Psychotherapy of the dying patient.

Abstract

In general no mention is made of attitudes to the dying in standard medical textbooks for the medical student, nor in training manuals for nurses. Most of these authors comment on the doctor's need to deny the fact of death and the loss of the patient. traditional detached professional attitude is regarded as the only possible means of coping with daily disaster and with the threat to the doctor's own omnipotent fantasies. The dedication to forestall death is an indication that the medical profession believes that death is never ap propriate.1 Yet death is an ever-present reality in medical and nursing practice and a time of crisis for the patient, the family, and for the medical and nursing attendants. This paper is an attempt to outline certain practical steps that can usefully be taken in this situation and is based on my experi ence of psychotherapy of a number of patients over the past year or two. I was particularly influenced by the very fine thoughtful contribution to the literature by Norton,2 who described in detail the partial analysis of a young married woman dying of m?tastases from a breast cancer over the last three and a half months of her Ufe. This sensitive paper is a very good example of how analytical insights can be applied in short-term therapy to a frequently recurring clinical situation.