Working with Chronic Illness, Trauma, and Hospitalised Populations

Healthcare settings bring counsellors face-to-face with human vulnerability. Unlike outpatient counselling rooms, hospitals are places where pain, uncertainty, dependency, fear, and loss are lived realities. Individuals coping with chronic illness, traumatic medical events, or hospitalisation often experience psychological reactions that are intense, confusing, and sometimes clinically significant.

The World Health Organization defines health as a state of complete physical, mental, and social well-being. Counselling psychology translates this definition into practice by addressing the emotional and psychosocial dimensions of illness, guided by diagnostic frameworks such as DSM-5-TR and ICD-11, but grounded in empathy, ethics, and holistic care.

1. Working with Chronic Illness

Understanding Chronic Illness Psychologically

Chronic illnesses are long-term medical conditions that often cannot be cured but must be managed over time. Examples include diabetes, cancer, cardiovascular disease, autoimmune disorders, neurological conditions, and chronic pain syndromes.

While chronic illness is not itself a psychiatric diagnosis, both DSM-5-TR and ICD-11 recognise that long-term medical conditions are powerful psychosocial stressors that significantly increase vulnerability to mental health problems.

For many individuals, chronic illness represents a biographical disruption—life is divided into before illness and after illness.

Psychological Responses Explained (DSM-5-TR & ICD-11)

Common diagnostic presentations include:

Adjustment Disorder

• DSM-5-TR: 309.xx

• ICD-11: MB43

This occurs when emotional or behavioural symptoms (sadness, anxiety, withdrawal, irritability) develop in response to the diagnosis or progression of illness.

👉 Example:
A patient newly diagnosed with cancer who develops persistent distress, difficulty concentrating, and social withdrawal.

Depressive Disorders

Chronic illness may lead to:

• Persistent low mood

• Loss of interest

• Hopelessness

• Fatigue beyond medical symptoms

Depression in chronic illness often arises from loss of function, autonomy, and future plans, not merely chemical imbalance.

Anxiety Disorders

Patients may develop:

• Health anxiety

• Fear of medical procedures

• Excessive worry about disease progression or death

These fears are often realistic but overwhelming, requiring psychological containment rather than reassurance alone.

Counselling Goals in Chronic Illness

Counselling aims to:

• Help clients emotionally accept the illness

• Reduce anxiety and depressive symptoms

• Promote treatment adherence

• Support identity reconstruction (“Who am I now?”)

• Enhance coping, resilience, and meaning

• Address family and caregiver stress

Counselling Interventions Explained

• Psychoeducation:
  Helping patients understand the illness and normalising emotional reactions

• CBT:
  Addressing catastrophic thoughts (“My life is over”)

• Acceptance-based approaches:
  Supporting psychological flexibility rather than resistance

• Mindfulness and relaxation:
  Managing pain, stress, and uncertainty

• Family counselling:
  Reducing caregiver burden and improving communication

Case Illustration: Chronic Illness

A 48-year-old man with chronic kidney disease became irritable and stopped attending dialysis sessions. He met criteria for Adjustment Disorder with mixed anxiety and depressed mood. Counselling focused on emotional expression, acceptance of dependency, and family involvement. Gradually, adherence improved and emotional distress reduced.

2. Working with Trauma in Healthcare Settings

Understanding Trauma in Medical Contexts

Trauma in hospitals may result from:

• Road traffic accidents

• ICU admissions

• Emergency surgeries

• Sudden life-threatening diagnoses

• Invasive procedures

DSM-5-TR defines trauma as exposure to actual or threatened death, serious injury, or sexual violence. Medical trauma disrupts a person’s sense of safety, predictability, and bodily control.

Trauma-Related Disorders (DSM-5-TR & ICD-11)

Acute Stress Disorder

• DSM-5-TR: 308.3

• ICD-11: QE84

Symptoms occur within 3 days to 1 month after trauma and include:

• Intrusive memories

• Dissociation

• Anxiety

• Sleep disturbance

Post-Traumatic Stress Disorder (PTSD)

• DSM-5-TR: 309.81

• ICD-11: 6B40

Includes:

• Re-experiencing

• Avoidance

• Hyperarousal

• Negative mood and cognition changes

Trauma-Informed Counselling Explained

Trauma-informed care is not a technique but a framework. It emphasises:

• Safety: physical and emotional

• Trust: transparency and consistency

• Choice: respecting autonomy

• Collaboration: working with, not on, the client

• Empowerment: restoring control

👉 Core principle:
Stabilisation before emotional exploration.

Case Illustration: Trauma

A 29-year-old woman hospitalised after emergency surgery experienced flashbacks and panic attacks. Diagnosed with Acute Stress Disorder, counselling focused on grounding, psychoeducation, and emotional regulation. Early intervention prevented progression to PTSD.

3. Working with Hospitalised Populations

Psychological Meaning of Hospitalisation

Hospitalisation represents loss of control. Patients must surrender routine, privacy, and autonomy. Even short admissions can trigger anxiety, helplessness, and dependency.

DSM-5-TR acknowledges that hospitalisation can precipitate:

• Adjustment disorders

• Anxiety disorders

• Depressive symptoms

• Delirium-related emotional distress

Counselling Goals in Hospital Settings

Hospital counselling aims to:

• Reduce fear and uncertainty

• Provide emotional containment

• Enhance cooperation with treatment

• Support communication with healthcare staff

• Assist families in coping

Interventions are often brief, focused, and supportive.

Case Illustration: Hospitalisation

A 65-year-old man awaiting cardiac surgery refused procedures. Counselling revealed fear of death rather than non-compliance. Supportive counselling and emotional reassurance improved cooperation and reduced anxiety.

Ethical Dimensions Across All Settings

Core Ethical Principles

• Autonomy: respecting patient choices

• Confidentiality: balanced with team care

• Non-maleficence: avoiding emotional harm

• Cultural sensitivity: respecting beliefs about illness and healing

• Boundaries: managing emotional closeness

Emotional Impact on Counsellors

Working in hospitals exposes counsellors to:

• Secondary traumatic stress

• Compassion fatigue

• Emotional exhaustion

Therefore, supervision, reflective practice, and self-care are professional necessities.

Integrative Comparison

Holistic Integration: Counselling Beyond Diagnosis

DSM-5-TR and ICD-11 provide diagnostic clarity, but counselling psychology adds human understanding. Working with chronic illness, trauma, and hospitalised populations requires a biopsychosocial-existential approach that integrates:

• Medical realities

• Psychological distress

• Social relationships

• Meaning, dignity, and hope

Together, these approaches ensure healthcare treats not just disease, but the person who lives with it.

Key References (APA Style)

American Psychiatric Association. (2022). DSM-5-TR: Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

World Health Organization. (2019). ICD-11: International classification of diseases.

Taylor, S. E. (2018). Health psychology (10th ed.).

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body.