Free Yourself from Death Anxiety: a CBT self-help guide for a fear of death and dying

Rachel E Menzies and David Veale(eds)
Jessica Kingsley Publishers 2022 ISBN: 978-1787758148 £14.99

We all know, from an existential viewpoint, that we are born therefore one day we will die. For some of us, this knowledge brings intense anxiety. Death is still a taboo.

The authors start by defining what is meant by the term ‘death anxiety’, then suggest how it might develop and how it is maintained. The aim of the book is to release a person from this anxiety so that they can live life more joyfully. Using five characters who have been drawn from real life case studies, the authors illustrate different ways that death anxiety can manifest and cause problems for a person.

It’s a self-help book that supports the process of looking at death anxiety. It invites the reader to define problems and set out goals. By doing so, there is the possibility to develop alternative ways of thinking about death. The reader can work at their own pace through the book with space to write a response to questions such as, ‘Can you identify ways of magical thinking that you have about death?’ With each question, comes the follow-up question, ‘How does this lead you to change your behaviour? For example, what do you avoid?’

From a counselling perspective, this book helps the reader to identify ways of thinking about death. A useful chapter for therapists to read is one in which the authors explain how death anxiety might develop for a person, and how we are shaped by our experiences of death as children, in the family, our culture, and in the context of religion. Even if you don’t work using CBT, some of the questions raised in the book could be worth addressing in the counselling room when death anxiety becomes a focus.

If I have a criticism about the book, it is that a client might not want to take on board so much homework, and may not be motivated to follow all the guidance given. However, for anyone who has death anxiety, and is willing to invest time and effort to work through the exercises, either independently or with the support of their counsellor, this could be valuable.

In my role as a Samaritan volunteer, and more recently since I trained as a counsellor, I have talked to many people about death. I am relatively comfortable contemplating my own death. My anxiety comes when I think about losing the people I care about the most. I was eager to read this book and was not disappointed: I found there was much I could learn.

Heather Southall MBACP Integrative counsellor

The Classics

In this series, Kevin Snow introduces the books that shaped his understanding of spirituality in a counselling context.

Staring at the Sun: overcoming the terror of death

Irvin D Yalom(eds)
John Wiley and Sons 2011 ISBN: 978-0749928780 £9.99

Yalom is a rare psychiatrist and psychotherapist who resonates with clinicians of all modalities, as well as lay readers. I had devoured several of his wise and highly readable books before turning to Staring at the Sun. I was needing guidance to get my bearings while working in an in-patient setting. Sometimes patients are admitted after recently losing loved ones or after being diagnosed with life-threatening health conditions.

Yalom is well known for his existential approach to psychotherapy. Staring at the Sun takes this further, weaving psychoanalysis and philosophy with clinical material to show how psychological defences against bereavement, age-related decline and death interweave with the usual defences with which therapists are familiar.

The book’s extensive case studies are compelling. Yalom is transparent in laying out his metaphysical scaffolding: his existential approach involves a conception of a rationalist-materialist universe in which life-after-death and supernatural phenomena are merely comforting illusions. Spiritually-minded therapists will baulk at such flimsy assumptions. But Yalom sensitively keeps the religious reader engaged, sprinkling thoughtful quotes from theologians and ancient philosophers throughout. While Yalom’s nod to ancient spiritual traditions adds to the richness, it also comes across as a rhetorical ruse, aimed at convincing the reader of the rightness of his atheistic approach, and seducing them into overlooking the book’s anti-religious prejudice.

Yalom’s wide erudition and readability don’t quite succeed in masking his own spiritual tone deafness. The author shares an anecdote where he intellectually challenges a rabbi so strongly he fears that he will destroy the man’s faith. Yalom’s belief that no psychologically healthy, intelligent person could subscribe to an ancient religious tradition reveals the author’s lack of attunement to the profound depths that the subtle poetry of scripture and worship can reach.

Despite this, Yalom appears to succeed in engaging readers of all metaphysical standpoints. Of course, the existential angst of the human condition is the bread and butter of the religious traditions. As the Judeo-Christian, Book of Ecclesiastes, bleakly reminds us, death awaits the wise and the foolish equally. The material level of existence, and the decline and eventual end of our physical bodies, is surely felt by spiritual people just as painfully as non-believers. But it has been argued that, rather than acting as a defence against death, religion can provide a framework which braces humans to bear reflection on their mortality. Ironically, Yalom’s emphasis on psychological defences against death may apply more to non-spiritual people who lack the robust, supportive structure for existential and metaphysical reflection that the spiritual traditions offer.

Staring at the Sun helped me to see what I was missing when assessing patients. While working on wards, I noticed that patients of all belief backgrounds felt able to share their thoughts on bereavement and death with the chaplain. They had not presented these aspects nearly so patently to me in their psychology assessment. This taught me to gently probe further in sessions with patients, encouraging them to explore issues such as bereavement and their own mortality.

Yalom is such a fine writer, his atheistic rhetoric does not detract from a work of real clinical richness and relevance that has value for therapists of all persuasions, and for spiritual and non-spiritual clients alike.

Chaplaincy and the Soul of Health and Social Care: fostering spiritual wellbeing in emerging paradigms of care

Ewan Kelly and John Swinton (eds)
Jessica Kingsley Publishers 2019 ISBN 978-1785922244 £24.99

I picked this book up as a ‘fledgling’ chaplain to help me in understanding my new role. This edited volume contains a variety of articles and discussions about the strategic work of chaplaincy within the healthcare system, and of suitable training for those engaged in this practice. It is not an easy read, and much contained within it is of greater relevance to those engaged in leadership, and in the training and empowering of chaplains, than those meeting with patients, carers and staff on a daily basis.

This is not a read right through book but a dip in as you need book. It is broken into helpful sections and embraces a range of chaplaincy concerns such as: who are we as chaplains? How do we meet spiritual need? How do we measure what we do? It explores different approaches to chaplaincy, training and future directions. There will be bits which are more relevant than others in the context in which you work. It raises important questions about the work of chaplains within a healthcare context, such as, how we can work more effectively and demonstrate what we do more effectively, while retaining the heart of what it is to sit with people in need.

Although I found it dry in places, there were some real gems which have been informative for my practice. Carlo Leget’s spiritual model of pastoral care for those in palliative care, based on his adaptation of the Ars moriendi, was very helpful and inspired me to learn more about this model and to use it in my daily work. It is useful, not only for those who are palliative but also for preparing older patients to think about their life and reflect upon it. Snowden and Telfer’s rather dry sounding chapter on the ‘Scottish Patient Reported Outcome Measure’ held within it a kernel of brilliance: they identified that patients reported feeling better for ‘being able to say what was on their mind’. Now when I visit a patient, I generally lead with, ‘What’s on your mind?’. It has opened up countless conversations and led to real understanding. I would suggest that this book is a must have for any chaplaincy department, if not necessarily for your own personal bookshelf.

Sian Nicholas Lay reader, hospital chaplain and spiritual accompanier