This is probably the result of the early recognition of the stress inherent in the field and the support mechanisms that were built into palliative care programmes from the beginning. As those in palliative care define their role as being involved at an earlier time in patients' illness, and as they are called upon to reduce the pressures on acute care beds, the issue of work overload may become a bigger stressor and will need to be addressed. Caregivers must be aware of personal needs for overwork and overinvolvement that might lead to emotional exhaustion and burnout. An extensive literature exists on the experience of adjusting to death and dying, much of it focused on observational studies of the responses of dying people to illness. The provision of different psychological levels is viewed as a core component of specialist palliative care, but there is no recommended structure for counselling services.
Most hospices employ social workers who focus on both welfare and psychological care.
There is a belief in the dynamic unconscious in the development of conflict and disturbance. From a psychodynamic point of view, the unconscious is a state of constant tension with external reality. In hospice care, the healthcare team can be viewed as a potential provider of this 'containment' between therapist, client and psychodynamic therapist, particularly for those who have significant difficulty in coping.