Circle of Trust: How Psychodynamic Themes Such as the 'Holding Environment' Optimize Coping with Serious Illness (FR458)

Abstract

•Describe the essential aspects of holding presence, holding environment and containment as they relate to psychological integration and improved prognostic awareness.•Demonstrate practical techniques and communication strategies to cultivate a holding presence for patients and families.•Identify key insights from psychodynamic theory that provide a useful framework for optimal psychological coping. One of the most challenging aspects of hospice and palliative care is encountering a patient's fear of the dying process, including the common existential worries of dying alone and the losses of physical decline. How does a patient have the psychological strength to go from the security of their previous healthy life to the many phases of loss and uncertainty with life-limiting illness? Recent literature reveals that many patients mitigate these fears by proactively creating a tightknit circle of trusted people "on the inside.” This "inner circle” generally consists of reliable family, loved ones and clinicians who are emotionally available to the patient, but not overly invasive or intrusive. The "holding presence” of this inner circle allows patients to better tolerate the possibility of dying by facilitating an environment where patients can smoothly vacillate between comfort and fear as well as more and less realistic hopes. This swinging between such extremes is most successful when a patient has secure attachments to this inner circle of relationships that can witness this back and forth. Moreover, this containing presence allows patients to better communicate their values and goals amidst intense affective experiences. Thus, such a holding environment can facilitate improved prognostic awareness and advance care planning. In this interdisciplinary concurrent session, three experts in psychodynamic theory and palliative care will highlight how the "holding presence” of an inner circle creates a containing environment for patients to better cope with life-limiting illness. One expert is a psychoanalyst and will reveal how contributions from thinkers such as Winnicott, Bion, Bowlby and Buber illuminate these relational dynamics at the end of life. Presenters will draw upon clinical case material to demonstrate practical techniques utilizing these insights when caring for patients and families.