Did you know that nearly 20% of the U.S. population is now over the age of 65? With aging comes not only the richness of life experience but also the challenges of preparing for the final stage of life. End-of-life planning and conversations can feel overwhelming, yet they are among the most important tasks older adults and families face together.
For marriage and family therapists (MFTs), this stage of life offers both challenges and opportunities. Grief, loss, and transitions rarely occur in isolation. They affect entire family systems—partners, children, caregivers, and extended networks. When families avoid or delay these conversations, they often face conflict, confusion, and unprocessed grief. As MFTs, we can help families approach end-of-life tasks with honesty, compassion, and hope.
Why Continuing Education in End-of-Life Care Matters
End-of-life issues touch every family, yet many therapists feel unprepared to initiate these conversations. Continuing education in this area is essential because it:
- Builds clinician confidence and competence. Few topics are as emotionally charged as death and dying. Specialized training helps therapists approach these conversations with clarity and compassion
- Expands the impact of systemic therapy. End-of-life care involves not only patients but also families, healthcare teams, and community systems. MFTs are uniquely positioned to bridge these worlds, and advanced training equips us to do so effectively
“When therapists increase their comfort with death and dying, they empower families to approach the end of life with courage instead of fear.”
Three Insights for MFTs Working With Older Adults and Families
- Advanced Care Planning Is a Family Task
End of life often involves decisions about goals of care and treatment preferences. These conversations are not just medical—they are relational. Families must navigate values, cultural beliefs, histories of grief, and differing hopes for their loved one. MFTs can create space for these conversations, ensuring that the voice of the patient remains central while also supporting family members in processing their own fears and grief. - Structured Life Review Can Promote Peace and Integrity
Drawing on Erikson’s stage of integrity versus despair, the structured life review is a powerful intervention at the end of life. By reflecting on key life moments, relationships, and meaning, older adults often find a sense of coherence and peace. For families, hearing these stories can provide comfort and a shared narrative that sustains them through loss. - Family-Focused Grief Therapy Builds Connection and Coping
This evidence-based, short-term intervention enhances communication, addresses conflict, and supports shared meaning-making. It helps families facing illness and loss strengthen bonds, navigate role changes, and prepare for the future. For MFTs, it is a practical and relational approach that aligns with our systemic worldview.
A Key Resource: The Family-Framed Caregiving Model
Developed by Carol Podgorski, PhD, the family-framed caregiving model is a biopsychosocial-ecological framework that is both person-centered and family-framed, shifting the focus from individual caregivers to the entire family system. This model emphasizes the importance of addressing relational dynamics alongside individual care needs and advocates for incorporating family relational history assessments, interprofessional education, and interdisciplinary collaboration to better support both the patient and their caregivers. This approach helps families facing end-of-life caregiving:
- Share responsibilities more equitably
- Identify both strengths and strains within their system
- Encourage open dialogue about expectations and limits
- Reduce caregiver burnout by framing care as a family task, not an individual’s duty
For MFTs, this resource offers a systemic lens that resonates with our training and provides a concrete structure for supporting families during end-of-life care.
Interested in exploring Dr. Podgorski’s model and more resources for working with older adults? Check out AAMFT’s new Systemic Family Therapy Certificate, Effective and Meaningful Relational Therapy with Older Adults. Use code Certificates to save 10% when you purchase before November 15!
“Caregiving is not a solo journey—it is a family story that requires honesty, flexibility, and shared responsibility.”
Key Takeaways for MFTs
- End-of-life care is not only medical—it is deeply relational
- Structured life reviews and family-focused grief therapy provide practical, evidence-based ways to support clients
- The family-framed caregiving model helps reduce isolation and promotes systemic solutions
- Continuing education strengthens both therapist confidence and client outcomes.
Final Thoughts
Death and dying are universal experiences, yet the way we approach them shapes how individuals and families cope, grieve, and find meaning. As MFTs, we have the privilege of walking with families during some of the most vulnerable moments of life. By integrating systemic models and relational interventions into our practice, we can help families face these transitions with dignity and hope.
Continuing education in end-of-life care is not just professional development—it is an investment in our clients’ well-being and in the strength of the families we serve.
Dr. Jessica Goodman, PhD, LMFT is an Assistant Professor of Psychiatry and Medicine at the University of Rochester School of Medicine & Dentistry. As a clinician, her work since 2018 has focused primarily on integrated relational healthcare with older adults and their families, as they navigate family life cycle and illness impacts during inpatient medical and skilled-nursing care. As an AAMFT approved supervisor, she has directed two MFT practicum sites that serve this population, including the integration of medical family therapy into inpatient medicine and geriatrics, supervising MFT trainees as they learn to work on healthcare teams to facilitate whole-person, relational care. As a scholar, Dr. Goodman is using a translational science approach to develop, implement, and test a structured approach to teaching interdisciplinary teams to enhance interdisciplinary team knowledge in areas such as recognizing depression in older adults and discerning death ideation from suicidal ideation. Dr. Goodman has earned two early career awards for integration of behavioral health in medical, interdisciplinary teams, including the Geriatric Faculty Scholars Award (2021-2022) and the VA Center for Integrated Healthcare (CIH) Incubation Grant.
