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6 Psychotherapy Questions for Medically Ill Patients

6 Psychotherapy Questions for Medically Ill Patients

  • This is a brief psychosocial tool that offers compassionate, tailored care using existential neuroscience, a new perspective for conducting bedside psychotherapy.

  • Assertive coping is the ability to confront adversities in a goal-directed and problem-solving manner, rather than avoiding, withdrawing from, or submitting to them. A failure to cope assertively with a medical illness and its treatment prompts a psychiatric assessment to gauge where and how to focus a medical intervention. Relational coping is a common coping response to adversity. Many individuals turn first to important relationships, rather than to individual problem solving.[1,2]

  • Patients coping with severe illness can become so apathetic that they lose their capacity to be motivated by either pleasure or pain. Impaired relational coping can result from markedly dissimilar processes: apathy, depression, negative symptoms of psychosis, or avoidance cluster symptoms of PTSD; logistical obstacles to family or friend visits; relational cutoffs due to alienated friends or family members; patient’s efforts to hide distress to protect loved ones from witnessing his suffering; emotion dysregulation that alienates family members and friends.

  • Helping a patient who uses relational coping begins by assessing which types of relationships matter most and how, then reestablishing access to that relationship or reproducing its function by using members of the treatment team as proxies. These 6 questions can be used to assess relational coping and mobilize assertive coping.[3-6] The also act as a springboard to further action.

  • 1. This is difficult to face alone—who do you want to be there to support you during your illness? This is difficult to face alone. Responses to this question indicate which kinds of relationships are most important. From the moment of entry into the room, meeting the patient as another person takes precedence over any other agenda. This entails learning about the priority of concerns.

  • 2. On your most difficult days, who do you want to turn to for support on your most difficult days? Hospitalizations too often strip patients from their vital connections. Yet the missing relationships or their functions often can be restored. Existential neuroscience offers a new perspective for conducting bedside psychotherapy that can contribute to its greater effectiveness, efficiency, and portability across clinical settings.

  • 3. Does anyone know what you are really going through? Who do you talk with about your illness? A creative consultation-liaison psychiatry service can replicate the roles of confiding relationships and social network relationships when patients are physically cut off from contact with familiar people.

  • 4. In whose presence do you most feel at peace? For patients with active religious lives, prayer and spiritual practices provide confiding and/or attachment relationships with the Divine or with important people and even pets.

  • 5. To whom does it matter that you recover from this illness? Relational interventions can be made by facilitating hospital visits by important attachment or confiding figures (parents, children, siblings, partners, or companions, either in person or electronically). Clinicians can also help a patient to reassert a family or work group role (eg, suppporting an elderly patient's position of family leadership during a family meeting of illness-related issues).

  • 6. To whose life do you most want to have made a contribution? In whose life will you make a difference? This question facilitates a patient's efforts to contribute to the lives of others, whether by kindnesses shown to patients or by phone calls or e-mails to individuals outside the hospital. For someone with a chronic medical illness, this means imagining a life worth living despite the illness.

  • For more information
    This information is based on an article by James L. Griffith, MD and Lynne Gaby, MD “Brief Psychotherapy at the Bedside: Existential Neuroscience to Mobilize Assertive Coping.”


Helping a chronically ill patient who uses relational coping begins by assessing which types of relationships matter most and how, then reestablishing access to that relationship or reproducing its function by using members of the treatment team as proxies. These 6 questions can help to begin a conversation; they do not replace but complement other psychotherapeutic tools that can be implemented in brief encounters.

Scroll through the slides for the discussion and questions.

This slideshow article was originally posted 3/18/2016 and has since been updated.


Dr Griffith is Leon M. Yochelson Professor and Chair and Dr Gaby is Clinical Assistant Professor in the department of psychiatry and behavioral sciences at The George Washington University School of Medicine, Washington, DC. The authors report no conflicts of interest concerning the subject matter of this article.


1. Singer T, Seymour B, O’Doherty J, et al. Empathy for pain involves the affective but not sensory components of pain. Science. 2004;303:1157-1162.
2. Tucker DM, Luu P, Derryberry D. Love hurts: the evolution of empathic concern through the encephalization of nociceptive capacity. Dev Psychopathol. 2005;17:699-713.
3. Griffith JL, Gaby L. Brief psychotherapy at the bedside: countering demoralization from medical illness. Psychosomatics. 2005;46:109-116.
4. Breitbart W, Gibson C, Poppito SR, Berg A. Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry. 2004;
5. Griffith JL. Locating personal spirituality through existential inquiry. Religion That Heals, Religion That Harms. New York: Guilford Press; 2010:81-95.
6. Griffith JL. Existential inquiry: psychotherapy for crises of demoralization. Eur J Psychiatry. 2013;27:42-47.


The points are common .. but not practiced or implemented ..

S.D. @

Hi - I cannot open/see the slides.
Please email them to me at


many thanks

norman @

This has been very very helpful. You did a fantastic job of having patients think about what lies ahead for them and for the counselor or therapist. I also found another way to have patients reach out to their love ones if or whenever they decide to feel that life is worth living. And that is to have the hospital where the patient is at, to get access to the internet so that they can reach out to friends and family in an email. They can take their time to decide what to say and how to say it without other influences. But it has to be a mutual understanding with the therapist that if they need help there is always someone they can rely on for help. Some patients may not have access to internet at the hospital, but hospitals can provide computers to the chronically ill only with the therapist ok and they can be check out to the patients who really want to help themselves cope with their illness. When you have a patient who has a chronic illness, you need to help in anyway you can. And if you can't get the patient to talk then you just can't let the patient close down emotionally. Then if crisis sets in, you may have to do things that as a therapist or counselor you hope that you wouldn't have to do.

Nancy @

I am having difficulty viewing too. May I request a copy emailed to dishamilitia @gmail.com ? Appreciatively,

Tasnia @

Where are the questions?

Kaulana @

Can't see the questions. Could you pls email them to me TIA ripetty1@aol.com

Richard @

Hi having difficulty viewing questions, could you please email them to me.
Kind regards, Sharon

Sharon @

Thank you very much. This is very helpful and thoughtful, brief and usable.

Merrilee Nolan @

This is excellent approach, It's simple for both the client and the psychiatrist or therapist. It provokes connection and begs for other's who are significant to the person to be involved. It sets the stage for more compassionate care and understanding from those involved. The outcome can only be good. Well put together.

Brenda E @

Clients/patients should have always have a crisis awareness plan, which includes this kind if information and which has been done with them. Also if the client is agreeable to it, a carer crisis awareness plan can be done too. It's a little like an advance care directive. I'm surprised they aren't automatically done as part of the care plan.

Michelle @

Joan Haliburn
Sydney, Australia
Thank you for this very short, but extremely useful technique to tap into the patient's relational system, when he/she is terminally ill. We have a short term psychotherapy program 1-3 http://www.psychiatrictimes.com/career/classifieds/pennsylvania/seeking-... and 10-20 sessions which is rolled out to cater to numerous types of problematic presentations, including psychosomatic, but have never used it for terminally ill patients. Particularly when relational coping is the bedrock of our therapy, you article has given me ideas to have it used in this population too.
Joan H


Is anyone else having difficulty getting the slide show to work ?

Domenic @

Hi Domenic
Thanks for your interest! Please make sure your ad blockers are disabled - or - you can try a different browser. If those options don't work, please feel free to email me at editor@psychiatrictimes.com. We would be happy to get this info to you.
Laurie Martin
Digital Managing Editor
Psychiatric Times

The @

I followed those instructions but still won't work. Can you send to me at Jeanette Pollard, jmprnrev@hotmail.com? Thanks.

Jeanette @

Yes...won't work for me either.

Jeanette @

Great presentation, hope to use these questions often...

Spencer @

Thnanks so much!

enrique @

30-40 years ago, when we were still physicians (not just providers) we took the time to speak with our terminally ill patients and we discussed these issues. what we may have missed wwas picked up by the spiritual adviser.

Martin @

my memory of 30 and 40 years ago is quite different. Physicians almost never spoke about these issues to terminally ill patients and so patients turned to the people at their bedside, the nurses. If the nurses said anything, they were disciplined for being out of their place. The patient was left hanging and thankfully, usually died not long thereafter.
Now many of those same nurses have become very much needed and highly respected Advanced Practice Registered Nurses.
I am not saying the world does not need physicians, because it certainly does. But there has been a very large gap in patient care and communication that has been filled by NP's .Many of whom do jobs that physicians would not want to do

Marilyn @

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