Illnesses that are considered medically critical, with the possibility of being terminal, take the patient to the point of perceiving the inevitability of the end of his or her life (Frank, 1991). Experiencing this realization, in relation to your patient, impacts not only on the patient but also on the therapist as well. This realization of the end of life, is a concept that can become a focal therapeutic issue, because it can elicit a réévaluation of the purpose and value of one's life. Group members may feel alive but removed from previous everyday tasks of living. They now have the opportunity to reflect on the life they had lived and how they would like their future to be, if in fact a future would be available to them. From his experiences and research, Frank

(1991) writes that "illness takes away parts of your life, but in doing so it gives you the opportunity to choose the life you will lead, as opposed to living out the one you have simply accumulated over the years" (Frank, 1991, p. I).

Working with this patient population allows you to help your clients (and yourself) see the choices ahead in their lives. Dealing honestly with the issues of grief and death can allow some people the freedom to live more openly and to feel more completely alive.

The group members may or may not be sufficiently motivated to listen and hear and want to grow to find meaning in their life. They may feel too physically ill or be suffering from major depression, and be unable to fully participate with all their heart and soul. Or, one strong group member intent on returning to his or her former life just the way he or she left it may dominate the entire group discussion.

The group leader has to decide with the members how to handle termination issues, such as notification of deaths of group members, how much medical information to give, and whether to bring up the question of attending funerals. Each death diminishes the group as a physical loss, but also as a reflection of the coming loss of the self. At the same time, each remembrance reassures the other group members they will also be remembered.

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