From Goals to Meanings: The Role of Psychotherapeutics for Psychiatrists Working with Palliative Care

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Palliative care has become the standard of care for individuals across a spectrum of serious and life-limiting illnesses. Palliative care focuses on understanding and managing distress in physical, psychosocial, and spiritual domains, complex symptom management, and exploring patients’ values. The provision of palliative care is often steeped in individual, dyadic, and group dynamics uncovered or exacerbated by the stressors of serious illness, mortality, high stakes medical decision-making, and physical symptoms. Palliative care communication paradigms are often oriented around serious illness care foci like goals of care and prognostication, which only partially captures this complexity. Consultation-liaison psychiatrists offer palliative care clinicians and patients expertise in understanding and managing complex dynamics including psychiatric formulation, psychotherapeutic interventions, and judicious use of psychopharmacology to help contain unmanageable affect. Despite complementary skillsets between CL psychiatry and palliative care, these specialties often remain siloed due to structural barriers, biases, and limited opportunities for co-education.

This panel will focus on the role of psychiatrists in utilizing psychotherapeutically-informed skills within the psychiatric-palliative care interface for the purposes of educating palliative care clinicians, improving patient care, and addressing inter-team conflict. Four psychiatrists both with and without palliative care training will each describe psychotherapeutically-informed approaches to their work with palliative care services.

Dr. Jacobowski will present from the perspective of dual training in child and adolescent psychiatry and pediatric palliative care, reviewing psychiatry education commonly provided in palliative care training, yet ongoing gaps in primary psychiatric skills and knowledge for palliative physicians. She will discuss the role of the embedded psychiatrist as role model and educator with a particular focus on how psychiatric formulation and basic psychotherapeutic skills serve as an important foundation for teaching primary psychiatry skills and addressing those educational gaps.

Dr. Gerwin will utilize a case-based approach to present psychiatry-palliative care collaboration in the care of hospitalized patients with serious illness from early childhood through young adulthood. She will focus on delineating psychiatry and palliative care roles in a complementary way and on how to incorporate concepts of grief, acceptance, and resilience into CL practice.

Dr. Chammas will share her experience translating psychiatric/psychotherapeutic concepts such as formulation into didactics for palliative care providers. She will share challenges and strategies for translating ideas that may seem foundational or basic to psychiatrists to a palliative care audience.

Dr. Shalev will discuss an initiative to develop literature aimed at helping palliative care providers to “think like psychotherapists.” He will discuss a multisite collaboration aimed at defining “psychological elements of palliative care” (PEPC) and an upcoming paper series in the Journal of Palliative Medicine focusing on high yield concepts in PEPC such as formulation, transference/countertransference, the holding environment, attachment etc. and how these concepts interpolate and modulate the palliative care encounter.