NYU Silver Summer Lecture Series Addresses Palliative Care
Clinical Associate Professor Susan Gerbino gave an impassioned, informative lecture on the challenging, oft-misunderstood, and invaluable field of palliative social work on Tuesday, June 24, as part of the Silver School of Social Work’s Summer Lecture Series. The lecture series features presentations on a variety of topics by NYU Silver faculty and guest speakers.
Gerbino, a 37-year veteran of the palliative care field who serves as coordinator of NYU Silver’s Westchester campus and is director of the Zelda Foster Studies Program in Palliative and End-of-Life Care, began the lecture with some terminology clarification. Palliative care and hospice care have elements that overlap, and are therefore often used interchangeably, but the two are not synonymous. Palliative care, as Gerbino described it, “is not about dying; it’s an extra layer of care for serious, chronic conditions and advanced illnesses, provides pain and symptom management, and can be helpful for people who are at a fork in the road, to help determine their goals of care.” The World Health Organization defines palliative care as “applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”
Hospice care, on the other hand, is a concept of care geared toward providing comfort and support to patients with a life-limiting illness that no longer responds to cure-oriented treatments. According to the Hospice Foundation of America, “Hospice care neither prolongs life nor hastens death… the goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.”
The two systems, Gerbino argued, are vital treatment models for all social workers to learn because death, dying, and illness “cut across all fields of practice and affect us personally.” Both models utilize a humanistic, biopsychosocial-spiritual approach that is in keeping with social work’s philosophy of looking at people as a whole. “[In the medical system] there is a great deal of otherizing or medicalizing of human beings: ‘cancer patient’ as opposed to a person with an identity, dreams, likes, and dislikes,” said Gerbino. Palliative care steers away from impersonal medical labels and uses an interdisciplinary team approach to address the varied needs of patients and their family systems for the goal of enhancing quality of life.
The person-focused emphasis of end-of-life care is becoming increasingly popular in the field, and is one that Gerbino hopes will make waves throughout the medical system. “Good medical care is usually only available to people of privilege,” she explained. “My hope is that some of what we do in the palliative and end-of-life care world will ‘move upstream,’ so that someone is going to care for you in a holistic way.” The biggest stumbling block to such an ethos in the United States, Gerbino shared, is the “‘treat, treat, treat’ mentality, which is right for some clients but not for all.” There is beginning evidence that curative-focused care alone may not be the best method for extending life. People with certain advanced metastatic diseases who have early palliative care may actually live longer than those who opt for standard care only.
The palliative care model upends the traditional boundaries created through the labeling of “therapist” and “client.” It requires the clinician to rethink the concept of of “social worker” or “therapist” and instead adopt a role of one individual helping another through his or her journey toward a “recognizable self,” which Gerbino explains as “Who am I now that I am ill? Who was I before?” This work actively encourages clinicians to bring their personalities to the table: “When working with the seriously ill, don’t be afraid to bring who you are, because that can be a source of great strength,” encouraged Gerbino. In her own practice, Gerbino views her work with clients as an exploration of various narratives on a journey towards the recognizable self. And in this humanistic focus, the client takes the reins: “They’re leading, and I’m following. Mostly it’s bearing witness, and creating Winnicott’s idea of a holding environment.”
Gerbino did not sugarcoat the difficulty of this field of social work. In addition to her work at NYU Silver, she runs a private practice in which she sees both bereavement and family therapy clients. “By far the most difficult clinical work I do is palliative, end of life, and bereavement,” she explained. “The number one reason it is difficult is because it’s very hard to ‘otherize.’ You can never say ‘I will never be ill, or die, or lose someone.’ So the boundary between client and social worker is more permeable, less rigid. That’s the ‘threat.’” But this lack of otherization is also what makes palliative care such an effective, positive model of humanistic, holistic care for clients, and a fulfilling and fascinating field for social workers. “There is a strong sense of intimacy in this work,” she said. “It is two people facing something together that you yourself have faced or one day will face. At its heart, it’s relational work.”
Students interested in pursuing palliative, hospice, or end-of-life care are encouraged to consider the Zelda Foster MSW Fellowship, a four-year program through the Silver School of Social Work whose mission is to educate, develop, and mentor the next generation of palliative and end-of-life care social workers.