Facing death: Working with a couple facing multiple systems atrophy

The end of life raises anxieties in clients, their partners and carers, and their therapists; paranoid‐schizoid and depressive mechanisms are brought into play to manage these anxieties. Case material illustrates some of the threats facing couples where one has a terminal diagnosis. A psychodynamic counsellor or psychotherapist may be able to help carer partners to face, own, and tolerate their conflicts and dilemmas in such a way that the sense of support from a good object is strengthened. In this way, a carer partner can be helped to continue to care, both for their partner and themselves.