Coma Therapy

A significant number of people will experience a coma in the process of dying. As people approach death, they often enter more or less remote states of consciousness for varying periods of time. These states may appear painful for the one dying and cause grief in loved ones. But coma therapists believe that altered states present opportunities, including a chance to complete unfinished business, explore meaning in life, and make spiritual connections.

In order to support a loved one who is near death, family and friends should become acquainted with some basic tools of coma therapy. These easy to learn skills can help people in coma become more aware and communicate better with themselves, friends and relatives, and the larger world. Here are a few core principles of coma work.

• Presume that persons in coma are always communicating to some extent. We need to be astute enough to pick up their cues and reactions.
• Working with those in coma can be invasive if done thoughtlessly. It is important to: always introduce yourself, ask permission to communicate, and pay close attention to feedback.
• If you attempt to communicate with someone in coma, they may show no change in the communication pattern. A lack of response indicates negative feedback. This means it is time to try something else.
• Whatever is happening during your interaction with a comatose person is potentially meaningful, including small changes in breathing, eye movement, a tear, a swallow, or a twitch of the body.
• Relating with people in altered states of consciousness, coma therapists find four categories, or channels of awareness, to pay attention to: visual, auditory, body sensation, and movement channels. In most cases, simply paying attention to a person’s breath will indicate which channel of communication may be open.
• Since the comatose person rarely speaks, it is important to respond to any movements or cues with blank access interventions; that is, speak in an affirming way about what you observe without judgment or evaluation. For example, if a tear appears, instead of presuming sadness, simply acknowledge that there is water coming from the eye. It could be a tear of joy or a mechanical reaction to something environmental.
• Coma therapy takes time. Be persistent with your communications and sensitive to feedback from the patient.
• Trust that by doing coma therapy you are helping your loved one or client to complete their inner work. If they do complete their inner work, they can use information from their inner and outer experiences to make important decisions, including coming out of coma, and life and death choices.

You need courage, awareness, and caution to communicate with someone in an extremely altered state. Trust your intuitions and body feelings. Consider purchasing one of the available resources that teach basic communication skills with comatose persons. Be willing to experiment with interventions, but respect your personal comfort limits. If you feel uncomfortable and tired, you can assume that your care receiver feels the same. If after several attempts you receive no response, say good-bye for the time being. Be willing to check out your presumptions and experiences with a trained professional or coma therapy manual. For everyone’s safety, coma therapy should be done with supervision and consent from family and medical staff.

Summarized by Margaret Verschuur from American Book of Dying (Groves, Klauser), using the work of Dr. Arnold Mindell.