Journal of Palliative Care & Medicine
Open Access

Response-based counselling, Hospice care, palliative care, Empathy, Unconditional acceptance, Authenticity, Patient-centered care, Emotional support, End-of-life care, Patient autonomy

Introduction

Response-based counselling in hospice and palliative care shifts the focus from finding solutions to fostering a supportive environment where patients and their loved ones can navigate and express their emotional journeys. Chronic illness and end-of-life challenges bring profound unknowns, and a counsellor is called to respond with empathy and respect for each patient’s unique journey. Response-based counselling generally establishes a shared emotional ground, as empathy allows the counsellor, patient, and family members to connect on a level of mutual understanding, fostering a sense of equality in facing these difficult experiences together. By grounding in principles like empathy, unconditional acceptance, and authenticity, response-based counselling builds a foundation of trust and understanding, allowing patients and families to feel safe in their most vulnerable moments [1].

Beyond Solutions: Embracing the Response

Traditional healthcare often centres on solutions a treatment or intervention that promises relief. In hospice care, however, the focus shifts from problem-solving to guiding patients and families in understanding and accepting their situation, which may not always align with expectations or desires. This journey reflects a deeper truth: while we may aim for control, there are aspects of life, like illness or death that remain beyond our grasp. In response-based counselling, creating a non-judgmental space is essential, allowing patients to express a range of emotions from anger and frustration to acceptance without fear of being judged. For patients who have led highly dignified and independent lives, adjusting to new dependencies on others for personal care can feel deeply challenging. Many express a sense of loss in not being able to tend to their own needs without assistance. In these moments, the counsellor offers empathy and validation, recognising the emotional weight of this transition and honouring the autonomy and self-respect the patient has always valued. The counsellor’s role is not to “fix” but to affirm the patient’s dignity and support their sense of identity, helping them navigate the balance between needing care and maintaining a sense of agency.

Response-Based Counselling as a Holistic Support System

Response-based counselling becomes a holistic support system by addressing physical, emotional, and spiritual needs. In palliative care, patients’ needs shift over time, often evolving from physical discomfort to existential and relational concerns. Response-based counselling adapts to these needs, meeting patients exactly where they are in each stage of their journey.

Acknowledging Multi-Layered Needs: Patients and families often face layered emotional experiences that go beyond immediate medical concerns. For effective support, it is crucial for counsellors to be mindful of hierarchy of needs of patients and families. Patients may shift between basic needs, like pain management (physiological), and higher-level needs, such as emotional security, social belonging, or self-fulfilment. Recognising these needs allows the counsellor to respond appropriately, whether by providing reassurance in moments of vulnerability or encouraging reflection as the patient seeks meaning and peace in their experiences. This awareness enables the counsellor to create a safe, supportive environment that meets each person’s unique requirements.

Emotional Dissonance and Behavioural Burden: Conflicting emotions are frequent in palliative care. Family members may feel both a desire to help and the sadness of impending loss. Similarly, caregivers may experience shifting bonds, where patients gravitate toward certain individuals for comfort. Response-based counselling normalizes these dynamics, allowing caregivers to focus on the patient’s evolving needs without self-doubt or judgment. By providing a space for both patients and caregivers to explore these complex feelings without fear of critique, the counsellor helps them find resilience and purpose.

Flexibility and Adaptation: The fluid nature of end-of-life care requires adaptability. One day, a patient may need emotional reassurance, while on another; they may feel withdrawn or introspective. This calls for the counsellor to respond to each new emotional moment with sensitivity. Just as a loved one might yearn for a mother’s comforting presence, a counsellor’s adaptable response helps meet the patient’s evolving emotional needs, creating an environment of stability even in uncertain times.

Empathy and Patient Expertise: Patients are often best equipped to understand their own experiences. By deeply listening and empathizing, the counsellor respects the patient’s inner wisdom and autonomy, especially as they confront difficult transitions and face questions about their own dignity and care choices. This support allows patients to explore their feelings on dependency, control, and independence in an environment that respects and values their self-understanding.

The Counsellor’s Role as a Steady Advocate

In response-based counselling, the counsellor serves as a steady advocate, providing the patient with a consistent, compassionate presence. This is particularly significant in palliative care, where the counsellor’s role involves affirming each patient’s dignity and worth. Here, advocacy isn’t just about supporting patient rights it is about holding space for their humanity, offering responses that bring comfort. For patients who worry that their increasing dependency compromises their autonomy and dignity, the counsellor’s role extends to advocating for each patient’s end-of-life care choices. This may include honouring the patient’s preferences in caregiving, their right to privacy, and their individual decisions about their own comfort and dignity. When patients express concerns about losing control over their own lives, the counsellor listens and affirms their autonomy, creating a space where they feel their values and choices are upheld, even when facing dependency on others for care.

Reflection of Realities in Medical Settings

Medical settings are structured, with protocols that often seem rigid and predefined. In contrast, response-based counselling reflects the fluid nature of illness, where emotional and psychological landscapes continuously shift. This adaptability acknowledges the need for a personal approach, as patients confront the unknowns of illness and end-of-life transitions. In these settings, focusing on the present is vital. Patients face rapidly shifting emotional landscapes, depending on their physical state, personal reflections, or interactions with loved ones. By centring on the here and now, the counsellor honours the patient’s immediate needs and responds without imposing expectations for certain emotional states or conclusions. The counsellor helps each patient confront the present moment, whether grappling with dependency or reflecting on personal strengths, supporting them through whatever feelings arise.

The Impact of Storytelling in Counselling

A powerful aspect of response-based counselling is the use of storytelling. Personal narratives and shared experiences provide patients and families with a broader perspective during difficult moments. For instance, a story of a wise sage who, despite efforts to control his fate, ultimately accepts his journey as part of a greater order can resonate with patients facing similar struggles. This reflection encourages patients to find peace in acceptance when control is elusive. Storytelling also conveys the universality of suffering and transition, easing feelings of isolation. When families struggle with the shift from curative to palliative care, stories that reflect release rather than loss can provide perspective and acceptance. The counsellor’s use of storytelling offers patients and families a means of understanding that their experiences are both unique and part of a shared human journey.

The Value of Response-Based Counselling for Patients and Families

Response-based counselling provides patients and families with a space to explore their emotions without pressure to resolve or suppress them. This approach nurtures resilience and vulnerability, recognising that each person’s experience is unique. For families, particularly, this offers solace, knowing they are supported in their moments of sorrow or uncertainty. In these final stages, a patient’s longing for connection may manifest as a need for the presence of loved ones or memories of times of strength and independence. A counsellor’s response honours these connections, affirming the importance of the relationships, dignity, and autonomy the patient has valued. By holding this space, the counsellor empowers patients to find comfort in their lives’ meaning and continuity, reinforcing that dignity and love endure beyond physical dependence.

Drawbacks of Response-Based Counselling

While response-based counselling offers a compassionate, patient-centered approach, it does come with challenges. One primary drawback is that it may feel ambiguous or unsatisfactory to those accustomed to solution-oriented care. Without clear answers, some patients and families may feel uncertain or even frustrated, especially in emotionally intense situations that lack closure. Managing expectations is crucial. Counsellors communicate that response-based counselling is a journey of support rather than a roadmap to solutions. Additionally, the emotional burden on counsellors can be significant, as they must continuously adapt to the needs of patients and families, often without clear resolution. This requires resilience and self-care to maintain the integrity of the counselling process and to prevent burnout [2].

Conclusion

Response-based counselling in healthcare honours each patient’s personal journey, guided by principles of empathy, unconditional acceptance, and authenticity. This approach respects the autonomy and expertise of patients, offering a compassionate presence that embraces their evolving emotions without judgment. By focusing on the present and adapting to shifting needs, counsellors support patients and families in their most challenging moments, creating a space where each individual can explore their thoughts and feelings openly. Through the balance of empathy, adaptability, and genuine support, response-based counselling transcends traditional solutions, allowing patients and families to find strength, resilience, and peace in the face of uncertainty. It reflects the heart of patient advocacy, providing a steady, compassionate presence that honours each patient’s dignity and values. By meeting patients in their most vulnerable times, counsellors foster a deeply human connection, helping them navigate the complexities of life’s most profound transitions.

1. Personal Experience of the author in Palliative Care and hospice care Counselling at Sparsh Hospice, Hyderabad, India .
2. Rogers C (1951) Client-Centered Theory on Unconditional Positive Regard, Empathy, and Authenticity.