Identity and the End‐of‐Life Story: A Role for Psychologists

Abstract

Objective Narrative approaches to identity, which conceptualise a person's identity as their life story, present a useful way for approaching support at end‐of‐life because they do not pathologise dying but rather recognise it is the final chapter of a life story. The construction of life stories is always a social process and could be supported by psychologists. Attention to issues of identity and relationships is beneficial for dying people and their carers and counteracts the medicalisation of dying. The Caring at End‐of‐Life Research Program identified the support necessary from family, friends, community, and professionals for people to die at home, which is the preference of over 80% of Australians. Identifying the current and potential role of psychologists is the present focus. Method Qualitative analysis of eight service provider focus groups (88 people), 13 focus groups with carers and their support networks (n = 84), and individual interviews with carers (n = 23), and community (n = 17) was conducted in urban and rural New South Wales and the Australian Capital Territory. Results End‐of‐life transition was achieved without loss of identity when relationships with people, places, and objects which sustained identity were maintained. Carers required knowledge, skills, and adjustments about which psychologists have expertise such as emotional work, supporting networks, resisting pressure from medical staff, and adjustment at death. However, no psychologists attended the service provider focus groups and carers identified only three psychologists among 58 service providers. Conclusion Psychologists could play a valuable role by recognising end‐of‐life as a major transition and assisting with identity maintenance through that time.

Australian psychologists' perceptions on their role in end‐of‐life care of older adults

“…Formal carers, especially physicians and nurses, struggle to provide effective emotional support for EOL and their family members (Kasl‐Godley et al, 2014). The current research identifies that greater psychological support is needed for family members in managing complex grief and trauma when caring for others, as frequently psychological support in EOL institutions is inadequate or not accessed (Leonard, Horsfall, Noonan, & Rosenberg, 2017). The under‐recognition of pre‐ and post‐bereavement support has been identified as a significant gap for both staff and residents in aged care, while family members may also fall between service systems (Thompson, Morris, and Williams (2017).…”

Psychosocial Interventions for End‐of‐Life Care: An Invited Commentary

“…Klasen et al (2017) emphasised that good end-of-life care goes beyond the person's death and that bereavement counselling services should identify carers at risk of complicated grief and suicide earlier in the process. Leonard, Horsfall, Noonan, and Rosenberg (2017) in their qualitative study, explored the supporting role of psychologists in end-of-life care, emphasised that psychologists are not well represented in end-of-life care in Australia. The authors went on to identify a number of potential supporting roles for Australian psychologists in end-of-life care, including aiding individuals in the management of distress, adjustment and transition, relationship management, care coordination, and helping carers navigate the health system (Leonard et al, 2017).…”

“…Leonard, Horsfall, Noonan, and Rosenberg () in their qualitative study, explored the supporting role of psychologists in end‐of‐life care, emphasised that psychologists are not well represented in end‐of‐life care in Australia. The authors went on to identify a number of potential supporting roles for Australian psychologists in end‐of‐life care, including aiding individuals in the management of distress, adjustment and transition, relationship management, care coordination, and helping carers navigate the health system (Leonard et al, ). This paper illustrates that psychologists are an underutilised resource in clinical service provision and further integration of psychologists into end‐of‐life care could be beneficial.…”

Psychotherapeutic Interventions Near the End of Life: Theory, Evidence, and Future Directions

“…The paper by Leonard et al (2017) on narrative approaches to identity as a means of accessing and creating a life story at the end of life similarly emphasises subjective experience and personal psychological constructs. The authors suggest that recognising a person's identity as a manifestation of his or her life story provides an opportunity for the integration at the end of life.…”