Grief Counselling in Therapeutic Process: Cognitive Behaviour Therapy vs. Person-Centered Therapy - Term Paper Example

Grief Counselling in the Therapeutic Process: Cognitive Behaviour Therapy vs. Person Centered Therapy Dr. Elizabeth Kubler Ross became the ityon death and dying as her book, On Death and Dying hit the media in 1969. Dr. Ross was a Swiss medical doctor who sat with many people who were going through the grieving process and she studied them. What she found was that most people go through several emotions that she called "The Grief Cycle." Many therapists have used her book and other materials to assist individuals and families as they go through the grief process. For this essay, I will start with these cycles to give more insight into what Mr. Green may be feeling. According to Kubler Ross just before the grief cycle people are stable in their emotions as they begin to take in the information about the individuals death. As they begin to grieve, they experience the following cycle: Shock stage: Initial paralysis at hearing the bad news. Denial stage: Trying to avoid the inevitable. Anger stage: Frustrated outpouring of bottled-up emotion. Bargaining stage: Seeking in vain for a way out. Depression stage: Final realization of the inevitable. Testing stage: Seeking realistic solutions. Acceptance stage: Finally finding the way forward. (Changing Minds, par. 7). A common problem within this process is that people can get stuck within a certain emotion and stay in the cycle for awhile. Often they will need therapy in order to move through these cycles. Although this may not be the case for everyone, it seems that Mr. and Mrs. Green have reached a stage where therapy is needed to get through their grief. Mr. Green is definitely in the anger stage. He wants to strike out at someone and he wants his son back. On the one hand he is in the denial stage because he wants to blame someone else for his sons demise. He doesn’t want to accept that his son could have done this on his on. Unfortunately we dont have a lot of information on Mrs. Green, but it may see that she is still in denial because she wants to keep some of his pictures around. We cant be sure whether this is because she has come to terms with her sons death or whether this is something that she is still holding on to because she is stuck in denial; we would need more information to tell. Mr. Green seems to be the focal point of the therapy session because he is the most vocal. As a therapist, I dont think the therapist in the scenario is doing her job. It doesn’t seem that the individual is helpful to her clients. She seems to want to distance herself from them instead of interacting with them. Although it is important not to hug a client in most instances, it doesnt seem from the information we have that this individual is actually helping them through the process. Some of the most successful therapists show empathy with tears or with a hug to a patient when they are grieving. It is clear that this is not this therapists style and although this is permissible, it doesnt seem like what this couple needs. Carl Rogers defines empathy as: To sense the clients private world as if it were your own, but without ever losing the "as if" quality--this is empathy, and this seems essential to therapy. To sense the clients anger, fear, or confusion as if it were your own, yet without your own anger, fear, or confusion getting bound up in it, is the condition we are endeavoring to describe. When the clients world is this clear to the therapist, and he moves about in it freely, then he can both communicate his understanding of what is clearly known to the client and can also voice meanings in the clients experience of which the client is scarcely aware. (cited in Feller and Cattone, 2003, p. 2). This therapist seems cold and distant and it doesn’t seem that she is involved in a therapeutic alliance with her clients. There are many definitions of the therapeutic alliance but Bordin (1979) is one that seems popular for many people. He has stated that the therapeutic alliance, to be effective must have the following components: 1. The client and therapist make goals and agree on them for therapy. 2. The client and therapist agree on how to achieve the goals. 3. The client and the therapist develop a personal bond. (Bordin, cited in Andrusyna, Tang, et. al., 2001, p. 1). This therapist doesnt seem to be working on building a rapport of any kind with her clients. She quickly starts to talk about the death of the son and it may have been more appropriate to deal with what they are feeling right now. The son died three years ago and although the death is still fresh, it seems that in order to get them past the anger or denial that they would need to talk about what they have done since those three years have passed. I dont think that rehashing the accident (which is something they have probably been doing for the entire three years) is helpful. A major reason why they are still grieving may be that he was very young when he died and it seems that the therapist needed to address this in the early stages of the session. I dont think that the therapist was showing bias however when she "supported" Mrs. Greens desire for photos of her son. I think instead she was attempting to bring a balance between the two people. It is clear that Mrs. Green is quieter than Mr. Green and may have needed the encouragement to console her. This may have been her one stop at attempting empathy. The Therapeutic Process The therapeutic process in the counselling setting is one of empathy and compassion without getting personally involved with the client. It is seen as the primarily agent of change throughout the process and it is important for the therapist to be genuine, empathetic, congruent, open, honest, non-judgemental and accepting (UKAHPP Core Beliefs Statement). The therapeutic process in grief counselling is a bit different than in other counselling situations. Grief counselling is usually very specific and has as its goal to help the individual grieve, address and accept their personal loss in a healthy fashion. Usually, grief counselling will have four components 1) expressing the loss 2) accepting the loss 3) adjusting to life after the loss and 4) coping with changes that the individual may experience with themselves and the environment after the loss. A major aspect of grief counselling should be to deal with the feelings of sadness, anxiety, anger, loneliness, guilt and so forth as the individual moves to acceptance. Also, any behavioural changes will be noted during grief counselling like a persons feelings of being tired, having trouble concentrating, having sleep or appetite changes and dreaming about the disease. These are all situations that would be a part of grief counselling. the loss. (Encyclopaedia of Mental Disorders). Grief counselling is usually very specific and has as its goal to help an individual or family grieve, address and accept their personal loss in a healthy fashion. Grief counselling will have four components that they want to move a client through: 1) expressing the loss, 2) accepting the loss 3) adjusting to life after the loss 4) coping with changes within themselves and the environment (world) around them. A major aspect of grief counselling should be to deal with the feelings of sadness, anxiety, anger, loneliness, guilt and so for that the individual will have as they move to acceptance. Also, they may experience behavioural changes like being tired more, having trouble concentrating and loss of appetite or having trouble sleeping. These are all aspects of what they might experience during a session. Cognitive Behaviour Therapy (CBT) CBT is "based on the premise that there is a close connection between cognition (how we think), our emotions (how we feel), and our behaviour (how we act)". (Department of Health, p. 9). In Mr. Greens case he is still thinking that someone else is to blame for his sons accident (how he thinks), and he is very angry about it (how he feels). It isnt clear in the case scenario whether he is acting out but in many circumstances when an individual is as angry as he appears, he would be pacing the room, perhaps his voice is louder than normal, and generally he may feel like he wants to hurt someone. One of his behaviours is mentioned, the fact that he doesn’t want any reminders of has son around because its too painful. However, this could be a way for him to continue to not accept his sons death. Mr. Green seems to be caught up in what can be called the "vicious cycle" as noted here: (Royal College of Psychiatrists, p.2). Mr. Green seems to be stuck in the situation of his sons death. He is constantly holding onto the thoughts about his son. He is telling himself that he cant accept that someone else isnt responsible for what has happened. His thoughts are feeding his feelings and his actions. What needs to happen in this situation, if they were using Cognitive Behavioural Therapy, each segment of this process would be broken down into smaller parts. Mr. and Mrs. Green would be asked to keep a diary to keep track of the thoughts they were having throughout their regular day. When this information came to the therapy session, the therapist would be able to help them see the pattern in their thoughts. There would be three points to look at when breaking the thoughts down: 1) Is the thoughts helpful? 2) How do the thoughts affect each other (do they escalate or calm them)? and 3) How do these thoughts affect them? (Mr. and Mrs. Green). Since CBT has been effective in depression this could work for Mr. and Mrs. Green. They could also do this therapy online because it is one of the only ones approved by National Institute for Clinical Excellence (NICE). Person Centered Therapy According to Carl Rogers, every person has inside them what they need to accomplish their own therapy. The therapist takes a non-directive role and the responsibility for how the sessions will go and the direction for treatment is to come from the client. The basic purpose of this therapy is for "increased self-esteem and greater openness to experience". (Encyclopedia of Mental Disorders, "Person Centered"). Rogers was looking for a closer congruence between the individuals ideal self and real self which would lead to better self-understanding. Once an individual could see themselves as they really were, they would have less guilt, lower their defences, have more security within themselves and have a more positive regard for themselves and others. They would also understand how to experience and express their feelings in the moment. If Mr. and Mrs. Green were to engage in Client Centered Therapy, the therapist would have talked with them and attempted to reach rapport quickly. She would have explained that they had the ability to find their way through grief and she would help them with the process as they were ready. Her job as a therapist would have been to help Mr. Green understand that he was being accepted and understood so that healing could occur. If Mrs. Green needed this understanding, the same would go for her. Mr. Green may be having difficult feeling that he is understood because he is so deeply into his anger (it seems) because he cant believe what the police said to him. From this point, he could have seen real healing as time went on. Another aspect of Person Centered Therapy was started by Rogers (1993) and it is called Person-centered Expressive Arts Therapy. This may have been a good thing for this couple because it would have involved them in some sort of creative venture that may have helped them get past the worst part of the grief. According to Rogers: Expressive arts therapy uses the expressive arts — movement, art, music, writing, sound, and improvisation — in a supportive setting to facilitate growth and healing. It is a process of discovering ourselves through any art form that comes from an emotional depth. (Rogers 1993, par. 1). Expressive Arts Therapy allows the individual to use the arts to let go of their grief, express themselves and to release the pain. The movement or form of the expression isnt the important part of the therapy. The Greens would have benefited from this expression because it would have taken them away from the grief aspects and quite frankly it would have given them something else to do. This therapy as an aspect of Person-Centered Therapy is there to help the individual go deeper into themselves to find the healing. According to Rogers (cited in Boeree, 2006., "Details") Person Centred Therapy would have helped Mr. Green find the positive self-regard that he may not have had or had "lost" in the process of his grief. When a child dies so suddenly at such a young age, parents have a tendency to blame themselves and add this to what society expects of us and it becomes more difficult to understand ourselves. In learning to express himself creatively, Mr. Green would find his way to what Rogers calls organismic valuing to positive self-regard. He would become a fully functioning person. He would develop the autonomy that he would need. Mrs. Green would probably come along with him if she continued the therapy. When considering the aspects of therapy as a therapist it is helpful to know that there are a variety of techniques and tools one can use in order to help a client. This paper made me realize that there are many things I still do not know about the therapeutic process. When I looked at this from just a therapy point of view without putting in the grief counselling, it seem a bit more simple. However, the therapist must take into consideration the fact that people do experience grief and there isnt a one size fits all type of counselling; counsellors must meet the client where they are and help them move through the process. Bibliography Andrusyna, T.P., Tang, T.Z., et. al. 2001. The factor structure of the working alliance inventory in cognitive-behavioral therapy. American Psychiatric Association. Psychotherapy Practice Res 10:173-178. Available from http://jppr.psychiatryonline.org/ cgi/content/full/10/3/173. [Accessed 10 May 2008]. Boeree, C. G. 2006. Carl Rogers 1902-1987. Personality Theories. Available from: http://webspace.ship.edu/cgboer/rogers.html. [Accessed 9 May 2008]. Changing Minds.Org. "The Kübler-Ross grief cycle". Available from: http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm. [Accessed 9 May 2008]. Department of Health. Improving access to psychological therapies (IAPT) programme: Computerised cognitive behavioural therapy (cCBT) implementation guidance 28 March 2007 Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_073470. [Accessed 9 May 2008]. Encyclopaedia of Mental Disorders. Grief counselling. Available from: http://www.minddisorders.com/Flu-Inv/Grief-counseling.html. [Accessed 9 May 2008]. Encyclopaedia of Mental Disorders. Person centred therapy. Available from: http://www.minddisorders.com/Ob-Ps/Person-centered-therapy.html. [Accessed 9 May 2008. Feller, C.P. and Cottone, R.R. 2003. The Importance of Empathy in the Therapeutic Alliance. Journal of Humanistic Counseling, Education and Development, 42. Available from: http://www.questia.com. [Accessed: 08 May 2008]. Rogers, N. 1993. Person-centered expressive arts therapy. Creation Spirituality. March/April. Available from: http://talentdevelop.com/articles/PEAT.html. [Accessed 8 May 2008]. Summers, R. F., and Barber, J. P. 2003. Therapeutic alliance as a measurable psychotherapy skill. Academic Psychiatry 27:160-165. Available from: http://ap.psychiatryonline.org/cgi/content/full/27/3/160 [Accessed: 7 May 2008]. The Royal College of Psychiatrists. Cognitive Behavioural Therapy. Available from: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx. [Accessed 9 May 2008]. UKAHPP Core Beliefs Statement. The nature of the therapeutic relationship. Available from: http://www.ahpp.org/about/core.htm. [Accessed: 10 May 2008]. Read More