How Does End-of-Life Counseling Work?


Everyone facing the end of life will react differently to the news when they receive a terminal diagnosis. Whether death is approaching because of illness, accident, or advanced age, many patients and their families are unsure what to expect. They often don’t know where to turn to for answers and end up relying on their past experiences with other family members who’ve died. 

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It is hard if someone has not had direct experience with all of the medical, emotional, spiritual, and financial issues that come up when a close relative is dying. A patient who’s dying will face several end-of-life issues that may need professional guidance.

The guide below will walk you through what end-of-life counseling is, where to receive it, and what to expect from it.

What is End-of-Life Counseling?

If you or your loved one is facing the end of life, you can expect to have different questions as your needs arise. It is also to be expected that your circumstances can change from one day to the next. 

As a result, end-of-life counseling can be a great source of comfort for you, your family, and loved ones to prepare for what lies ahead as death approaches. This form of counseling is generally offered together with palliative care by hospice or hospital staff when appropriate or requested. 

An end-of-life counselor provides emotional, psychological, and spiritual support to both the patient and their family.

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The purpose behind end-of-life counseling is to provide the patient and family with an opportunity to learn about end-of-life options and to guide them into selecting an action plan that’s best for them.

A terminal patient will have the opportunity to explore the different care options, what end-of-life directives should be considered, and who and where they will receive their final care. Their wishes are taken into consideration, and accommodations are made whenever possible. The patient and their family may have several end-of-life questions that can best be answered by a professionally trained counselor.

End-of-life counselors help a dying patient and their families with the following:

Processing of emotions

A person who’s facing the end of their life may not know how to process what they’re feeling. Generally, a feeling of overwhelm, grief, and sadness accompanies the news that they’re dying. Their family and loved ones may also have difficulty processing and accepting a terminal diagnosis.

A counselor will help the patient and family recognize and explore their feelings and emotions. They serve to educate the patient on the grief process, and they answer any questions about death that they may have. 

Situating end-of-life issues

There can be a lot of red-tape associated with dying. This may include making financial and pre-need funeral arrangements, drafting a will, and signing advanced healthcare directives.

A legal or financial counselor helps ensure the patient or family takes care of the end-of-life planning checklist recommended to most people concerned with estate planning.

Offering spiritual care and guidance

Another often overlooked aspect of end-of-life counseling is obtaining proper spiritual care and guidance. This type of counseling helps patients come to terms with their approaching death regardless of their spiritual or religious backgrounds. It also helps their families reconcile death and their spiritual beliefs concerning death, dying, and the afterlife. 

There are many other aspects related to end-of-life counseling. Everyone’s needs are different, and a counselor can ensure that they are all met. 

Who may need it

Those facing a terminal illness, advanced age, or who’ve suffered an accident can all benefit from receiving end-of-life counseling. Family and friends should also consider obtaining counseling to help them process their grief and get answers to their many questions. 

Here are some of the more common things that people may experience emotionally when they are confronted with the end of life:

Fearful people

Many people are afraid to die, but may not know exactly why they fear it. An end-of-life counselor will help you determine what part of death and dying causes you stress and anxiety and why. While it may not be as severe as thanatophobia, counselors can help address past traumas with you and current concerns to help you reconcile your fears. 

A counselor will address issues such as being afraid of dying alone, whether death hurts, and finding purpose and meaning in your life. Once you’re able to recognize your fears, it becomes easier to face and manage them. 

Angry people

A common reaction to getting the news that you’re dying is one of anger. Most people are not ready to die, and they become angry at learning that their life has been cut short. Those who have lived a long life may feel angry that they didn’t get to fulfill some of their life goals. Sometimes this anger manifests in the form of resentment towards others. A dying patient may take it out on their doctors, caregivers, and loved ones.

Regretful people

Many people live with guilt and shame at some point in their lives. When they get the news that they’re dying, this regret tends to resurface over the things they’ve said or done to cause hurt and resentment in others. They may also regret not reconciling with loved ones or offering and accepting apologies. 

Regret also comes in the form of not having lived a full life, not getting to do and see the things on a bucket list, or not living long enough to see children grow into adults. An end-of-life counselor will address the above concerns and help you work through your death anxiety, make sense of your life, and will encourage you to discuss spiritual or religious considerations. 

Who Usually Offers End-of-Life Counseling?

End-of-life counseling is traditionally given by hospice chaplains, a patient’s pastor or spiritual advisor, doctors, grief counselors, hospice organizations, doulas, or laypersons. Depending on your needs and the resources available to you, any or all of these individuals can help you prepare for the end of life. 

The following will help you determine which type of counselor is best for you. In some circumstances, you may need to seek the advice of one or more different types of counselors. 


Many physicians don’t offer end-of-life counseling because they either aren’t adept at giving it, or their patient’s insurance doesn’t cover it.

When provided, it makes for a deeper relationship between physician and patient. Those who offer it provide medical care and support through the end of life to both the patient and their immediate family. 

Attorneys and financial advisors

Although lawyers and certified public accountants (CPAs) don’t immediately come to mind when talking about end-of-life counseling options, they do have a place in the overall death planning for both the patient and their family.

Lawyers and financial advisors typically help with the recommended end-of-life documents such as wills, trusts, and healthcare directives and provide financial advice.

Chaplains or pastors

A chaplain or pastor can also provide end-of-life counseling from a religious or spiritual standpoint. They help ease suffering at the end of life and help those who are in spiritual distress. In general, spiritual care is known as pastoral care, and it supports patients and families through the end-of-life and grieving process. 

Most patients who request this type of counseling will benefit from it, whether they’re religious or not. It tends to have a calming and uplifting effect on patients and their families who are distressed and need to find peace. Other benefits of spiritual end-of-life counseling are helping the patient find meaning in their life and offering strength and hope.

Grief counselors or therapists

Generally, a grief counselor or therapist offers bereavement support to those suffering through loss. Typically a bereaved person will seek counseling to alleviate grief symptoms such as fear, anxiety, regret, and longing. 

A grief counselor or therapist can also be beneficial to those facing death by helping them process the grief that comes with the anticipation of death and other feelings and emotions that they may be having difficulty reconciling. 

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Hospice organizations

Many terminally ill patients will receive end-of-life counseling as part of the medical, emotional, and spiritual care they receive through hospice. This service is offered to the patient and their family before and after death. 

Not everyone gets hospice care at the end of life. For those who do, this resource is usually available free of charge.

End-of-life doula

A doula is more commonly used when giving birth. However, a new trend has emerged in utilizing death doulas who offer support through the end of life. A doula will sit with the dying patient, offer comfort, and listen to them. 

In some instances, a doula will arrange for music therapy to usher a more peaceful transition into death. 

Laypersons or volunteers

Many hospitals and nursing facilities have a roster of available layperson volunteers who will come in and sit with patients and families.

Sometimes they are specially trained to offer end-of-life counseling, but mostly they come in as additional support to the nursing staff. 

What Happens During End-of-Life Counseling?

You can expect a traditional counseling session to focus on you and your end-of-life needs. 

A counselor will listen closely to your thoughts and fears, recognize your feelings, and help you understand them and explore your deeper feelings regarding death and dying.

How to Find a Great End-of-Life Counselor Near You

When looking for the right counselor for you, you have many options to choose from. However, finding the right end-of-life counselor for you goes beyond attaining the services of the highest-rated professional in your area. Individuals struggling with end-of-life transitions have different needs than those suffering through loss. 

As a result, the counseling goals are very different and often require the therapist to dig deep into their client's background to give them the best guidance as they prepare for death. The following suggestions may help you find a counselor that's better suited for your individual needs than merely going off online ratings or general recommendations.

Make sure you get along

End-of-life counseling clients die at the end of their treatment with their counselor or therapist. Because of this, the longer the two are acquainted, their relationship tends to develop into a more personal connection. You’ll want to pair up with an experienced counselor who’s emotionally mature and competent to help you with this final transition. 

End-of-life counselors help you in many aspects of life, like repairing estranged relationships, finding meaning in your life, and finding closure. The right one can guide you through your final moments of life and help you find peace before you die.

Interview several before deciding

Many people don’t know that you can interview end-of-life counselors regardless of who’s paying for their services. For insured individuals, you’ll likely have a list to choose from, meaning it may be a bit more challenging to find the perfect counselor for you. 

However, don’t lose hope. Ask to speak with an insurance representative to check for any special conditions. For private-paying individuals, only your location and budget will limit your choices. Always ask for a free consultation to get a feel for the counselor and ask about any private-pay discounts. 

Look for one that’s culturally competent

Finding an end-of-life counselor that's competent to not only deal with death, dying, and bereavement but who's sensitive to your cultural needs can be challenging. Private hospice organizations provide social services to patients and their families. They can be an excellent source of information to help connect you to a counselor outside of their often-overloaded casework. 

A counselor who's skilled in addressing the issues of different cultures may better serve your cultural background and traditions. Multicultural competence is required of a great end-of-life counselor to guide their clients successfully.

How Do You Become an End-of-Life Counselor?

To become licensed as an end-of-life counselor, you’ll typically need to hold a bachelor’s or master’s degree in counseling or social work. Most organizations look for these minimum requirements in the professionals they employ. 

Outside of the educational background requirements, employers look for highly skilled and empathetic candidates who understand the needs of individuals facing the end of life. You’ll want to carefully look into if this is the right career field for you because of the constant pain and sorrow you’ll confront daily. If you’re sure this is right for you, here are some tips and considerations for becoming an end-of-life counselor.

Do your research

As with any job or career, there are both pros and cons to working as an end-of-life counselor. Generally, individuals entering this field are highly empathetic and understand the human desire to live a personally fulfilling life. They are also in control of their emotions and can offer a dying person advice and counseling without allowing their personal feelings and opinions to get in the way. 

As much as your role as a counselor is emotionally demanding, it’s equally rewarding. You’ll learn to adjust to the constant presence of death and dying to focus on the more humane requirements of showing empathy, listening without judgment, and helping individuals navigate the grieving process at the end of life. 

Apply to an accredited institution

To become eligible to practice as an end-of-life counselor, you’ll need to obtain the proper basic educational requirements, at a minimum. Ensure that the institution you choose has the appropriate accreditation to practice in your state or where you think you may end up living. 

Many universities offer a four-year bachelor of arts degree that can be a stepping stone to the career of your dreams. Many counselors and therapists attain a graduate or postgraduate degree to access the more lucrative and higher-paying positions in this field. 

Get hands-on training

Earning a degree is sometimes just the first step to fully understand the complexities of any career. Becoming an end-of-life counselor isn’t any different. You’ll want to extend your education beyond the classroom to gain clinical experience. Consider training under an experienced and highly regarded counselor in the field whenever possible. 

Working one on one with clients is the fastest way of becoming competent in your work and learning how to handle the emotional rollercoaster that is your work initially. Within a few months, you should have gained enough experience to tackle your very own clients without much supervision.

What Does Death Counseling Mean For Everyone?

An end-of-life counselor will not only prepare you for death but will offer you reassurance and affirmation up until the point of death. A part of their job is to ensure that all of your emotional, spiritual, and psychological needs are met or that you are referred to an appropriate counselor who can help you with processing your grief. 

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