Question

Case Vignette

A 66-year-old male has known for about 2 years that he is terminally ill, with Melanoma but he is still in good health. He tells you that for the past 2 years, his disease was in remission. Suddenly 3 months ago, he had a relapse, cancer metastasized and he was told that the disease this time would need more aggressive chemotherapy.
He tells you that this wasting disease is very painful and there will be little relief for the pain. So he has been drinking a lot to deal with sadness. To complicate matters further, he has been told that he needs to stop drinking to receive chemotherapy. He has made multiple trips to his oncologists to receive chemotherapy, but he was denied treatment and told that he needs to stop drinking and needs to be detoxed from the alcoholic. He has decided to settle all his affairs, and he tells you he feels satisfied that his family will be better off with him gone. He has decided to die with dignity. He has a definite plan to keep drinking knowing he would not receive chemotherapy and it would kill him. He has come to you to check things out about how to let his family know what he is going to do. He told you his wife has been encouraging him and wants him to be better. While-talking with you he expresses the ambivalence that plagues
him.
"On the one hand, if I quit drinking, I can get chemotherapy and it may prolong my life. I don't know for what."
"On the other hand, if I don't stop drinking, I will not get chemotherapy and I will die."
Tears roll down his cheek, he tells you he is tired of the pain and then makes jest of the situation by laughing and joking about how life is meant to be lived.

1. What strategies do you suppose could be employed in working with this person? What other alternatives might the counselor help this individual to explore?

Answer 1

I am no expert just my opinion.

. He started drinking because his mindset changed with his diagnosis wich let him hopeless , he sees no future and his acts makes him get away from the change of having a future. So how do we change his mindset? Maybe the attitude of crying in desperation for him to stay and try chemo makes him more stubborn defensive of the feeling of anhedonia and also under the control of addictions he is more depresed gets more defensive . In my opinion the best solution is not directly tell him to start chemo but to give him subtle motivation first to quit alcohol and to start chemo.If he starts seeing a future people talking good about life around him ,talking about progress of others with the same disease even if it s not his own progression it s some of the best to give motivation, talking in a permissive way like he is the one making the decision to quit although not healthy saying thay he is allowed to drink how much as he wants after chemo -just to making him stop and get chemo and deal with everything after. for some individuals maybe seeing the consequences and future complicatiosns not death a term that he can be numb maybe useful for motivation using some fear. Saying that he is a lucky one having an options some of the people with cancer don t. I would try in subtle manner to give him motivation, a feeling of gratitude with examples and also showing the reality.