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Secrets at the End of Life

Closing Plenary
Wednesday, September 20, 2017

Dale G. Larson, PhD

Working with people facing grief, loss and life-threatening illness ushers us into a world of secrets. Clinical experience and empirical evidence now reveal how secrets and secrecy can undermine both the outcomes of hospice and palliative care and the well-being of the health professionals delivering it.  As death draws near, and the opportunity for end-of-life closure is slipping away, patients can feel a need to share their painful and often stigmatized experiences of childhood abuse, wartime trauma, self-hatred, extramarital affairs and concealed identities.  Family members, too, struggle with secrets and emotional cutoffs passed from generation to generation and with shocking postmortem revelations that can complicate both their caregiving and their bereavement. Hospice and palliative care professionals contend with family members’ requests for nondisclosure of medical information, and with their own experiences of self-doubt, burnout and moral distress, experiences often easier to conceal than to reveal.   

Navigating this world of secrets, and sensitively managing conflicts surrounding disclosure and the real-world constraints against it, are hallmarks of the effective end-of-life care professional. In this address, Dr. Larson will provide a framework for understanding the phenomena and dynamics of concealment and disclosure, drawing upon recent work in the areas of self-concealment and health, patient secret keeping, helper secrets, social constraints, the writing cure, and end-of-life conversations to offer guidelines for overcoming these barriers to quality care and professional well-being.  

Learning Objectives:  

  • Identify the ways secrets and secrecy can affect the quality of hospice and palliative care
  • Identify strategies for facilitating the safe discussion of secrets
  • Understand the psychology of secrets and the effects of self-concealment on health and well-being, especially at the end of life

Dale G. Larson, PhD

Dale G. Larson, PhD (U. C. Berkeley) is a Professor of Counseling Psychology at Santa Clara University, where he directs graduate studies in health psychology. He is a Fulbright Scholar, a Fellow in three divisions of the American Psychological Association, and member of the International Work Group on Death Dying and Bereavement.

Dr. Larson is a clinical psychologist and author of the award-winning book, The Helper's Journey: Working with People Facing Grief, Loss, and Life-Threatening Illness.  He was Senior Editor and a contributing author for Finding Our Way: Living with Dying in America, a Robert Wood Johnson funded national newspaper series that reached 7 million Americans. His scholarly publications on grief and loss, grief counseling, stress and stress management in health professionals, self-concealment and secrets, and transdisciplinary teams are widely cited, both in the scientific literature and in the popular media.

Dr. Larson is a frequent presenter at national and international conferences, and awards for his contributions to end-of-life care and training include ADEC’s 2016 Death Educator Award.