Opening the door to difficult conversations

Recently I had the opportunity to attend the British Psychological Society conference, for its Clinical Psychologist Division. I was there to present on working therapeutically with gender diverse people but was also able to attend the different seminars and workshops.

Which is how I ended up in one of the most thought-provoking workshops I have ever attended. Neither the Sun nor Death – being bold to have conversations about death and the end of life. The first part of the title comes from a quote from Francois de la Rochefoucald

Neither the sun nor death can be looked at with a steady eye.

We live in a society where talking about death is still very much a taboo subject as I have explored before. Whilst 68% of us say we are comfortable talking about it, only 30% have had conversations with those around them about what they want to happen after they die. This workshop was intended to challenge a taboo which can silence mental health professionals as much, or perhaps more, than anyone else.

The innovative format of an outsider witness exercise meant that from the first moment we were confronted with that which we are usually at great pains to avoid. A psychologist, person with vascular dementia, and person who had cared for a dying parent, had a conversation, peeling back the curtain which shrouds death. Three of us were the outsider witnesses, listening and reflecting on our reactions to the conversation, whilst the rest of the audience observed both conversations in totality.

When you hear someone describe a death what comes to mind? For many of us it will be a personal, not a professional response. We will remember the deaths of loved ones, or how we dealt with issues such as funeral arrangements and family notices. As one of the outsider witnesses listening to this intimate, and very moving conversation about death I instantly was thrown into my own frame of reference. The group of four explored issues such as professionals telling them not to be morbid, or dwell on death, others who were unaware of specific cultural or religious requirements and an almost knee jerk aversion to death planning.

As the workshop continued, and we in the observer group were asked to respond, themes emerged around how professionalism, which may come across as coldness, can actually be a mask behind which we are hiding our own unresolved fears.

If we have not had the courage to look at death with a steady eye, we may be closing the door to conversations which the dying, and those around them, need to have. Again and again those who were looking, or had looked steadily at death said “Just ask”. I suggested that our role is to open the door, if a patient or client does not want to walk through it, that is fine, but in opening the door we give permission for death to be approached.

The idea of a good death, contrasted with a bad death, is a uniquely personal one. It is though one which can be facilitated by early enough conversations, by opening the door and making explicit it is OK to talk about death. We seem to have a superstition that if we name death it draws nearer. However, it is in the unnamed that fears, regrets and guilt lie. I am not saying it is always easy to have these conversations, but as therapists we hold space to many difficult conversations. We need to have the courage to open up dialogue, both professionally, and personally, in order to be bold in the face of death. This may mean admitting to our own vulnerabilities, and by doing so we may create a safer space for all, including ourselves.

A website recommended by the workshop participants is Dying Matters.

To continue my own “opening of the door” I hope to attend a Death Cafe this year.

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