Engaging the Soul

I encounter dying and death every day in my work. I’ve journeyed alongside people as they approached the end of their lives and sat with families as they faced the profound shift of stepping into a new life without someone they deeply loved. In those moments, I’d often hear people nearing death say, “I wish I could have Voluntary Assisted Dying (VAD) now,” especially when they were in severe pain. Some would say it in the heat of suffering, while others spoke with unwavering certainty about their wishes.

Knowing that VAD doesn’t come into effect in the Australian Capital Territory (ACT) until November 2025, there was little I could do but offer gentle, holistic care. Those times were often filled with heartbreak — conflicts within families, uncertainty about death, and deep existential struggles. These struggles often touched on the core of spirituality, raising questions about meaning, purpose, connection, and the nature of existence itself. For many, these crises weren’t just emotional or psychological: they were spiritual, reaching into the soul and grappling with the profound realities of life and death.

Working in Spiritual Care, a unique field distinct from therapy, has given me a deeper understanding of these transcendent dimensions. Spiritual Care offers therapeutic benefits but employs approaches and modalities that are not therapy in the traditional sense and are distinct from counselling interventions. It allows for a different kind of connection — one that honours the sacredness of each individual’s journey. As a counsellor, I’ve found that my work in Spiritual Care has taught me critical insights about humanity and spirituality that directly inform my counselling practice.

These two disciplines, while distinct, share powerful potential to engage with clients who are considering or have chosen the VAD pathway. Both Spiritual Care and counselling have a role to play not only in supporting individuals making these decisions but also in walking alongside their families, who may experience residual grief, guilt, or conflict following a loved one’s choice to pursue VAD. The integration of these fields offers a way to address the profound emotional and spiritual needs that arise in these moments, creating space for healing, meaning, and connection.

Spirituality today isn’t just about religion. While it may include faith for some, it is more broadly about how people seek meaning, purpose, and connection in their lives. At its core, spirituality often involves a sense of transcendence — feeling connected to something beyond oneself, whether it be nature, humanity, or a divine presence. This expanded understanding of spirituality has led to a shift in counselling models, moving from traditional frameworks like pastoral counselling, which were closely tied to specific religious institutions, to the more inclusive concept of “Spiritual Counselling”.

Pastoral counselling historically focused on guiding individuals through life’s challenges using religious principles and teachings specific to particular faith traditions (Bushfield, 2020). While this approach provided comfort and support to individuals within those traditions, it often excluded people without strong religious affiliations or those from diverse spiritual backgrounds. Recognising the need for inclusivity, this kind of counselling has evolved into what is now called “Spiritual Counselling” which prioritises individual meaning-making and personal growth, regardless of religious belief or absence thereof (Koenig, 2012).

In my proposed model “An Exploratory Review of Spiritual Care in the Voluntary Assisted Dying Environment: Towards a Holistic Theoretical Framework”, spirituality is understood as both an internal experience — such as beliefs and emotions — and an external dynamic, encompassing relationships with family, community, and broader philosophical or religious frameworks (Dudfield & Finlay, 2024). This broader and more inclusive lens helps counsellors connect with clients in ways that honour their individuality while addressing the deeper questions of life and existence that often arise during times of crisis.

Spirituality has tangible benefits for wellbeing. Research shows it can enhance resilience, reduce distress, and help people make sense of life’s most difficult moments (Koenig, 2012; Page et al., 2020). It provides a sense of grounding and offers a way for individuals to find coherence in their life story. These effects are particularly important during crises or periods of profound change, where a lack of meaning or purpose can contribute to heightened anxiety, depression, or existential despair (Ardelt & Koenig, 2006). For example, in end-of-life settings, addressing spiritual needs has been shown to reduce patients' fears about death and improve their overall quality of life (Olsman et al., 2014). Similarly, for individuals experiencing trauma or significant life transitions, engaging with spirituality can foster hope and provide tools for coping with uncertainty (Lohne, 2022).

The World Health Organisation (WHO) emphasises spirituality as one of the four pillars of wellbeing, reflecting its essential contribution to holistic care and people’s overall health (WHO, 2021). Counselling, with its person-centred focus, offers a unique space to explore and nurture this dimension of health. This is particularly important because traditional approaches that focus solely on emotional or psychological dimensions may overlook the deeper existential questions that many clients face. Addressing spirituality has been linked to improved mental health outcomes, including greater life satisfaction, reduced anxiety, and enhanced emotional regulation (Rovers & Kocum, 2010). By integrating spirituality, counsellors can foster a stronger therapeutic alliance with clients, particularly those who prioritise spiritual or existential meaning in their lives. This holistic approach also supports greater self-awareness, helping clients uncover internal resources they may not have recognised through more conventional interventions (Koenig, 2012; Page et al., 2020).

Spirituality often surfaces naturally in counselling sessions asclients bring their questions about purpose, meaning, and connection into the room, whether explicitly or implicitly. These moments provide counsellors with an opportunity to engage with clients at a deeper level, addressing existential concerns and fostering a sense of coherence in their lives. Integrating spirituality also strengthens the therapeutic alliance, as it demonstrates a counsellor’s willingness to engage with the client’s worldview. It fosters trust and rapport, enabling clients to feel safe in exploring deeply personal and often vulnerable aspects of their lives. Counsellors who align their practice with both ethical standards and spiritual dimensions can provide transformative support, empowering clients to find clarity, meaning, and peace in their decisions.

Integrating spirituality into counselling also aligns with the Australian Counselling Association (ACA) Code of Ethics, which emphasises respect for the inherent dignity, rights, and autonomy of every client. The Code urges counsellors to provide a safe, supportive environment that fosters personal growth, while being sensitive to clients’ cultural, spiritual, and individual values (ACA, 2024). This includes recognising that spirituality can be an essential part of a client’s identity and wellbeing, requiring counsellors to approach these topics with care and professionalism.

In Voluntary Assisted Dying (VAD) contexts, where decisions are deeply intertwined with questions of existence, relationships, and transcendence, addressing spirituality becomes particularly critical. VAD clients often grapple with profound existential questions: “What does this decision mean in the context of my life? How will it affect my relationships? What lies beyond this moment?” By incorporating spirituality, counsellors can offer a space where clients feel seen and supported as they explore these questions.

Moreover, the ACA Code of Ethics calls for counsellors to uphold cultural sensitivity and inclusivity, ensuring their practices are responsive to the diverse needs of their clients (ACA, 2024). Spirituality is a significant element of many cultural frameworks, including Buddhism, Taoism, Hinduism, and various Indigenous traditions. Each of these traditions has unique practices and beliefs that highlight the diverse ways spirituality manifests across cultures; , and neglecting this aspect risks alienating clients or overlooking vital facets of their wellbeing. My research reminds us that spirituality can be a powerful lens for exploring both internal struggles and relational dynamics, particularly during critical junctures such as those encountered in the VAD context. By integrating this lens, counsellors fulfil their ethical responsibility to provide holistic care that respects the complexity of human experience.

In the context of Voluntary Assisted Dying (VAD), my foundational research (Dudfield & Finlay, 2024) proposed a thoughtful framework that highlights two key areas for spiritual care: internal concerns and relational dynamics. Internally, clients often need help reconciling their decision with their personal narrative and beliefs. This might involve exploring how VAD fits into their sense of self or aligning the decision with their understanding of transcendence. Spiritual counselling in this setting can provide clients with a safe, non-judgemental space to clarify their values and navigate these deeply personal reflections.

Externally, relational dynamics are equally complex as VAD decisions can sometimes strain relationships with family, friends, and the broader community. These tensions may arise from differences in values, misunderstandings, or fear of discussing death openly. Counsellors, within this framework, act as mediators to foster understanding, communication, and reconciliation among all involved parties. A key aspect of this is equipping clients and families with tools for open dialogue, helping them share concerns, offer support, and preserve relational integrity, even in the face of differing perspectives.

Having explored the nature of spirituality, its integral role in holistic care, and its importance in counselling, along with the practical considerations of supporting clients in the VAD context, we now have a foundation to begin moving forward in this complex and evolving space. This is a time of significant change for the counselling profession — a call to adapt and rise to the challenge of providing compassionate, inclusive, and ethically grounded care for those who are vulnerable and in need of support. By understanding spirituality and embracing its role in good care, counsellors can navigate this transformative period with confidence, helping clients and their families find clarity, meaning, and peace amidst some of life’s most profound moments.

Australian Counselling Association [ACA]. (2024). Code of ethics and practice. Retrieved from https://www.theaca.net.au/
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Bushfield, S. (2020). Spirituality in counselling: Pastoral models in a modern era. Counselling Today, 62(4), 15-20.
Dudfield, C., & Finlay, D. E. (2024). Towards a holistic framework for VAD spiritual care. Canberra Health Services.
Koenig, H. G. (2012). Religion, spirituality, and health: The research and clinical implications. International Scholarly Research Notices, 2012, 1–33. https://doi.org/10.5402/2012/278730
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World Health Organization [WHO]. (2021). The Geneva charter for wellbeing. Retrieved from https://www.who.int/

Chris Dudfield is an experienced counselling professional and Manager of Spiritual Support Services at Canberra Health Services, specialising in end-of-life care and spirituality. With a Master in Pastoral Counselling (Clinical) and a Graduate Certificate in Legal Studies and Ethics, Chris integrates holistic approaches into counselling practice. His recent research and presentations, including Toward a Holistic Framework: Spiritual Care for Voluntary Assisted Dying, reflect his commitment to exploring spirituality’s role in addressing complex client needs. He is a Level 2 member of the Australian Counselling Association and a sessional academic at the University of Canberra.

Engaging the Soul: Supporting Clients and Families in Voluntary Assisted Dying Contexts