Death, death, and the therapeutic relationship

Our society has developed the belief that death, disease and fear should be avoided. Denying the fact that death can happen has caused people to view illness and death as something that happens to them, rather than a natural process that can be embraced without worry or suffering. Our thoughts and perspective on death and disease are based on fear rather than viewing it as a potential opportunity for an experience that can offer new learning, challenges, growth, and a positive view of our existence and ourselves. Denying the fact that death can happen has caused people to view illness and death as something that happens to them, rather than a natural process that can be embraced without worry or suffering.

Upon awareness of a terminal illness, Kubler-Ross identifies the different stages a patient goes through in response to this new knowledge. These defense and/or coping mechanisms often help the patient deal with the stress of facing his death. These include the first stage, denial and isolation; The second stage, anger. The third stage: bargaining. Fourth stage: depression. and the fifth stage of acceptance (1969). The stages are defined as successive, in which hope is usually present in one form or another. In the final stage of admission, there is no hope of finding a cure and the patient may not want any more visitors. The person will have finished their unfinished business and there is a feeling that the patient has reached a sense of peace (Kubler-Ross, 1969). Another indicator of the final stage is the role of hope. Once hope is gone, the patient is often on the verge of death.

Stephen Levine, who has also worked extensively with dying people, goes further with the stages defined by Kubler-Ross, showing that these stages are really about changes in the mind. Instead of being swallowed whole as an ultimate truth, these stages can instead be used as a means of focus, a way of encouraging recognition of the impermanence of all things so that one may go beyond seeing others as they have become, and instead experience them as they are. To touch upon the living truth of their being, participation in a reality that transcends death” (Levine, 1982, p. 234). Many individuals have identified the different stages humans go through when they meet their ultimate destiny of death. In the face of death, Levine (1982) defines the mind as a serpentine that changes thoughts on a given day. During the evaluation process, the stages are reviewed more than once.

Levene adds a spiritual dynamism to his view of the stages of dying identified by Kübler-Ross. He refers to its phases as psychologically based, associated with thoughts, feelings, and emotions. He adds, “The difference between the psychological and the spiritual is that the spiritual is not just about the contents but rather the space in which these contents unfold. The five stages deal with death as if it were outside ourselves. Perhaps true acceptance is the first time we take death inside. Where death is not the enemy but Instead it becomes the great teacher who directs us toward our fear and encourages us to relate to it instead. Death’s teachings are about your life as a whole rather than a fractured reality that you want to escape from.” (Levine, 1982, p. 242) Spirituality is often intertwined in the dying process regardless of prior spiritual development.

As I have seen in my office, a person can feel settled in a certain belief system and with a diagnosis or when an opportunity for a death examination arises, many beliefs are immediately re-evaluated. I have had the opportunity to serve as a chaplain in a community hospital, and have worked extensively with people who have recently been diagnosed with a life-threatening illness and/or know someone close to them who is going through the process. I think everyone has a different response to their own life circumstances. The therapeutic process can be very informative, supportive, and helpful for feeling and moving through emotions as they arise. Therapy can also be a place to process what may remain incomplete.

As a healer, my job is to hold space for someone else’s process rather than fix, heal, and/or dismiss one’s own experience. Through all the feelings of grief, anger, shock, denial, and acceptance, I have the space to choose in the midst of difficult circumstances. Sitting with another human being in this process is humbling, powerful, and reminds me of how choice plays out until our last breath.


Levin, S.; (1997). A Year to Live: How to live this year as if it were your last. New York: Bell Tower.

Levin, S.; (1982). Who Dies: An Inquiry into Conscious Life and Conscious Death. New York: Anchor Books.

Kübler Ross, E.; (1969). At Dying and Dying: What the Dying Should Teach Doctors, Nurses, Clergy, and Their Families. London: Macmillan Corporation.

Kübler Ross, E.; (1974). Questions and answers on death and dying. New York: Simon & Schuster.