborative treatment. Just as we have learned from our discussion post, there are many ways to approach ethical dilemmas. The counselors varying interpretations of this study, supports why it is important to work closely with colleagues and supervisors. This helps to ensure the counselor provides a comprehensive treatment plan. **