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This paper is based on the authors' work offering psychological therapies to patients and their families in a specialist palliative care unit, pre- and post-death. In addressing issues of family interaction around the bedside of the dying patient, the authors have noted a pattern of events that arise from strongly ambivalent relationships.
In particular, family adjustment to the declining health of the patient is acted out in a physical and emotional move around the bedside, with a ‘hierarchy of bereavement’ indicating the status of the relationship to the patient. Previously conflicted feelings towards the dying patient are replaced by an impermeable idealization, lasting throughout bereavement.
In trying to understand this process of
1. ‘Families’ refers to all those people who are significant at the bedside of the dying patient.
idealization the authors have used an analytical frame, referring to Freud and Klein and their work on mourning. This leads on to an exploration of the implications for clinical practice within palliative care. An unshifting idealization can be problematic for many reasons. The reader is left with a discussion about how to work best with families whose initial protective defence can easily crystallize into a long-term grief reaction.