Dr. Manju Antil | Counseling Psychologist | Psychotherapist | Educator| Founder- Wellnessnetic Care

Counselling in Medical, Psychiatric and Palliative Care Contexts

Illness—whether physical, psychological, or terminal—extends beyond biological symptoms to affect emotions, identity, relationships, and meaning in life. Counselling in healthcare settings responds to this broader human impact by addressing psychological distress, coping, decision-making, and dignity alongside medical treatment. The World Health Organization conceptualises health as complete physical, mental, and social well-being; counselling operationalises this ideal in medical, psychiatric, and palliative care contexts, each requiring distinct goals, skills, and ethical sensitivity.

1. Counselling in Medical Care Contexts

Nature and Scope

Medical counselling supports individuals dealing with acute, chronic, or life-altering physical illnesses and medical procedures. While physicians treat disease processes, counsellors address the psychological meaning of illness and its impact on daily functioning.

Common contexts: diabetes, cancer, cardiovascular disease, neurological disorders, chronic pain, trauma and rehabilitation.

Emotional and Psychological Concerns

• Shock and denial following diagnosis

• Anxiety related to prognosis and procedures

• Depression due to loss of functioning or role changes

• Anger, helplessness, and fear of dependency

• Non-adherence to treatment as avoidance or denial

Objectives

• Facilitate acceptance and emotional adjustment

• Reduce stress, anxiety, and depressive symptoms

• Improve treatment adherence and lifestyle change

• Strengthen coping skills and resilience

• Support families and caregivers

Interventions

• Psychoeducation about illness and treatment

• Cognitive–Behavioural Therapy (CBT) for pain and stress

• Motivational interviewing for health behaviour change

• Relaxation and mindfulness techniques

• Family counselling for chronic illness management

Case Study – Medical Counselling

A 46-year-old woman diagnosed with rheumatoid arthritis frequently missed follow-ups and avoided physiotherapy. Counselling revealed grief over loss of independence and fear of being a burden. Through psychoeducation, CBT-based coping strategies, and family sessions, she accepted the chronic nature of the illness and demonstrated improved adherence and emotional stability.

2. Counselling in Psychiatric Care Contexts

Nature and Scope

Psychiatric counselling addresses mental, emotional, and behavioural disorders, usually in combination with pharmacological treatment. It is delivered in hospitals, outpatient clinics, and community mental health settings, requiring close collaboration with psychiatrists and multidisciplinary teams.

Common disorders: depression, bipolar disorder, anxiety disorders, schizophrenia, substance use disorders.

Emotional and Psychosocial Challenges

• Stigma and self-stigma

• Poor insight and resistance to treatment

• Emotional dysregulation and interpersonal difficulties

• Risk of relapse and suicide

• Family stress and caregiver burden

Objectives

• Symptom reduction and emotional stabilisation

• Development of insight and coping skills

• Medication adherence and relapse prevention

• Psychosocial rehabilitation and community reintegration

Counselling Approaches

• Cognitive Behaviour Therapy (CBT)

• Psychodynamic counselling

• Person-centred counselling

• Family therapy to reduce expressed emotion

• Group therapy and psychoeducation

Case Study – Psychiatric Counselling

A 24-year-old postgraduate student with major depressive disorder reported hopelessness and passive suicidal ideation. Alongside medication, CBT-based counselling focused on cognitive restructuring, behavioural activation, and safety planning. Family psychoeducation reduced blame and stigma, leading to improved mood and academic functioning.

3. Counselling in Palliative Care Contexts

Nature and Scope

Palliative counselling supports individuals facing life-limiting or terminal illnesses, focusing on quality of life, dignity, and meaning, rather than cure. It extends to family members and includes bereavement support.

Typical contexts: advanced cancer, end-stage organ failure, neurodegenerative disorders.

Emotional and Existential Concerns

Patients:

• Fear of death and dying

• Existential distress and loss of meaning

• Loss of autonomy and dignity

• Unresolved relationships

Families:

• Anticipatory grief

• Guilt and helplessness

• Caregiver burnout

Objectives

• Alleviate emotional and existential distress

• Facilitate acceptance and meaning-making

• Support end-of-life decision-making

• Preserve dignity and autonomy

• Provide grief and bereavement counselling

Interventions

• Supportive and presence-based counselling

• Existential and meaning-centred therapy

• Life review and dignity therapy

• Spiritual and culturally sensitive counselling

• Family and bereavement counselling

Case Study – Palliative Counselling

A 68-year-old man with terminal lung cancer expressed fear of death and concern for his family’s future. Counselling focused on emotional expression, life review, and reconciliation with family members. Family sessions addressed anticipatory grief. The client reported emotional peace and acceptance during the final phase of life.

Ethical and Emotional Aspects Across Contexts

Ethical Considerations

• Informed consent and respect for autonomy

• Confidentiality within multidisciplinary teams

• Balancing beneficence and non-maleficence

• Cultural sensitivity and respect for beliefs

• Boundary management in emotionally intense settings

Emotional Demands on Counsellors

• Exposure to suffering, trauma, and death

• Risk of compassion fatigue and burnout

• Need for supervision, reflective practice, and self-care

Comparative Overview

Conclusion: Holistic Integration

Counselling in medical, psychiatric, and palliative care contexts represents the holistic integration of mind, body, and meaning in healthcare. Medical counselling supports adjustment to physical illness; psychiatric counselling promotes recovery and psychosocial functioning; palliative counselling preserves dignity and emotional peace at the end of life. Together, these approaches transform healthcare from a purely biomedical model into a person-centred, ethical, and compassionate system, ensuring that individuals are not merely treated for disease but cared for as whole human beings.