In the palliative care setting, existential issues circulate—implicitly or explicitly, among patients, significant others and clinicians. Different disciplines, such as philosophy, anthropology or theology address existential issues of man. These disciplines may play a role to gain a theoretical perspective, but in the palliative care clinical setting, patients with existential questions or existential distress are often referred to spiritual care and/or liaison psychiatry.
Among the liaison psychiatry approaches, specific interventions based on Existential Psychotherapy (e.g., Meaning-Centered Therapy) co-exist with a growing number of so-called Positive Psychology Interventions. They may be beneficial for patients in existential distress, but also carry certain risks. A risk (i) of psychiatrization of patients’ existential experiences, (ii) of focusing on partial aspects of the lived experience of the severely ill and (iii) of neglecting the general psychoanalytic and object relational concepts, which are most helpful to conceive the encounter with patients under existential threat. In addition, they can also shut off from view the role palliative care physicians and nurses have to contain existential distress and obscure liaison psychiatry’s task to address clinicians’ defensive maneuvers towards the existential in medicine (e.g. by means of supervision).
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