Mindmap-BookSummary-Challenges in Counselling Loss

Mindmap-BookSummary-Challenges in Counselling Loss

• About Challenges In Counselling Loss
  • Date Read: September 10, 2016
  • Author: Sally Taylor
  • ISBN: 978 1 444 1 8772 4
  • 161 pages
  • MyRating: 5 Stars
• 1 Introduction
  • Between stimulus and response there is a space. In that space isour power to choose our response. In our response lies our growthand our freedom. Viktor Frankl

    Loss

    • Loss is a large and complex subject; its effects are far ranging andcan be likened to the impact of throwing a huge pebble into a pond.After the first impact, which cuts through the calm of the water, itsripples continue to spread across its surface.

      Loss is an area where notwo stories will ever be the same, which is one aspect that I believemakes the work both challenging and fascinating. When we face losswe can t change what has happened the lost person/object/state ofour being will remain lost bu

      Loss is losing something we are attached to. This can be loss of a person(through death, which is the focus of this book), of an object, or of our being

    4 dimensions of loss

    • LOSS OF PERSON THROUGH CIRCUMSTANCES
      • EMOTIONAL
      • S E X U A L
      • Friendships
      • THROUGH ABUSE
      • foster care
      • adoption
      • SEPARATE
      • DIVORCE
    • LOSS OF PERSONTHROUGH DEATH
      • TYPE OF DEATH
        • Long term illness/disability
        • murder
        • suicide
        • accident
      • age
      • Age of the bereaved
      • Who Died
      • ALSO IMPORTANT TO NOTE
      • when they died
      • relationship
      • PLACE OF DEATH
      • MISCARRIAGE
      • termination
    • THE LOSS OF AN OBJECT
      • WORK
      • Possessions
      • MONEY
      • RETIREMENT
      • Redundancy
      • Stocks/shares
    • LOSS TO SELF
      • CHILDHOOD
      • FAITH
      • Vision/hearing
      • Hair
      • IDENTITY
      • Hair colour
      • AT BIRTH
      • FEMINITY/VIRILITY
      • Untitled
      • ROLE
      • fertility
      • Sex
      • SKIN TONE
      • PHYSICAL ILLNESS
      • MENTAL ILLNESS

    Why is counselling needed followinga death?

    • Natural communities of support are less available
      • Society s response to death has changed across the years, which hasresulted in the former natural communities of support being less accessible
    • Lost for words
      • A central theme with bereaved clients is their difficulty in talking aboutexperiences of death to friends and acquaintances. They describe howpeople cross the road to avoid talking to them, or avoid the subject. Thisreflects a difficulty in society in fac
    • A loss will turn your life upside down
      • Loss can be a life-shattering event and an experience which can and willprovoke a series of powerful emotions that can create a ripple effect intosurrounding relationships and activities. Much more can be affected thanthe loss itself, which can leave people
    • Varying reactions to different types of loss
      • Reactions can be affected by different factors of loss such as the type andstrength of relationship the bereaved individual had with the deceased. Thiswill be affected by the age and/or stage of life of the person who has died,or the way in which he or she

    Chapter Summary

    • It is important to note when working with loss that it is a topic thatis all around us. When someone loses a person close to them theindividual s whole life can be turned upside down.

      All aspects of life are affected by loss, which make them central to ourwork. It is also important to acknowledge that loss can create a rippleeffect of further losses in someone s life.

      Loss has an holistic impact and therefore requires holistic responses,which is one of the reasons why working with loss is so challenging.

      There are many challenges in counselling people who are facing loss,including the professional and personal anxieties we may have for ourclient, as well as those we may have for ourselves.

      Above all, it is important to note that however many anxietiesyou may have about working with loss, or working with loss in thefuture, you are not alone. Many counsellors find that loss is a highlychallenging subject and its effects are multifold

• 2 Settings
  • The service (hospice bereavement) . . . it was tucked away. Youknow what they say out of sight, out of mind . Parent, Flatteau Taylor 2003

    Setting: space and place

    • It is a given that the physical place for counselling always needs to be ascomfortable, confidential, and accessible as possible. In the voluntarysector, often with the most stringent of budgets, this can be a struggle,but it is possible

    Counselling in the home setting

    • Feedback I have received from many tutors of counselling courses hasnoted a view that counselling provided in the home is not pure counselling (and often therefore sessions cannot be included inplacement hours). However, it is intrinsic to some aspects of

      1. Interruptions: we cannot control the postman calling or the phoneringing. However, we can create contracts with our clients to minimisethese possibilities

      2. Privacy: another family member/care staff may be in the home whichmay cause concerns about confidentiality and may cause constraintsfor the client who may fear being overheard.

      3. The environment: we cannot create seating that is set at acomfortable distance apart or on the same level, etc; we have to sitwhere we can. It is important to check with the client that where wechoose to sit is appropriate to them; for example, in case i

      Importance of environment

    Chapter Summary

    • Loss and bereavement counselling is integrated within differing levelsacross a variety of settings.

      The majority of policies and procedures are created locally; there arefew national guidelines

      However, what does emerge is that loss and bereavement can beseen as a secondary service when it is offered as a part of a widerorganisation

      Whether a service stands alone or is a department in a largerorganisation, it will have its own culture and this will always have aneffect on the service provided and the clients who receive that service.Some of the impacts are apparent; some are quite hidd

      The name of the service will have an impact on clients, which weshould acknowledge explicitly alongside our job title. It will also havean impact on us as practitioners

      Working off-site can lead to additional tensions for a counsellor, butcan be extremely beneficial for clients due to accessibility of services,being in their own setting and therefore feeling more relaxed andable to talk

• 3 Theory and skills
  • She (counsellor) said I had reached acceptance . . . then the TVbroke down. I miss Steve more and more as time goes on! Kirsten (2005)

    A brief social history: why is counsellingneeded for bereaved people?

    • Loss through death is an inevitable and intrinsic part of life; in past eraspeople died and were grieved for openly in their community. However,we now live in what could be described as a death denying society ,where death is invisible, often denied, and t

    The foundation of psychotherapy andthe beginnings of grief theories

    • The forefather of psychotherapy, Sigmund Freud, described howfollowing a significant loss feelings need to be expressed in Trauerbeit or grief work . He described how the emotional energy of the bereavedneeded to be withdrawn from the deceased so that the

    Early theories of attachment, loss,bereavement

    Attachment theory

    • John Bowlby closely studied our patterns of attachment; he suggestedthat attachment and love would inevitably result in a loss. He notedresponses to the loss of a parent; he found expressions of sadness, fearand anger. From this he outlined a paradigm of lo

      1. Secure attachments

      • Secure attachments are formed by children whose parents providedsecurity, sensitivity and were really there for their child(ren). Through thisrelationship base, separations are seen to be tolerated without anxiety;but this does not prevent strong reaction t

      2. Anxious/ambivalent relationships

      • Anxious/ambivalent relationships are formed by children with parentswho were overprotective, anxious and insensitive to their child s needto be independent. The child(ren) may grow up lacking in trust, selfconfidenceand tending to cling. Separation therefor

      3. Avoidant

      • Avoidant parents are those who could not express emotions, or closeness.Their children similarly are unable to tolerate closeness and relationshipdifficulties ensue. Feelings are often not expressed; therefore aftera loss, grief may be restrained. Providing

      4. Disorganised

      • Disorganised parents are unable to respond consistently to theirchild(ren) s needs. Children tend to grow up unhappy, with little trust,feeling helpless. Loss will increase feelings of despair and fear.

      It is important to understand a client s attachments, as this can providean insight into the possibilities of the individual s reaction when an importantother is lost. For example, a positive attachment pattern, whereprimary carers have been attentive and

      Conversely, insecure attachment or relationships, a lack of comfort orsupport can mean that feelings have been hidden, subsumed, not expressed;and this can be a factor leading to complications in grief, whena significant loss is encountered later in life (S

    Stage theory

    • Through the study of attachment and detachment Bowlby and Parkesdefined four stages in the grieving process (1970):

      1. Numbness, shock and denial a sense of unreality

      2. Yearning and protest sadness, crying, anxiety, lack of concentration,guilt, sense of the deceased s presence as a protestation against theirdeath

      3. Despair, disorganisation, hopelessness, lowness

      4. Re-organisation letting go of the person who has died

      These stages focus on the psychological processes; they do not allow foran exploration of cultural difference or sociological aspects; they emphasisethe resolution of grief as letting go .

    Task theory

    • In 1981, alongside the swiftly growing profession of psychotherapy andcounselling, Worden re-introduced Freud s concept of grief work ; hedescribed four tasks of mourning which were

      1. Accepting the reality of the loss

      2. Experiencing the pain of grief

      3. Adjusting to the environment without the deceased

      4. Letting go of the deceased, closure

    Critique of the earlier theories amove to new theories

    Dual process model

    • However, an underlying approach of grief work continued in sometheories. A significant paper by Stroebe and Schut (1999) outlined a dual process model . They suggested that although we do need togrieve and the psychological processing of grief is importan

    Meaning reconstruction

    • Neimeyer (2001) is developing theories around meaningful reconstructionas a central tenet of the process of grief; a social constructivist model.Any major loss upturns our assumptive world, on which our sense ofsecurity and expectation of the world is based

    Continuing bonds

    • In 1999 Klass et al. wrote about continuing bonds , which underlinedhow people continue relationships with the deceased through memories,dreams, sense of presence and photographs. In line with Walter (1996)he found that many people have a role in rememberi

    Complications in grief

    • It has been noted that people who are bereaved as the result ofunexpected causes, such as violent acts or at a young age, tend to beseen as having complicated grief (CG) (Prigerson et al. 1999; Horowitzet al. 1997); this was later renamed as prolonged gri

    Counselling theories in loss and bereavement

    • Alongside the theories about loss and bereavement, we need tounderstand the best framework in which to integrate them

      Knowledgeof family systems and dynamics is important when working withpeople facing bereavement through death; as the whole structure of afamily will change; however, lack of space prohibits exploration here

      Psychodynamic theory holds that people have a limit to their levels ofemotional, psychological energy that they can invest in relationships, andthat following a loss their energy has to be withdrawn to ensure that theycan redistribute it into new relationsh

      The echoes can be heard hereof needing to let go of the deceased in order to move forward withoutthem, and re-invest energy in new relationships. Haugh (2011) describesthe hold that this letting go hypothesis has in counselling practice, aswell as in

    Chapter Summary

    • In the past few decades of psychoanalytical thinking, we can seethat there has been a major shift in theory from the focus onpsychological, psychodynamic ways of seeing bereaved peopletowards person-centred, more holistic approaches

      More recent theory has a broader focus, integrating differingviewpoints, acknowledging the holistic nature of the experience ofgrief.

      This chapter provides just an outline of information to give anoverview of this shift. It is important to draw on other resources,the additional suggested reading, your own practice, and your ownexperience to help guide you to the best way of working. It is

• 5 Strategies for management of anxieties
  • 4 Anxieties and management strategies
    • 1. The issues which raise anxiety levels
      • The breadth of the subject:
      • Relationship, relationship,relationship
      • Client s relationshipwith the deceased
      • Counsellor s relationshipwith their client
      • with their clientThe counsellor srelationship with self
      • Active listening: Lost for words
      • Language in all settings
      • Dealing with strong emotions,and different states ofbeing
      • Not knowing whento end, whengrief is resolved
    • 2. Supervision
      • Policing and checkingboundaries, ethics, policies andresponsibility

        Teaching: monitoringknowledge, understanding of theoryand how to be truly in contact with theclient by looking at different ways of working

        Creativity: the work itself, the content, theprocess for both client and counsellor

        Monitoring counsellor scompetence, reactions andcoping in working in lossand bereavement.

        Explains language processof counselling

    • 3. Training
      • The different types of loss,contexts and reactions
      • Historical and currenttheoretical approaches to loss
      • Reactions of bereaved people
      • Exploration of our own experiences andreactions
      • Defining endings
      • Finding the right words to say
      • Help you to look afteryourself
    • 4. Personal development / therapy
      • Picking up issues triggered/noted in supervision/training/client work

        Creating and maintaining self-supportsystems

        Developing coping mechanisms, stepping out of empathy and client sworld, identifying blocks

        Balancing life with work

        Understanding who we can workwith picking up the personalissues contained intransference, countertransference

    Issues and reactions in loss and bereavement

    • Training can alleviate many concerns by simply acknowledging thebreadth and scope of loss. A training program should include thefollowing:

      the different types of loss, contexts and reactions

      theoretical approaches to loss

      reactions of bereaved people

      clients who express suicidal thoughts

      finding the right way and words

      defining endings

      exploration of our own experiences and reactions

      looking after ourselves

    Theoretical approaches

    • understand the shattering and complicated effects and ramificationsof loss

      gain an understanding of how people make sense of their changedlives

      understand how bereaved clients maintain an ongoing relationshipwith the deceased which helps us not to become anxious if a clientsenses the presence of the deceased, talks about them in the presenttense, or talks of ongoing conversations with them

      understand the importance of relationship between client andcounsellor

      understand the need bereaved clients have that their counsellor willbe alongside them as they re-tell their story

    Questioning our values and beliefs about loss andbereavement

    • How long does grief last?
    • Children grieve
    • Children should go tofunerals
    • Death of a child is harderto bear than the death ofan adult
    • How a person dies has animpact on grief
    • Grief can lay unresolvedand can re-emerge yearslater
    • Children and adults arenaturally resilient to loss
    • Families pull together inthe face of loss
    • Loss through deathstrengthens an individual sfaith and belief

    Clients who express suicidal thoughts

    • Bereaved people are often very sad and seem very low. It is vital thatwe take note of any signs that they may be becoming suicidal, withoutbecoming too anxious or reactive. Phrases such as life is just not worthliving and I d really like to join him (the

      help the client to explore what they mean by those statements

      explore for any specific intention to take their own life

      consider the support the client has

      explore any previous history of self-harm or suicide attempts

      consider the client s use of medical support (i.e. GP)

      and (if you are not already aware) find out exactly what is making ithard for the client to carry on (don t assume the obvious

    Finding the right ways and words

    • not being able to respond
    • feeling speechless
    • worrying about finding the right words
    • being able to empathise with clients who are presenting difficultstories and strong emotions

    The process of counselling following a loss

    • Phase 1-Client Meets Counselor
      • CLIENT MEETS COUNSELLOR
      • START OF RELATIONSHIP
      • NEEDS EXPLANATION OF THE WORK
      • NEEDS EXPLANATION THAT THIS TIME WILL
      • NEEDS EXPLANATION THAT THIS TIME WILLMEAN OPENING UP ISSUES PAINFUL AT TIMES
      • LOOKING AT THEIR COPING STRATEGIES STILL WORKING?
      • LOOK AT DYNAMICS ACROSS THEIR SOCIETY FAMILY/FRIENDS/WORK ETC.
      • DEVELOPMENT OF TRUST IN RELATIONSHIP
      • MEMORIES COMMUNICATION/BOND
      • RATHER THAN DIRECTLY PHYSICAL
    • Phase 2-Exploring Issues
      • EXPLORING ISSUES FACTS/PICTURES
      • OPENING UP EVENTS/ISSUES
      • LOOKING AT WAYS OF COPING
      • LOOK AT RELATIONSHIPS FAMILY/FRIENDS
      • DEVELOP RELATIONSHIP WITH CLIENTTO MUTUAL TRUST/EMPATHY
      • LOOK AT VALUES AND BELIEFS/FAITH
      • NOTE POSSIBLE RIPPLE EFFECT OF LOSSES
      • NEEDS FIRM BASE, MAY FEEL DECONSTRUCTIVE AND DESTABILISING
      • NEED TO ENSURE CLIENT HAS SOME OTHER SUPPORT
    • Phase 3-Feel Vulnerable
      • CLIENT MAY FEEL VULNERABLE/SADDER
      • OVER TIME MAY FEEL INCREASING MISSING LONELY ISOLATED LACK OF PHYSICAL TOUCH/INTIMACY
    • Phase 4-Reconstruction Starts
      • RE-CONSTRUCTING STARTS
      • CHANGED IDENTITY/ROLE
      • RE-ESTABLISH RELATIONSHIPS
      • ESTABLISHING NEW COPINGMECHANISMS/STRATEGIES
      • CREATING NEW RELATIONSHIP
    • Phase 5-Coundelling Ends
      • COUNSELLING ENDS
      • CLIENT AT GOOD ENOUGH PLACE FOR ENDING
      • PROBABLY STILL IN PROCESS OF RE-LEARNING LIFE
      • LIVING WITH DECEASED THROUGHONGOING RELATIONSHIP WITH THEMALTHOUGH THEY ARE NOTPHYSICALLY PRESENT

    Defining endings

    • Grief is our response to the loss of someone or something to which we haveformed a connection or bond

      Loss of this bond can shatter life as it wasand we, as counsellors, are there to help the client put things back togetheragain; to find their new normal , whatever that looks like

      This new statewill be unique to each individual.

    Suggested techniquesIdentify your support network.

    • I need someone who will . . .
      • Listen wholeheartedly
      • Understand my world
      • Accept me as I am
      • Help me come to my own decisions
      • Be there for me whenever

    Balance in our lives

    • When working in thanatos (death and loss) it is important that we do notbecome subsumed in this area. We also need eros (love and life) to bepresent in our lives to create a healthy balance

    Wheel of balance

    • 1. family
    • 2. friends
    • 3. work
    • 4. intellectual
    • 5. spiritual
    • 6. emotional
    • 7. physical
    • 8. health
    • 9. time alone
    • 10. relaxation

    Wheels need to be round if they are to rollsmoothly. In the same way our lives need to bebalanced if they are to run smoothly;lack of balance can cause distress and/or stress.Take each section and join the lines where 10 is alot of time, 5 is enough time

    The Johari Window

    • 1. The OPEN area
      • is one which is known to the self, and is known byothers, the parts of yourself that you are happy with and openly share

        The aim when looking at the Johari Window is to increase the size ofthe open window minimising the others

    • 2. The HIDDEN area
      • is known to the self, but hidden from the sightof others. This may be through shame, due to childhood messageswhich are now out of date for you and unhelpful for growth

        Self-disclosure will open this area and will only occur in a safeenvironment/relationship.

    • 3. The UNKNOWN area
      • this may be about issues unknown to self,but are more likely to have been forgotten, repressed or denied.Discovering this can be frightening, but also can be exciting.

        Experiment, play, fantasy, myth, story-telling, drama and art canopen up this area; and need a very secure relationship base forexploration

    • 4. And, the BLIND area
      • unknown to self, out of personal awareness,but others can see them.

        Honest feedback within a safe and supportive relationship, orsometimes play and art therapy will open this area

    Chapter Summary

    • As counsellors we will experience challenges in our daily life; thisis not only normal, but also helpful as it both stimulates us in ourpractice and keeps us on our toes a bit of scary is good.

      While there are many levers which can help us to manage ouranxieties we will allay them, but we will not necessarily completelyobliterate them

      Managing our anxieties can be about managing expectations:through training we can learn what we may expect from clients, theirstories, experiences, behaviours, feelings

      We can also start to re-learn and re-think our own experiences andreactions, check that our earlier losses are not re-stimulated in a wayin which we are immobilised

      Through training and supervision we can hear that we don tnecessarily need the right words ; the right way is best for clients they want us to be with them and bear their pain and sorrow

      Through supervision we can explore ways of understanding ourfeelings of overwhelm; they may be our issue when we hear a client sstory, rather than the client s. We can also learn more about specificclients and their unique reactions and way of being.

      In this chapter I have outlined some thought-provoking exercises doremember that it is also good to discuss these with someone else

      Find your own networks local and national which can provide youwith information/support

      Finally, it can be really important to be aware of other factors thatmay help you. Having a good resource base of networks, informationprovision, literature and training can be vital; this text will providesome information, but it is good to expand this wit

• 4 Identifying anxieties
  • No one ever told me that grief felt so like fear. C. S. Lewis
  • Facing the issues: loss andbereavement
    • Death and bereavement contain multi-layered experiences andresponses because it can shatter life as we know it; this makesbereavement a potentially challenging area to work in.
  • Possible experiences specific to loss through death
  • Different deaths, relationships and co-factors will have a varying impact,for example
  • 1. Way of death: it may be:
    • a. expected following a long-term illness (although death may neverbe truly expected )

      b. sudden, through short-term illness, murder, manslaughter, suicide(although it is important to note that all death can be sudden evenif at some level expected ).

  • 2. Timing of death/age of deceased
    • a in pregnancy: miscarriage, termination, stillbirth
    • b early in life: neonatal deaths, child deaths
    • c death of an adult child
    • d death in old age
  • 3. It may be a public or private death
    • a death can be public and sometimes high profile due to the type ofdeath (e.g. a gangland murder), or can occur in public, (e.g. roadtraffic accident), or the death can be made public because theperson who died was famous (e.g. Diana, Princess of Wales)

      b death can also be private: hidden in a home, a residential setting, ahospice, a hospital. Death may also be so private that the bereavedbecome disenfranchised, as others may be unaware of their grief

  • Other factors will affect the client s reaction such as
    • 1. Relationship with the deceased
      • a the person who died will have an impact in terms of theirrelationship to the bereaved person

        b the death may connect to the bereaved person s role (e.g. vicar swife/mum to deceased child) and therefore aspects of identity

    • 2. The age/stage/life experiences of the bereaved person:
      • a the bereaved person may react differently due to their age/stagein life, or losses which are earlier, concurrent, or future.
    • 3. Loss through death shatters many aspects of life
      • a role and identity (ties in with relationship)
      • b ability to work: finances can be disrupted
      • c the security of the home may become threatened
    • 4. Belief/value/cultures which are questioned and frequently changed
    • 5. Relationships
      • a the myth that families pull together is often shattered; friendsare often strangely absent (although those who were not soclose sometimes pull closer); communities are not always there toprovide support
        • b marital relationships become stressed
          • c physical relationships and sex can be affected.
  • The bereaved will express a range of feelings and reactions
  • identifyingand demystifying the ripple effect of loss:
    • 1. Emotional and behavioural responses
      • a there is a myriad of different responses, from expressing feelingsto ways of coping and behaviours.
    • 2. Physical somatised responses such as
      • a fear being present as butterflies in the stomach
      • b sense of loss as losing half of self
      • c presenting with symptoms similar to the illness of the deceased
      • d bodily reactions through repression of emotions, such as
        • stomach upsets
        • heart pains
        • headache
  • Isolation
    • Bereaved clients often experience a feeling of isolation

      They report feeling in a different world, a differentculture from others and these feelings can be exacerbated when relationshipswith friends and family come under stress or even breakdown

  • The way of death
    • The way a person dies impacts on our clients and, as a result, oncounsellors. The way of death can range from long-term illness to violentand sudden death and from public to private deaths

      Long term illness: cancer

      Sudden death

      Place of death: a public death

      Place of death: a private death

      Trauma

  • Active listening: lost for words
  • Not knowing what to say
    • Not knowing what to say, feeling stuck or helpless has been outlinedas an anxiety and a challenge when counselling bereaved people. Thisanxiety has been connected to a feeling of being overwhelmed whenthe full impacts of loss through death have been realise
  • Client looking for answers
    • This is a very common anxiety for counsellors when working in loss andbereavement, as clients are often looking for answers: for example, Whydid he/she die? Why me? Where are they now they re dead?

      Clients even ask, How can you help me? Have you ever had the sameexperience? I just want her back , resulting in a counsellor wondering What can I do? How can I help them, I can t bring back a dead person sowhat use can I be? Training and supervision can

  • Language of loss
    • Language is a powerful counselling tool, particularly when dealing withloss; let us take a look at the use of language in three different areas

      between professionals: terminology/jargon

      in society: which is often cliché or metaphor

      of clients.

  • use of clichés
    • In societyAnother noted anxiety is the potential to fall into the use of clichés or toreact to the use of clichés such as:

      1. On the death of a husband: from one friend to another, You ll getover it .

      2. On the loss of a child: from a doctor, You re lucky, you ve got anotherchild .

      3. On miscarriage: from a friend, It s nature s way of telling you thatthere was something wrong with the baby; it s probably for the best

  • Dealing with strong emotions, anddifferent states of being
    • The array of issues associated with loss may make us start to wonderhow indeed we can help; likewise, the range of responses can have thesame effect

      Bereaved people express feelings of chronic sorrow, anger,and fear.

      These are what we may expect to see, but they can still raiseanxieties for us; then there are issues such as clients who don t show theiremotions, and raise the question of can grief be said to be complicated?

      Sorrow

      • Chronic sorrow is often confused with depression ; the feelings andstates of being on bereavement are very similar to the DSM IV categoriesfor depression. However, most bereaved people feel sad but are notdepressed.

        Clients who express chronic sorrow and strong emotions can create anxietiesfor counsellors. We may question whether our client s grief has becomecomplicated, which begs the question, when is grief complicated ?While it is important to note that grief is a

        Clients who express suicidal thoughts

        Listen for expressions such as life is just not worth living , and why am Igoing on? They are very commonly heard from bereaved clients whoselives have been turned upside down after a significant person has died.It is vital in this situation to stay suff

        During counselling it is important for clients who have experienced a lossto tell their story, to make links in losses and, through this they will alsoinevitably express their feelings about these life events

      Fear

      • Counsellors have reported concerns about their clients levels ofanxiety and how it expresses itself. One counsellor noted, Is a flutteringheartbeat an illness or a bodily felt reaction to the loss/fear? Bereavedclients also talk about having a broken he

        In these instances it is importantto help clients to differentiate between illness and somatised effects ofloss (which are common). In parallel with any counselling we provide, itis important to ensure that clients have any physical symptoms medicallychecke

      Anger

      • Anger and death are inextricably linked; this may be a very strongstatement, but pause and reflect. If you were bereaved you may be angry:

        that someone you love has died

        at the cause of death: it may be a murder, a road traffic accident, or anillness that could have been prevented

        with your family, following the death (issues around the reading of awill, for example)

        that your belief has not held .

      Relief

      • A less reported fact is that people who are facing loss sometimes feelrelieved; for example, someone dies after a long illness, a separation aftera traumatic relationship, or finally a diagnosis after a long period of illnesswithout explanation

      Guilt

      • “Guilt has often been described as anger turned inwards. It is an emotionthat has also been described in Elizabeth Kübler-Ross s work on stages(1971) as self-questioning as well as bargaining if only I had/had notIdentifying anxieties 53. . . . While”

      Happiness and laughter

      • Not all client sessions are full of tears; there is often laughter too, whichcan be very therapeutic. Memories can be both sad and happy; if you thinkabout a funeral, for example, there is often a range of stories, with varyingemotions alongside

      Non-expression of feelings

      • Anxiety has been conveyed to me by counsellors when their clientdoes not seem to be expressing their grief . It is important to notethat in different cultures, expression of grief will differ; understandingfrom the client s perspective is essential, and n

      States of being

      • Death and bereavement also affect people s being, which in turn affectshow they feel. For example, in the early days following a loss (howeverlong this may be) people are in shock. This is an impact whether thedeath is expected or unexpected; sleep patterns

      When is grief resolved?

      • When working with loss, how do we know when grief is at an end? It is aquestion I am frequently asked. So can we know when grief is resolved ?The simple answer to this can be found in the more recent theories andis that grief does not end. An over-used cli

        As counsellors we need to stay alert to indicators from our clientsthat demonstrate they may be making some adjustments to their newchanged life, such as how they are making (sometimes nearly imperceptible)moves forward

      Chapter Summary

      • Loss through death is a multilayered/multifaceted experience, whichis uniquely different and will be faced by everyone. A very brief glancehas been presented into a wide range of issues of loss, and a similarlybrief glance at the challenges and anxieties th

        Bereaved people may feel confused, helpless, out of control,overwhelmed and in counselling we may feel this as a parallelprocess.

        As counsellors we wonder where to start, what to say, how to say it,but the most important aspect is to learn how to meet and be withour clients in their grief, in their story

        The powerful way in which emotions will be displayed and the stateof being of the client can also impact on us and leave us anxious andunsure how to move forward.

        The lack of clearly defined resolution or closure to loss can make usanxious

        Loss is an ongoing experience and state of being

        Building a relationship can also be affected. If we are feeling anxiousthen we need to steady and ground ourselves in order to createand maintain relationships

        There is a fear that our own personal losses may re-emerge insessions

        In parallel with these concerns, counsellors must also personally readythemselves to experience explicit details of a topic that is generallyhidden from public view

        It is also important to highlight the strengths of anxieties as everytime I meet a new client, even after years of practice, I still feel slightlyanxious; what will they be like, how will they react, and what is theirstory? If I ever lose that scary feeli

        Now we have named our anxieties we need to find, as Selye (1976)notes, ways to actively cope with challenge and stress

• 6 The voices of clients
  • daughter s death brought with it strong reactions, emotions, andquestions which they needed to express in counselling. They needed totalk about
    • her last illness
    • her death itself
    • how she looked
    • how they panicked
    • how they wanted her to be at home and how this was an impossibilityin the event
    • the impact on their surviving child
    • their fears and concerns
    • that she was now an only child not the youngest any more, nosibling with disabilities
    • the change in their roles we have got to start anew
    • no more caring
    • no more forms to fill out
    • no more medical teams to meet
    • no more appointments
    • what does this mean to them?
    • what would their world look like now?
    • the initial possibility of relief does this last, will it change?

    Chapter Summary

    • Clients whole lives are turned upside down by loss. Often theseanxieties are feelings of immobilisation shock and trauma like arabbit in the headlights, as is often reported in the early days of grief.Clients need proactive guidance to access counselli

      Clients also need

      • Services to be sensitive to, and flexible about, the setting of theircounselling (without presumption of what is right).

        To talk about everything after the initial splash of that rock in thepool, the ripple effect of loss affects all aspects of life.

        Services which will go the distance and stay alongside bereavedpeople for as long as it takes, as grief is not resolved, and has noending.

        Counsellors to understand that they do not fit grief into patterns ortheories grief is about all of life; there are no stages or tasks.

      These client s stories also ask counsellors to:

      • Let me be with my relationship with the deceased don t make mefeel mad because I feel her inside me, hear her voice

        Don t go ahead of me and show me what is there

        Don t go behind me or take me to the past until I am ready, if Iam ready to go there

        Just be alongside me I need to talk about everything I need myown timescale.

        Accept me; help me to accept myself and to explore how I amcoping.

        Be honest with me

      It is about being not doing

      I use the quote at the start of this chapter to remind myself constantlyof the privileged place I am in when clients talk about their whole livesto me, and to respect what they need to talk about, and how scary itcan be to talk about all aspects of life.

• 7 Professional challenges
• 8 Ethical challenges
  • What are ethics as applied tocounselling?

    Being trustworthy: honouring the trust placed in us

    • mission statement: outlining the service s values and aims, its referralcriteria
    • who the service is supporting, when, where, the parameters of theservice
    • length of service: brief intervention, long term
    • the way of working: cognitive behavioural therapy, person centred

    Autonomy: respect for the client s right tobe self-governing

    Beneficence: a commitment to promoting theclient s well being

    Non-maleficence: a commitment to avoidingharm to the client

    Justice: the fair and impartial treatment of allclients and the provision of adequate services

    Self-respect

    Chapter Summary

    The challenges and diversities in counselling mean that practitionerswill inevitably encounter situations in which there are competingobligations

    Our first duty to clients is premum non nocere , first do no harm.Bereaved people have already faced the most devastating of life sexperiences, and it is essential that the counselling we providealleviates rather than exacerbates the issues they face.

    Counselling people facing loss and bereavement raises someadditional ethical issues, both of the framework in which we providecounselling and of the content of counselling itself

    While a statement of ethics cannot take away difficulties in makingprofessional judgements, such information can be of great assistanceby providing guidelines that may need to be taken into consideration

    focus on what clients needed and wanted from counselling

    • stay with their story; be with them; step into their world andunderstand

      listen to whatever they described without deflection withoutoverlaying theories on them; with an open heart

      accept them however they are, whatever views/emotions they want toexpress

      and yet at times demonstrate an initial understanding by introducingsome common feelings when people face loss; normalising yet notprescribing their experiences and helping them in making some senseof a nonsensical world

• Glossary
  • Anticipatory grief
    • refers to a grieving that can sometimes occur before a loss, which maybe anticipated. This impending loss can be the death of someone due toillness. It is also said to be experienced by dying individuals themselves
  • Autonomy
    • is the capacity of an individual who is deemed to be able and rationalto make an informed, unforced decision. Autonomy is often used as thebasis for determining the moral responsibility for one s actions in moraland political philosophy. It is used here to
  • Beneficence
    • refers to actions that will do, or produce, good including the promotionof the well being of others. In a medical context, this means takingactions that serve the best interests of patients
  • Bereavement
    • the state of being we are in when we are deprived or something orsomeone, i.e. following a significant loss (in contemporary society). Theforerunner of our modern word bereavement was the old English wordbereafian, which included the definitions to be ro
  • Bereavement counselling
    • in general terms, used to describe a form of counselling that focuses onhelping people to cope with grief and mourning following a significantloss, including the death of loved ones, or with major life changesthat trigger feelings of grief (e.g., divorce).

      However, the definition and job description for someone carrying out bereavement counselling are varied. See also Counselling bereavedpeople below

  • Bereavement process
    • the process we go through when we grieve following a loss is a personaland individual experience; no two people s pathways through grief willbe the same. The process has been described in different ways throughtheories which can be noted in Chapter 3. Howev
  • Cognitive behavioural therapy (CBT)
    • is based on the belief that behaviour is learnt in response to pastexperience. As such, we can recondition ourselves or unlearn thebehaviours without the need to analyse past experiences, to find thereasons or triggers for such behaviours. It is noted to wo
  • Complex medical needs
    • an illness or disability: where the diagnosis may mean that life isthreatened, but the illness may be curable; where the diagnosis meansthat life will be shortened; where an illness or disability means constantGlossary 131ongoing treatments; may be acquired
  • Complicated grief
    • now referred to as prolonged grief disorder (PGD) is a pathologicalreaction to loss (formerly known as complicated grief). An attempt isbeing made to create a diagnosis category for complicated grief in theDiagnostic Statistical Manual V (DSM-V); critics of
  • Confidentiality
    • requires providers of bereavement support to respect the privacy of eachbereaved person and information shared by them. It is essential that therelationship between each bereaved person (the bereaved client) and theindividual or agency which offers them sup

      The duty to maintain confidentiality extends to all those involved inoffering support, including management committees, and continuesafter that support has stopped and beyond the death of a bereavedclient. Confidentiality is not absolute. In exceptional cir

      Bereaved clients need to be made aware of the limits to confidentialityas soon as possible, preferably before support begins. If informationis to be disclosed to a third party, bereaved clients should, whereverpossible, give informed and meaningful consent.

  • Counselling bereaved people
    • help a bereaved person to work through grief in their own way, at theirown pace and in their own time; without a specific way to experiencebereavement. This book encourages the integration of a whole of life orholistic approach to counselling people on be
  • Disenfranchise
    • to deprive of a franchise, of a legal right, or of some privilege or of afranchise in the context of grief (see below).
  • Disenfranchised grief
    • a term describing grief that is not acknowledged by society. Examplesof grief becoming disenfranchised are: the loss of a pet; a trauma in thefamily in an earlier generation; the loss of a home or place of residence;an aborted/miscarried pregnancy; a mother
  • Disenfranchisement
    • can also occur when a loss is associated with what is seen as a positivelife event: the areas are huge; for example, a marriage when the newlyweds may also be leaving home; a graduation, when the graduate isleaving the safety of the university/college and h
  • Ethics
    • a set of principles of right and appropriate conduct and/or a systemof moral values. Ethics also includes the study of the general nature ofmorals and the specific moral choices to be made by a person: moralphilosophy. Most importantly, ethics refer to the
  • Grief
    • primarily an emotional reaction to a significant loss; this may be causedby the death of someone close. It will be expressed in many ways:emotionally, behaviourally and physically
  • Grief work
    • the work we do when we grieve can be described as the cognitiveprocess of confronting the loss, of going over the events before andat the time of death, of focusing on memories and working towarddetachment from the deceased. It is often associated with th
  • Holistic
    • the root of the word holism is o´´»o (holos) a Greek word meaningall, whole, entire, total; the idea that all aspects of a g
  • Informed consent
    • usually refers to the idea that a person must be fully informed about andunderstand the potential benefits and risks of their choice of treatment.An uninformed person is at risk of mistakenly making a choice that doesnot reflect his or her values or wishes.
  • Moral
    • the lesson or principle contained in, or taught by, a fable, a story, oran event; a concisely expressed precept or general truth; a maxim.Morals are rules or habits of conduct, especially of sexual conduct, withreference to standards of right and wrong: for
  • Mourning
    • as contrasting with grief, is the social expression or acts expressive ofgrief that are shaped by the practices of a given society or cultural group.
  • Mutual help group self-help group
    • a group of people who provide mutual support for each other.The members will share a common issue or problem; for example,bereavement, or a specific bereavement such as death of a child. TheCompassionate Friends provides support based on self-help groups.Th
  • Non-maleficence
    • the first concept is primum non nocere (Latin) first, do no harm , referringto the first line of importance not to do harm to your client.
  • Parallel process
    • the idea encapsulated through the way in which elements of thecounselling relationship can be paralleled to other aspects of life. Forexample, a client/counsellor relationship may parallel a relationship theclient has with other people in his or her life,
  • Pathological grief
    • Margaret Stroebe (2000) acknowledges that grief can becomecomplicated and, therefore in her view, pathological . However, shesuggests that there are no clear guidelines available to establish at whatintensity, and/or duration, and/or type of symptomatology
  • Person centred therapy or counselling
    • can also be named client-centred or Rogerian counselling. It is basedon the view that people will, given the right environment, find theirown way forward. Through counselling, the right environment will bethat of an accepting, genuine, understanding r
  • Somatise
    • to express psychological issues or conflicts through somatic symptoms;people who are bereaved, who feel unable to fully express their feelings,often have chest pains and suffer from a broken heart . This should bemedically checked, but when unexplainable b
  • Specialist
    • in this text is as person who devotes himself or herself to one subject, orto one particular branch of a subject or pursuit.
  • Specialist organisation
    • can be defined because it has a client group that need special training tounderstand their needs; in the context of this book, this will be bereavedpeople. And their client group will require professional qualifications/specific experience of the staff spec
  • Statutory services
    • are services required to exist by law, e.g. social services and the NationalHealth Service. All local authorities are obliged to provide statutoryservices, which tend to be those considered as so essential to modernlife that for moral reasons their universa
  • Trauma
    • a serious injury or shock to the body, as from violence or an accident; anemotional wound or shock that creates substantial, lasting damage to thepsychological development of a person, often leading to neurosis; or anevent or situation that causes great dis
  • Unresolved grief (or delayed grief)
    • any aspect of grieving that has yet to be resolved. In cases of unresolvedor delayed grief, the reaction to the loss is postponed until a later time,even years later, and might be triggered by a seemingly unrelated event,such as a recent divorce or even the
  • Vicarious traumatisation
    • a term coined with specific reference to counselling and therapists whowork with clients who survive trauma. Resulting from being empathic withtraumatised clients, therapists will be changed in their sense of meaningof the world and life experiences
  • Voluntary service
    • an organisation that undertakes voluntary activities, i.e. those whichdo not have to be provided by law (statutory services). They have thefollowing additional characteristics: clear objectives, contents and tasks,structure and framework, appropriate suppor
  • Volunteers/voluntary activities
    • have the following characteristics: open to all, unpaid, undertaken of ownfree will, educational (non-formal learning aspect), adding social value
• Compiled By:
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  • Rigel Arcayan