Case study 1 looks at Bereavement Counselling. The Collins English Dictionary (2014) defines bereavement as the condition of having been deprived of something or someone valued, especially through death. In 2012 499,331 deaths were registered in England and Wales, an increase of 3.1% from 2011. Individuals who incur bereavement also suffer from a reaction know as grief. Those who endure grief experience behaviours such as aggression, Individuals feel anger towards others such as God, medical staff or other family member for the loss of their loved one in order to find blame and reasoning. Other behaviours could be a lack of sleep and possible illusions. Alternative emotions of grief can be physical sensations such as a …show more content…
hallow stomach or pain in the individuals heart. Although grief does not cause actual physical harm it can be distressing and may feel like an injury due to the upset caused to daily functioning. Individuals who are grieving for a loved one often suffer from cognitive feelings such as belief that the loved one will comeback from the dead or even still due to disbelief and confusion that they are still here. Another form of grief is Anticipatory Greif, this occurs in individuals who are caring for a person who is known to be dying. Despite this individuals still hope that person will recover and survive. These individuals can often be exhausted due to their lives being focused on the ill relative/friend. Once that person passes away the initial response is relief, as they are no longer suffering, however in due course this recedes to the individual feeling “lost” once the absence of that person is realised.
Dr. Elizabeth Kubler-Ross theoretical work on grief and trauma associated with death and the dying her ideas sited in The 5 stage model (also referred to as The Kubler-Ross Grief Cycle) are transferrable to support bereavement counselling. Stage one of the cycle is Denial. Denial can be conscious or unconscious depending on the individual. It is the individual refusing to accept the facts and reality of the situation. It is a defence mechanism to bypass change. Once individuals have accepted the death of the person they then move on to stage two, which is commonly known as the anger mode. Anger is an emotion, which is difficult to control individuals could be angry with God, family members, medical staff or even with themselves for not doing more to save that person. Subsequently once a person has detached from denial emotional anger is used as a coping mechanism. Shortly afterwards the bargaining stage occurs this is when individuals will attempt to bargain with God. Those who struggle to find meaning in the situation often reach out to God for strength and willpower to proceed with daily life. Once the reality of the situation has been accepted individuals feel the emotions connected with stage four. Kubler-Ross believed that in stage four individuals feel a mild depressive state, this includes emotions such as overwhelm and helplessness. The final stage of this model is the acceptance stage, this stage indicates that an individual can look objectively and has found a coping strategy. Individuals at this stage will look at exploring new options and somewhat resume daily activities.
Colin Murray-Parkes believed that the body goes through 5 modes when suffering from grief during bereavement. Firstly is shock mode where individuals will find it difficult to talk/eat etc. Following that individuals feel the pain of the person passed away. Leading on is despair, which presents emotions such as anger and guilt. Similar to Kubler-Ross once strong emotions have passed acceptance occurs and finally a resolution and reorganisation. It is only once individuals have reorganised they are able to begin recalling memories.
Each and every individual who suffers from bereavement react in a different way, situations affect us all differently. The affects could be psychological such as an individual loosing their identity this is commonly occurs if an individual becomes widowed and begin feeling lost. Individuals can also be affected psychologically such as loosing faith, due to the harshness of death individuals often turn to God and ask “why” and failure to reason with death reduces their faith. In order for individuals to cope and recover from bereavement support they have to turn to their support networks for help. This can be as simple as friends, family and work colleagues. Or individuals are able to reach out further for professional support, which could be provided by counsellors, support groups or religious leaders.
Theoretical Orientation
Bereavement is a current issue which counselling services have been established to support. The DSM –IV allowed clinicians to explore Major Depressive Disorder (MDD) and can distinguish it from bereavement and the natural features that occur through loss. The DSM states that bereavement can lead to depression after 2 months of bereavement. When looking at theoretical orientation for those suffering with bereavement counselling therapists will look at a therapy suited for that individual depending on their needs. Humanistic therapy leans towards the belief that the individuals can help themselves. Counselling therapists will help patients self-actualize allowing a natural incline towards self-fulfilment, understanding and acceptance in order to reduce suffering. The types of humanistic therapies available for bereavement include existential, person centred or gestalt therapy. Cognitive-behavioural therapy also finds ways to deal with bereavement. This type of therapy would require the counselling therapist to help their client understand their identity and perhaps adjust their beliefs or behaviours in order to have a positive impact on the client life. Other therapies, which are known to have a positive impact for individuals suffering with bereavement, are attending support groups. Individuals are then able to meet those who have experienced the same grief and can often be inspired by others who have concurred difficult bereavement.
Intervention/Method/Application
Reading Arthurs case study it is inevitable for a GP not to referring him for bereavement counselling due to the symptoms, emotions and behaviours he has displayed since the death of his wife Lily.
During the first session of Arthurs bereavement counselling with a counselling therapist the Counsellor will determine the type of grief Arthur has. Based upon the findings of the case study the fact that Arthur is still displaying behaviours such as not eating, anger and difficulty sleeping suggests he is still in the early stages of bereavement. Due to the fact that it has been two months and Arthur still has not been able to get his life back together could suggest that the grief is acute. If the grief were pro-longed for 12 months it would then be categorized as chronic grief. Also the DSM IV suggests that depression can occur after 2 months of bereavement, In Arthurs case two months have passed since the death of Lily therefore it may be suited for Arthur to be prescribed antidepressants by his GP for short term depression as a coping mechanism. It is important for a Counsellor to distinguish whether a client suffering from depression is suicidal. It could be considered practical for the counsellor in session one to ask Arthur if he is suicidal after the death of his wife. If Arthur is suicidal then the Counsellor would check the level of suicide and ask Arthur “what’s stopping him?” in order to focus on the positive aspects of his life. If the client has planned a suicide attempt then it is crucial that clients GP is contacted at the earliest opportunity.
In any case of bereavement it is normal to expect reactions of the client to intensify immediately following the death of the person then to decrease over time.
From a cognitive perspective bereavement is the negative loss through death, which nobody has any control over.
It is associated with the client’s emotions, behaviours and belief system. CBT looks at gradual detachment from the deceased and then re-establishing new relations with others. Although this may be difficult in Arthur’s case as he had been married to Lily for 52 years therefore probably would not be willing to replace her. The bereavement process does not necessarily lead to recovery or closure but more as accommodating emotions and experiences to the new reality. CBT perspective lays its emphasis on the client reorganising what has been destroyed by the loss of a loved one. They do this by revising the client’s negative thoughts and feelings. Epstein, (1993) noted in his work that death is an event that is new information that has to be processed then accepted then accommodated. CBT helps clients through the processing stage. The process of grief is one that ends with the client’s acceptance of the loss however this has not been empirically …show more content…
supported.
Life long struggle to find a balance between “What is” and “what was”. It is important for the client to maintain inner relationships with the deceased.
Types of CBT work carried out by professionals for clients such as Arthur would be exposure techniques, thought stopping, breathing exercises, homework assignments. Ellis (1991) REBT cognitive model highlights the cognitive process in understanding emotional disturbance. The model differentiates between rational and irrational cognitions based upon emotions and behaviours. In the case of bereavement according to Ellis counsellors are able to identify healthy reactions to bereavement and dysfunctional grief. The model provides guidelines for the assessment based upon the client’s interpretation of the person’s death. Ellis administered strategies to overhaul irrational thinking into realistic and rational thinking. Malkinson, (1996) suggested that clients must tell their story, interpreting the death, expressing their feelings (irrational thoughts) and the personal meaning of the loss. Counsellors from this look at the language used by the client to asses the client’s grief cognition. Malkinson mentioned the importance of dealing with pain in order to come to terms with bereavement in Counselling. When a client feels pain as an emotion this indicates that they are able to recognize and understand the death of the person. Pain is a process clients have to go through in order to fully recover from bereavement. Arthur must be able to increase his sense of control both cognitively and physically over the pain he feels in order to over come his loss.
Rational Emotive Behaviour Therapy has an ABC exercise. This is a form of Cognitive behaviour therapy, which is one of the earliest forms of CBT developed by Albert Ellis (1957). This exercise is used to analyse a situation and change our thinking about it. Often in cases of bereavement this occurs when clients blame themselves or other for the death of a loved one. The first aim of the exercise is to identify the event, secondly is the irrational belief linked to this event following this is to classify the consequences of this belief. The client must then dispute these irrational beliefs finally allowing them to create effective new thinking. In Arthur’s case this may help Arthur with has lack of eating. Counsellor would identify the event as his lack of food intake then link this to an irrational belief. Following this self help exercise it should help Arthur create new positive responses to the grief he has been struck with since the death of his wife.
CBT offers behavioural strategies for clients suffering with negative thoughts. These are prescribed in the form of homework assignments. Every time the client has a negative thought they are asked to write down these feelings. The counsellor would them use these a guideline to work with during the therapy. Arthur suffers with difficulty sleeping during the nights therefore it would be beneficial for him to write down his thoughts and feelings which haunt him at night time so the counsellor could apply therapeutic techniques to battle these.
Ethical Implications
The British Association for Counselling and Psychotherapy (BACP) published The Ethical Framework for Good Practice in Counselling and Psychotherapy in 2002 with the latest revised edition in February 2010. The BACP outlines the professional standards expected from counsellors.
When working with any client it is important for Counselling practioners to understand the ethical issues, which may occur, and what the guidelines suggest they do. The first ethical rule for all practioners is to be fair and impartial. This means that they are forbidden from making any judgements and must understand the situation from the client’s perspective. Counsellors are clients hold a confidentiality contract; confidentiality is defined as the respect for a client’s confidences. Due to strict legislation it is mandatory for Counsellors to follow confidentiality guidelines during practice so no privacy laws are infringed. However confidentiality is not clear-cut and there are cases where counsellors are obliged to break it. This may occur in cases where there is a legal requirement on the counsellor or in the case of an emergency. For example if Arthur was to tell the counsellor he had a planned suicide attempt post the death of his wife it would be impediment a supervisor and medical staff where informed about this. It is the counselor’s responsibility to ensure that the client is protected from harm whether that is any cause of hurt or self harm. Nonetheless the consequences when breaking confidentiality would often have an impact on the counselor-clients relationship so it must be considered whether it is in the benefit of the client to do so.
Another ethical issue is the scheme titled Protection of Vulnerable Adults (POVA). The POVA scheme is set out in the Care Standards Act 2000. The scheme creates an extra layer of protection during the employment process to ensure that vulnerable adults are in safe hands. Anyone working with Arthur must be POVA approved due to his sensitive nature at the current time.
Evidence based practise
Evidence based practice (EBP) is used to demonstrate the best methodological process which can be sustained through rational acknowledging the clients best interests. Maslow’s hierarchy of needs fits with the CBT framework. Clients are able to self actualise and create positive psychology which in other words means they are able to live life as happy as they can. Maslow referred to CBT as a method of personal discovery and growth of an individual. Through self-actualization individuals are able to find meaning to life (again). However CBT has been criticised due to the fact that it requires confronting your emotions, which can be incredibly uncomfortable for clients in the initial stages. CBT focuses mainly on changing yourself (the clients) and often ignores wider problems, which may he, cause of negative distress. However CBT is one of the shortest therapies in comparison to other therapies. The skills clients learn through CBT can later be interpreted into everyday life situations which would be highly beneficial to the client for a full long term recovery reducing any relapses.
Conclusion
In conclusion Arthur pain, which he is avoiding currently through the disbelief and irrational behaviour will conclusively through bereavement counselling be healed.
Counselling will guide Arthur to regain equilibrium between his mind, behaviour and feelings.
References
Bereavement. (n.d.). Collins English Dictionary - Complete & Unabridged 10th Edition. Retrieved November 30, 2014
Ellis, A. (1957). Rational Psychotherapy and Individual Psychology. Journal of Individual Psychology, 13: 38-44.
Ellis, A. (1991). The revised ABC’s of rational-emotive therapy (RET). Journal of Rational Emotive and Cognitive Behaviour Therapy, 9(3), 139-172
Epstein, S. (1993). Bereavement from the perspective of cognitive-experiential self-theory. In M. S. Stroebe, W. Stroebe, & R. O. Hansson (Eds.), Handbook of bereavement: Theory, research and intervention (pp. 112-125). New York: Cambridge University Press
Kübler-Ross, E. (2005) On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss, Simon & Schuster Ltd,
Maslow, A. H. (1962). Towards a Psychology of Being. Princeton: D. Van Nostrand Company.
"The Price of Love: The Selected Works of Colin Murray Parkes" (2015) publ. Routledge, Hove, UK & New
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