For many caregivers, the psychological dimensions of care can be more difficult to deal with than the physical dimensions. In the physical dimensions, there is something that the caregiver can try to do to relieve physical suffering: medications, physical contact, etc.  However, when the sufferingis psychological, i.e., involving feelings such as sadness, anger, fear, anxiety, and other so-called negative feelings, what can a caregiver do to help?

The first question to ask about help for psychological suffering is what does the word "help" mean in this context?  If "helping" really means "make the negative feelings go away," there is nothing a caregiver can do.  No one can make someone else feel different.  it is impossible for one person to flip a switch and make another’s negative feelings disappear.  Many times, the drive to "help" in this way has more to do with the caregiver’s discomfort with being around these feelings than it does with the dying person’s suffering.  Besides, trying to eradicate negative feelings might not even be a proper goal.  A dying person is not a dead person! (S)he is still alive and must live with and through their own feelings as (s)he faces the end of life just as (s)he has the rest of life’s experiences. A dying person can be helped to work through the experience of dying by assisting him/her identify the feelings, validate them as appropriate (if that is the case), and give permission to vent or share the feelings.

What can a caregiver do for a dying person?

1. Since there is no magic statement that will make a dying person change his/her feelings of anger, sadness, etc., the first thing a caregiver needs to do to help a dying person is to learn to be comfortable with his/her own discomfort. After all, dying involves a multitude of losses and when humans lose something precious, they grieve. As we discussed earlier, grief can include various reactions, including  sadness, anger, fear, etc., that are reasonable, appropriate, natural, and normal.  Caregivers need to realize that the dying person is not necessarily directing these feelings specifically at them, but rather is trying to find a way to release the pent-up feelings.


2. A second way a caregiver can aid a dying person is to learn to listen.  Saying something like "I know how you feel" is NOT helpful for a couple of reasons.  First, it is obviously not true.  It is impossible for one person to crawl into another’s skin and know how they feel, especially if that person is dying.  Second, since it is not true, it can be interpreted as trivializing the dying person’s feelings.  Listening empathetically, however, demonstrates that the caregiver considers the dying person to be important and what (s)he has to say is interesting.
   
   I want to emphasize that during the time of being with and listening to a dying person, there is a difference between being present with compassion and empathy vs. pity.  Pity carries with it the implication of aloofness and distance while compassion implies attempting to understand and suffer along side of another.


3. A third way of helping a dying person is through touch. In my discussion about the physical dimension of care, I mentioned that touch can be beneficial to a dying person.  Touch can also provide strong psychological help.  Many dying persons crave closeness, and physical contact with another human being can bring a closeness that words alone cannot convey.  Of course, the degree that a person feels comfortable with touching is a matter of personal choice.  Some people like "their own space" that is not "invaded" by others without permission.  Sometimes illness can alter the range of that space so helpers probably should ask permission and verify what is comfortable for the dying person before actually touching.

In conclusion, even though some preparation and training may be useful, almost anyone can provide the help a dying person needs as (s)he works through the psychological tasks of dying.  The major things to remember are: 1) do not try to change how a person feels, 2) learn how to be present in spite of any negative feelings expressed by the dying person, 3) listen emphatically to what the person is saying, and 4) provide touch to the extent the person is willing.