• A thirty-six-year-old mother learns that the tingling in her arm has been diagnosed as multiple sclerosis.
  • A sixty-four-year-old man, experiencing chest pains, is told he is having a heart attack.
  • The parents of a two-year-old boy sit anxiously in a doctor’s office, waiting to learn why their son has experienced continuous fevers and bruises so easily.
  • A twenty-eight-year-old architect finds that he is HIV positive.
  • During a routine examination, a sixty-nine-year-old man is informed that he has a spot on his lung.
  • A forty-one-year-old physician finds a lump in her breast.

In all of these situations an individual’s life – and that of their family’s – has now changed as each experience the crisis of an impending illness.  The experiences of all these people may be very different.  Some may find their worst fears are not realized.  The lump may turn out to be merely a cyst; the spot on the lung may be benign.  Some may undergo surgery or chemotherapy and eventually recover, but be forever changed by the experience of the illness.  Others may struggle with chronic illness.  And still others may face impending death.  Each individual – and family – may need to reach out for support.

Kenneth Doka Kenneth J. Doka, PhD, is Professor of Gerontology at the Graduate School of The College of New Rochelle and Senior Consultant to the Hospice Foundation of America

As I began to teach in the 1970’s, I was in the forefront of those offering courses in death and dying. My students were professionals seeking a Master’s Degree in Gerontology.  I began to incorporate additional material that reflected the changed reality of illness, dying, and death that has occurred since the 1969 publication of Kübler-Ross’s epochal On Death and Dying.  My classes began to consider issues related to the diagnosis of illness such as decisions about when to seek medical help or take diagnostic tests such as the HIV test.  We also started to address issues associated with the problem living with chronic illness.

In short, we began to look at the dying process in the larger context of life-threatening illness.  We studied the writings of E. Mansell Pattison and Avery Weisman, two pioneering clinical researchers who emphasized the idea that life-threatening illness is a long process, best viewed as series of phases, each with its own unique issues and problems.  The latest edition of my title, Counseling Individuals with Life Threatening Illness, owes a heavy debt to their insights as well as to the work of many writers, researchers, and clinicians.

Moreover our knowledge and practice in the field continues to change as policies and practice are buttressed by emerging research.  One of the most significant changes involves the adaption of models of concurrent care.  This model of care has significant implications for end-of-life care since it blurs the sharp divide between treatment that is primarily palliative and treatment that seeks to cure or extend life.  In concurrent care, patients can ease into the benefits of hospice care – symptom relief and pain management – while continuing treatment for disease.  In addition, a number of newer therapies have been developed that seek to enhance meaning-making at life’s end.

Counseling Individuals with Life Threatening IllnessThat is part of the biography of the second edition of Counseling Individuals with Life Threatening Illness.  But the goal of the book was probably best taught to me by another student.

A number of years ago one of my students, soon after taking my dying and death course, found that her brother, with whom she was very close, had cancer.  She nursed him, helped her parents, and struggled with her own emotions.  One day she came to class to talk about her experiences in coping with his illness and subsequent death.  Someone asked her if the course had helped.  She answered, “It didn’t change my feelings or the situations and crises we faced.  It did make them more understandable.”  That really expressed the goal of this book: to make the struggle with life-threatening illness a little more understandable and perhaps less lonely and frightening.