Secrets in Grief Counseling and End-of-Life Care: Making the Invisible Visible  

Working with people facing grief, loss, and life-threatening illness ushers us into a world of secrets. Secrets that are most tightly held, such as sexual abuse and other traumas, self-hatred, family secrets, suicidality, extramarital affairs, disenfranchised grief, and serious medical conditions are painful and often stigmatized experiences. These secrets reflect the core of clients’ inner worlds--the places where they feel least loved and lovable, and most alone. Family secrets and cutoffs, often passed from generation to generation, can complicate mourning, produce the symptoms that bring families into our consulting rooms, and complicate movement toward closure at the end of life. Health professionals can also have helper secrets--self-doubts they are reluctant to share with colleagues, or unresolved feelings about difficult clinical situations.  Finally, when diagnoses and prognoses are not openly discussed, secrets grow and make the transitions within treatment and therapy more difficult and hazardous. Navigating this world of secrets, and sensitively negotiating conflicts surrounding disclosure and the real-world constraints against it, are hallmarks of the effective end-of-life professional.

In this workshop we will explore secrets in everyday clinical practice and identify therapeutic techniques and relationship qualities that can bring the dialectic of concealment and disclosure, and the transformation of shame, into the center of therapeutic action.  We will draw upon recent work in several areas: self-concealment and health; client secret keeping in therapy; secrets at the end of life; social constraints, stigma and disenfranchised loss; family secrets; trauma healing, the writing cure, and adaptive disclosure; ethical issues in the management of client secrets; helper secrets; and end-of-life conversations.

Objectives:  Participants will be able to

• Describe the pathways for the effects of self-concealment on health and well-being
• List the secrets clients most frequently keep from their therapists
• Identify strategies for facilitating safe discussions of secrets and the transformation of shame to pride
• List common content of helper secrets
• Describe the ironic rebound effect and its relation to thought suppression
• Describe the dynamics of the dual-motive conflict between the urges to conceal and to reveal

Presenter:

Dale G. Larson, Ph.D. (U. C. Berkeley) is a Professor of Counseling Psychology at Santa Clara University, where he directs the graduate Health Psychology Program. A national leader in end-of-life research, theory, and training, he co-directed a national mental health skills training program for hospice workers and was Senior Editor and a contributing author for Finding Our Way: Living with Dying in America, a national newspaper series which reached seven million Americans.

Dale Larson is a  Fulbright Scholar, a Fellow in the American Psychological Association, a clinician, and author of the award-winning book, The Helper's Journey: Working With People Facing Grief, Loss, and Life-Threatening Illness. He publishes widely on grief and grief counseling, end-of-life issues, self-concealment, professional stress and stress management, and counselling skills, and worked directly with Gene Gendlin and Carl Rogers.

Dr. Larson’s ability to translate theory and research into effective clinical practice makes him a popular speaker at national and international conferences. He recently gave keynote addresses for the American Academy of Hospice and Palliative Care Medicine and for the Australian Psychological Society Counselling Psychology Conference in Melbourne. In 2016 Dr. Larson was honoured with the Death Educator Award by the Association for Death Education and Counseling.