Supporting Clients Through Terminal Illness

Supporting Clients Through Terminal Illness

Working with clients who are facing a terminal illness requires Counselors to maintain emotional composure, clinical competence, and ethical standards to ensure conversations about death occur openly and safely.

Dr. Raman Kaur Mohabir, PhD, NCC, LMHC, LPC, LPCC, FT, Chief Executive Officer at Good Mourning Mental Health Counseling, Inc., offers her expertise on fostering this delicate balance and other strategies for Counselors serving these individuals.

Early sessions with terminally ill clients are often best focused on establishing safety and trust while gaining a clear understanding of their experience of the diagnosis, according to Dr. Mohabir. Counselors can begin by exploring how the client understands their condition, the information they have received from their medical team, and the losses they are already encountering as their illness progresses.

“Open-ended questions, such as asking what their care team has shared about what to expect or what feels most important for the Counselor to understand about their illness, allow clients to set the tone and depth of the conversation,” says Dr. Mohabir. “At the same time, Counselors benefit from developing a basic understanding of the illness trajectory, potential symptoms, and functional limitations so that the counseling approach and care planning remain realistic and responsive to the client’s changing needs.”

In many cases, the most effective approach with terminally ill clients is allowing them to define the goals and direction. Since time in treatment may be limited, Dr. Mohabir says that goals are often concrete, immediate, and focused on personally meaningful concerns. Some clients may wish to address unfinished business, repair strained relationships, clarify end-of-life wishes with loved ones, or organize personal belongings and important documents. Others may seek emotional support as they process anticipatory grief or navigate changes in identity and independence.

“Allowing the client to lead the care plan respects the urgency and individuality of their experience, while also acknowledging that priorities may shift as the illness progresses,” says Dr. Mohabir.

The National Cancer Institute emphasizes the vast changes a person can experience upon learning they have a terminal illness. Thoughts can be overwhelming and change by the day or even the hour. There’s no right or wrong way to respond, and the range of feelings can include hope, sadness and depression, grief, fear and worry, anger, guilt and regret, loneliness, and inner strength. Individuals may experience one, while some might feel them all.

Dr. Mohabir suggests inviting reflection through questions, such as who the person is beyond their illness or which aspects of themselves feel most important to preserve. This can help reconnect clients with a broader sense of self and allow individuals to reflect on legacy, purpose, and the enduring elements of their lives that extend beyond their physical decline.

“Dignity-conserving and meaning-centered approaches emphasize the importance of seeing the client as more than a patient defined by illness. This involves recognizing the roles, relationships, achievements, and values that have shaped the client’s life and identity,” says Dr. Mohabir.

Balancing conversations about a client’s life while acknowledging their approaching death is another central aspect of end-of-life counseling.

“Many clinicians find it helpful to gently shift the focus from questions about how long a person has left to questions about how they want to live during the time they have. In this way, awareness of mortality can deepen engagement with life rather than diminish it.” states Dr. Mohabir.

Acceptance-based frameworks can be particularly helpful in this process. Emphasizing mindfulness, difficult realities, and values-based action can support clients in identifying what matters most to them and committing to small, meaningful actions that reflect these values, even within the constraints of terminal illness.

Collaborating within a broader network of care, which can include medical providers, caregivers, and family members, can enhance support for the client and improve continuity of care. However, any involvement of others must include the client’s informed consent and clearly defined therapeutic goals. Counselors should be attentive to role boundaries, confidentiality, and the client’s preferences for how and when loved ones or medical professionals are involved in counseling conversations.

Given the sensitive nature of these sessions, Counselors should also remain mindful of language and responses that could unintentionally invalidate the client’s experience.

“Statements that minimize the illness or offer unrealistic reassurance—such as emphasizing that everything will be okay or encouraging the client to simply focus on positivity—can undermine trust and discourage honest expression of fear or grief,” says Dr. Mohabir.

Dr. Mohabir also urges Counselors to avoid ignoring conversations about death because of their own discomfort, comparing the client’s experience with that of others, or providing medical advice outside their scope of practice. Maintaining a stance of presence, curiosity, and respect allows clients to speak openly about the full reality of their circumstances.

There are also several ethical considerations for Counselors working with terminally ill clients. Dr. Mohabir notes the importance of professional competence, pursuing the appropriate training and consultation, and upholding respect for client autonomy, especially when individuals are making complex decisions about end-of-life care.

In addition, she advises Counselors to support the client’s right to self-determination while navigating sensitive topics, such as medical decision-making or the possibility of Medical Aid in Dying (MAID) in jurisdictions where it is legal. Clinicians who choose not to participate in counseling related to such decisions should still provide appropriate referrals and resources.

Dr. Mohabir adds how Counselors should recognize that cognitive changes can occur as illness progresses, which makes informed consent an ongoing, dynamic process rather than a one-time discussion. Continuous self-reflection around personal beliefs and biases about death is also necessary to ensure a Counselor’s values do not interfere with their therapeutic relationship.

Working closely with a terminally ill client inevitably affects the Counselor as well. Dr. Mohabir advises that feelings of grief, anxiety, helplessness, or attachment-related distress are common responses and should be expected rather than suppressed.

“Recognizing these reactions as a natural part of the work can reduce the stigma or shame clinicians sometimes feel about their own emotional responses,” says Dr. Mohabir.

Dr. Mohabir adds that Counselors can benefit from self-awareness and recognizing signs of grief within themselves, whether those appear physically, cognitively, emotionally, or behaviorally. This requires intentional coping practices, such as ongoing supervision or consultation, supportive peer relationships, consistent self-care, and permission to grieve when a client declines or dies.

“When Counselors acknowledge and care for their own emotional experiences, they are better equipped to remain present, compassionate, and grounded for the clients they serve during one of the most vulnerable periods of life,” concludes Dr. Mohabir.

Dr. Raman Kaur Mohabir, PhD, NCC, LMHC, LPC, LPCC, FT, is the Chief Executive Officer of Good Mourning Mental Health Counseling, Inc. She received her MSEd in Clinical Mental Health Counseling from St. John’s University and her PhD in Counseling from Montclair State University. She is a Fellow in Thanatology with over a decade of experience in hospice, palliative care, and bereavement support. Her work is grounded in compassion, cultural sensitivity, and evidence-based care to help clients carry grief with intention.

Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.