Counselling Week 4 Flashcards
Loss and grief in relation to counselling (SLP) ⛪
- > You will have clients who have faced death (especially head and neck cancer, head injuries etc.)
- > loss of function, independence, loss of contacts/relationships (sadness and loss)
- > Parents, partners and children coming to terms with
- > “ambiguous loss” (loose things you haven’t even loss e.g. severe dementia-> still alive, but loss of who they once were)
- > Death and loss=we now expect death to be caused by specific things (some diseases-not others, the old-not the young)-> anything deferring from these “norms” is seen as tragic
- > MOST are not exposed to death and loss
- > most DIFFICULT aspect of counselling (90% were wanting to know if they are dying, 60% were prepared to tell them directly)
What is Elizabeth Kubler-Ross’ model of grief and loss? 🏴
*5 stages of grief
-most influential approaches to working with people experiencing death and grief
-Stages:
💔(1) Denial: “There is a mistake”
🧡(2)Anger: Angry at God and Nature, “How can people go on as if it is not happening?”
💛(3) Bargaining: deal with God and nature, “If I…then maybe”, “I’ll stop smoking”
💚(4) Depression: impending loss, reduction of social activity, pleasure, mobility
💙 (5) Acceptance: not “happy”, but understand and accept the inevitability
Criticism of Kubler-Ross’ model ✍🏼🏴
- implies that there is a time sequence ⌛🖇️
- later made clear that is is NOT CONCRETE stages-psych responses to dying rather than stages
- people move back & forth, “ebb and flow” 🌊
- no real evidence of the 5 stages of grief
- revised to complex and changing psychological responses people have to death (RANGE of complex responses NOT a sequence)
Assumptions of Kubler-Ross’ model 🤷🏴
-grief is a UNIVERSAL experience 🪐
-go through “stages” (now revised to psych responses, not a sequence) 🖇️
-traditional psych responses=grief will be resolved (let go, move on)
^contemporary approaches do NOT have this response ❌
Powers and Singer (1993) model for grief
- Similar to Kubler-Ross
- shock
- denial
- anxiety
- anger
- guilt
- depression
- acceptance
Common idea across traditional models of grief 🌞
-common ideal: “okay again” 🌞
Worden (Grief counselling and Therapy)-“move on”
Raphael (Anatomy of Bereavement)-“reintegration”
Rando (treatment of complicated mourning)-“reinvest in the world”
-Endpoint: loss has been passed “back to normal” 🎯
(old, traditional concept in counselling and therapy)
**however, LIFELONG intimate relationships 💑=fundamental change by not having them around, not entirely separable
Silverman and Klass (grief and loss) 💞
- intimate couples are not entirely separable (interdependent, intimately involved in the lives of others) 👼
- Loss=> may incur loss of part of self
- Some level of continuous relationship 💞
- Inner representation=allow people to interact with person who is dead (in their head-> some level of interaction with them e.g. ongoing imagined conversations, recognising bonds in the past can inform present & future) 💬
- internal dialogue 📝
- “continuing bonds” (NOT “end point”)🖇️
- people shouldn’t “seek closure” (negotiate how to live life with the part of their partner inside of them)
- point=to understand the loss they had and make meaning of their life with internal change
Counselling issues (working with people who are dying, grieving-self or someone else) ❕❕❕
-stage grief 📈(moving through grief reactions)
-episodic grief 💥(ongoing unresolved loss and sadness, unanticipated and sudden)
^”Continuing bonds” type of approach 🖇️
-must use EMPATHETIC use of knowledge (how much can the family take on? how much can they absorb? what can be done?-useful/helpful)
-distress (don’t process information correctly)
^thus, language must be CLEAR, CONCISE, No ambiguity, here and now (FUTURE) 💬
-muster strength and POSITIVE attitudes 🌼(e.g.
disability-> strength of child// bereavement-strength
of the surviving family)
e.g. “You seem like a really strong couple”, “You
make things great for Jilly” (optimistic about
strengths)
-openly talk about and model strategies (optimistic
but realistic, active and engaged, don’t internalise
emotions)
-Empathy and active listening (make FEW
assumptions
on how people feel and respond)
-Reflection of feelings (emotional reasoning and
paraphrasing)
-sensitive to culture and familial differences (feelings)
-be sensitive of mental health complications (make a
referral where appropriate)
Breaking Bad News (PEWTER)
-telling people what they may or may not want to hear
-diagnosis, prognosis, likelihood of treatment success
-worse news=less likely to talk about, but more important
PEWTER
📗Prepare
📘Evaluate
📕Warn
📙Tell
📒Emotional response
📓Regrouping
PEWTER: Prepare 📗
Prepare 📗
- setting (free of disruptions, debrief, make sure the appointment is scheduled for longer-not rushing off to other sessions)
- tissues/comfy chairs 🪑🤧
- can you say it ina clear/direct way?
- do you have all the info you need?
- alert, positive (confident), counselling skills (SOLER, Basic Listening Sequence)
PEWTER: Evaluate 📘
Evaluate 📘
- what does the client know or suspect?
- open qs “tell me what you think Jilly might have” ❓
- listen for misconceptions (hear them before jumping in)
- make sure you’re on the same page 📖
- don’t correct mini details (look at BIG picture)
PEWTER: Warn 📕
Warn 📕
- foreshadowing that you’re going to break bad news (“I have some news for you, may not be positive”-> give them time pause) 📰
- gage/mentally prepare them 🧠
- comforting (words of empathy/respect) 💖
PEWTER: Tell 📙
Tell 📙
- simple, direct and clear (people don’t process information when they are stressed)-don’t over-explain details
- check back if they have understood 👂)))
- non-apologetic
- empathetic (not negative or positive)
PEWTER: Emotional response 📒
Emotional response 📒
- own and client’s emotional response
- how to respond to them 🗨️
- people respond in a range of ways to unhappy things (Kubler-Ross) 🗩
- reflecting on feelings, paraphrasing, summarising (basic listening sequence)
PEWTER: Regrouping 📓
Regrouping 📓
- gathering thoughts and ideas together-> way forward (stay here? need a tea? need a tissue? more time? another room?) 🤧🍵
- Immediate=ring family member, time to self
- Long term=professional referral 💌 ☎️
