Counselling in Loss - Report Example

Counselling in Loss Loss of a close person is a traumatic experience for any individual; and working through the grief and pain can sometimes seem overwhelming to them. Levine (1982 p97.) states that “Grief comes from trying to protect anything from being what it is. From trying to stop the change." The changes that occur in an individual’s life when they lose a significant other are often drastic even when anticipated. Each individual tends to cope with bereavement in a different manner; and may take different periods of time to move through their loss (Lendrum and Syme, 2004; pp 51). If an individual is unable to process their loss or is unable to deal with the pain, there may be a need for therapeutic intervention (Kailash, 1985). This report is an attempt to understand the experiences of an individual who is at an intermediate stage in the process of coping with the loss of a loved one; and to understand the manner in which a therapist can help such an individual transit between stages with less distress. Case study The case under consideration is of Steven, a man who has lost his wife of many years to cancer. He has been bereaved for two years now, and although he has accepted her passing and has experienced the grief of her death and responded to it with life changes; he has not been able to adjust to life in her absence. His grown – up sons are concerned about his lack of social life, and encourage him to move on with his life and meet people. They are also concerned about his increased drinking, and have impressed on him their concerns. Steven also feels concerned about his behaviour, but feels ‘stuck’ and lonely. He wishes to reduce his drinking; but finds that it dulls his experience of loss at times when he feels it most particularly. He also believes that his deceased wife would want him to move on and take an interest in his community and friends; but he also states that these experiences make him feel her absence more deeply. Steven wants to take active steps to move out of the rut he finds himself in; but is unable to take the steps on his own. He has come for counselling of his own volition because he feels that it may help him deal with the experience of loss and also that it may help him move on without feeling guilty about doing so. Introduction Counselling for individuals who have suffered the loss of a significant other is slowly being seen as an essential skill for all counsellors; given the impact that death has on the life of the bereaved. Research into the experiences of individuals who have suffered a loss have revealed that most individuals experience a number of stages through which they must effectively pass in order for them to make peace with their loss (Lendrum and Syme, 2004; pp 40). There are certain tasks that are an important part of this process; and these need to be completed in an appropriate manner. Kubler-Ross (2005; pp. 7) describes five stages of experiencing grief and working through loss. These stages include Denial, Anger, Bargaining, Depression and Acceptance (Axelrod, 2011). According to her, Denial is the first reaction that occurs when one hears of the death or imminent death of a dear one, and is a reaction that helps in reducing the strain of processing information which is very painful. It provides some distance for the individual so that the news can be accepted slowly (Kubler-Ross, 2005; pp.8). Anger is the next response that is often the first sign of acceptance; and may be mixed with guilt and envy for others. Anger could be directed at particular others, at self, at a generic idea of life, or a supernatural entity (Kubler-Ross, 2005; pp. 12). Bargaining can include thoughts of negotiations and fantastical conversations that could bring the lost individual back. The stage of Depression is the first stage that emphasizes the present rather than the past. It represents the acknowledgement of the finality of death, and the implications of the loss of the particular individual. This experience may cause the individual to find coping with daily tasks difficult, as everything becomes a reminder of the loss (Kubler-Ross, 2005; pp. 21). Finally, there is the stage of acceptance, in which the person comes to terms with the loss, and slowly starts to explore life without the deceased. For someone who is faced with the news of a terminal illness, these stages may start from before the actual death of the significant other (Kubler-Ross, 2005; pp.1). Many individuals will move back and forth through these stages, till they achieve acceptance; and fresh experiences may trigger a reversion to an earlier stage. Other theorists like Bowlby, Sanders and Parkes have described a phase process of dealing with bereavement. According to Parkes (1970), an individual faced with death of a loved one first experiences numbness, which acts as a defence against the onslaught of emotions, and allows the individual to understand the implications of the news slowly. The next phase is that of searching and yearning, in which the individual tends to experience the extent of loss, and shows behaviour similar to the second and third stage described by Kubler-Ross. The individual yearns for the deceased (Parkes, 1970) and may experience a variety of emotions from anger to sadness. In the third phase of disorganization and despair, the individual experiences a feeling of over-whelming loss; and may be unable to function normally. They may experience a withdrawal from previously liked activities and may become apathetic towards things and people. Finally, in the fourth phase of reorganization and recovery, the individual is able to pick up the pieces of their lives, and starts taking an interest in things once again. Bowlby (1980) has reaffirmed the work of Parkes. Worden (1991; 2003) believes that describing grief experiences in the form of stages and phases can provide an illusion that the process is a passive one that continues from one stage to another with little input from the subject (Worden, 2003; pp 26). Rather, the process of dealing with bereavement requires active participation from the person, and can be affected by external intervention. Thus, he discusses the process of mourning as a set of tasks that need to be completed. According to him, the first task is accepting the reality of the loss; in which the individual is needed to come to terms with the death, and its implications and impact on their life. This task may be seen as the action element in passing through the first stage / phase as described by the other researchers. The second task involves working through the pain, and experiencing its effects in order to understand the extent of the loss. Often people try to minimize this pain or dull it in some way; but this only hinders their ability to work through the emotions (Worden, 2003; pp 31). The third stage is the stage of adjusting to the new environment in which the deceased is missing. This involves setting up of new behaviours, building of new rituals, and changing schedules to accommodate the loss. Finally, the individual reaches the last goal of emotionally relocating the deceased and moving on with life. This involves not only extracting the energies invested in the deceased but also re-investing them in new ones (Worden, 1991; pp 17). Successful completion of this task may be seen in the development of healthy new relationships that are unaffected by the past. Case Analysis For this case, I chose to analyze a session that built on previous work, and was designed to help Steven deal with the completion of the second task as described by Worden (1991, 2003), as well as initiate actions that would help with the third task. At this point, Steven is unable to complete his grieving, and still feels the pain of losing his wife. He uses alcohol to help with this pain instead of allowing himself to experience it. This leads to days when he drinks more than he is happy with. Upon probing, I found that he feels the need to move on for the sake of his sons’ satisfaction as well as the promise he made to his wife. Also, since his wife suffered from cancer before her death, he seems to believe that he should not feel sad about her death, as a longer life would have been full of pain for her. Thus, he has not allowed himself to grieve; but is also unable to move on (Worden, 2003; pp 31). If Steven can complete the second task adequately; it would help him in working on the third task, and establishing new patterns for himself, and being a part of activities while adjusting to the loss of his wife. He admits that her clothes still hang in the cupboard, and he sees them every day. He also avoids meeting friends, or becoming involved in activities that they enjoyed together. It is important for Steven to be able to deal with these situations as part of his grieving process (Crenshaw, 1999); and as a counsellor, I shall be helping him set goals that will help him complete the remaining tasks. Skills Used In the process of helping Steven cope with his wife’s passing, I used reflecting back, active listening and empathy at each stage (Lendrum and Syme, 2004; pp 100-101), and tried to help Steven understand the motivations that brought him to therapy. Active listening was also used in the process of goal setting; where inputs from the client were developed upon to establish goals for each aspect of his grieving process. The client was reassured about the validity of his feelings, and the normalcy of the emotions that he was experiencing. I did this by using phrases like “It’s perfectly normal… each person needs some time to grieve… you obviously had a very dear relationship” This helped Steven realize that it was acceptable for him to grieve as long as he needed to. At the same time, phrases like “Over time you may find that you need this less and less….” were used to convey the expectation that with time, grieving does end, and other aspects of life take over. Reinforcing the end result was important since Steven was not focused on reaching an end state; but rather on coming out of his present mental state (Boseman, 2002). Goal setting was used extensively during this session. I emphasized the need to develop small, simple goals that would eventually lead Steven to a point where he felt less distressed as compared to the present state. Goals were set for each of the three incomplete tasks. Worden (2003) describes the various situations that can inhibit the individual’s experience of grief. In Stevens’s case, it was his need to comply with his dead wife’s and his three son’s wishes and move on. But since he was not allowing himself to grieve; he was also unable to move on adequately. This made him feel lonely and isolated. Three goals were discussed. To help him complete his grieving and pay his respects to his wife; the idea of setting up a memorial to her in the house was discussed; and I encouraged him to light a candle and interact with her memories for some time each day until he stopped feeling the need to. I believe that this would help Steven actively attend to his memories and feelings, and thus would be able to address them effectively. Secondly, a goal was set for Steven to resume participation in activities that he has avoided since his wife passed on. Steven mentioned that he used to like bowling and meeting friends for dinner – something that he has not done much of in the last two years. Thus, Steven was encouraged to go to a bowling alley with trusted friends, or with his sons, and try to resume the game. I cautioned him about taking small steps in doing this, and also assured him that it was ok to not be able to carry out the goal. Sentences like “If you can’t do it, it’s ok. We will set a smaller goal for the next time.” help in reducing the stress associated with a goal, as well as reducing the client’s need to push boundaries beyond what they are able to cope with. Finally, a third goal was set to help Steven relocate the memories of his wife and to make more place in his life for new memories and people. This goal involved Steven packing his wife’s clothes out of the cupboard and into a box or suitcase. This box or case could then be kept as close as under the bed, or as far as another room, until he knew what he wanted to do with these clothes. At this point, Steven was cautioned that this would be an emotional experience; and that he should take the help of friends or family if he felt intimidated by the task. Ineffective Practices As a counsellor, it is important to acknowledge the emotions of the client, even when they are uncomfortable and painful. At one point, Steven makes the statement “… drinking too much. it seems like… my whole life is empty.” At this point, I should have first acknowledged the loneliness and pain he mentioned before proceeding to discussing the alcohol concern; but I did not. Although this has been done at other points in the session, in retrospect I realize that I should have done so at this point as well – particularly since this was at the beginning of the session. Worden (2003) discusses impediments faced by counsellors when conducting grief counselling and counselling for Loss. I do need to evaluate if there are any personal reasons for this lapse. I also did not address Steven’s statement about being lonely at any point; and perhaps it would have been significant to respond to that emption. Another problem that I see after reviewing the session was that I did make suggestions for activities; but did not invite Steven to contribute alternatives. Although I did check that Steven was comfortable with the proposed goal or activity; I was more active in developing it. I do believe that I felt the need to do this in order to provide some structure to Steven’s grieving process; but it may have been possible to involve him a little more. Conclusion In conclusion; it is possible to say that I used counselling skills effectively in this session; and was able to help Steven set concrete and achievable goals that would help him complete his grieving process, and to re-enter his social circle and learn to enjoy activities even In the absence of his wife. It may have been possible to involve him some more; and to address all his emotions; and these are elements for which I need to develop my skills further. References Bowlby, J, 1980, Attachment and loss: loss sadness and depression, Vol III, Basic Books, New York. Crenshaw, DA 1999, Bereavement: counselling the grieving throughout the life cycle. Crossroad: New York. Lendrum, S, Syme, G, 2004, Gift of tears: a practical approach to loss and bereavement in counselling and psychotherapy, 2nd edn, Psychology Press, New York. Levine, S, 1982, Who Dies? An investigation of conscious living and conscious dying, Anchor Books. Kalish, RA, 1985, Death, Grief and Caring Relationships, 2nd Edn, Brooks/Cole Publishing Company, New York. Kübler-Ross, E, 2005, On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss, Simon & Schuster Ltd, York. Parkes, CM, 1972, Bereavement: studies of grief in adult life, International University Press, New York. Boseman, M, 2002, ‘Bereavement’, in Kinzbrunner, BM, Weinreb, NJ, and Policzer JS, (eds.), 20 Common Problems in End-of-Life Care. McGraw-Hill Professional, USA. Worden, WJ, 2003, Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner, 3rd edn, Breunner-Routledge, East Sussex. Worden, WJ, 1991, Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner 2nd edn, Springer Pub. Co., New York. Read More