32. 辅导因悲伤和失落而困扰的人

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32 Counselling those troubled by grief and loss We have noticed that a high proportion of problems people experience are concerned with relationships. Issues related to relationships fall into four major categories. These are: 1 dysfunctional relationships 2 failure to form meaningful relationships 3 lost relationships through death and separation 4 negotiation of the normal or developmental challenges and changes in relationships. TYPES OF LOSS In each of the relationship categories listed above, issues of loss and grief may arise. In dysfunctional relationships there is a loss of expectation that these relationships will be functional and harmonious. People who are unable to form meaningful relationships may have to cope with the loss of their expectations. When couple relationships break up, both people need to adjust to the loss of a partner. In the case of married couples, there is also the loss of marital status and the loss of the expectation that marriage is for life. If children are involved, then each parent has a loss of support from their spouse in the day-to-day rearing of the children, and often one parent has a significant loss of contact with the children so their parental role is to some extent diminished. When relationships are functioning normally, new situations will arise from time to time — changes will naturally occur due to changes in roles as a consequence of the inevitable developmental stages of the relationship. There is therefore a need to confront the challenges incurred by change, and change often involves loss. Counsellors also hear about many other types of loss: for example, the loss of a limb, loss of an internal part of the body, loss of mental functioning due to ageing or brain damage, loss of a job, loss of a home or loss of self-respect. HELPING A PERSON WHO IS GRIEVING In order to be effective in helping people who are grieving over a loss, counsellors need to understand the process of grieving. There are many books on loss and grief counselling, including those listed at the end of this chapter, for those who wish to read more about the subject.

When counselling somebody who has suffered a loss or who is grieving, it is important to be able to reassure them that the feelings they are experiencing are normal for a person who is grieving, and that it is normal to take time to grieve. In this regard it may be useful to self-disclose if you yourself have in the past taken time to grieve over a similar loss. RESTRICTING COUNSELLOR SELF-DISCLOSURE Although at times self-disclosure is appropriate, it should be used sparingly, and never solely to satisfy the counsellor’s needs. Before self-disclosing, we suggest that you may wish to examine what you are personally experiencing and to make a decision about whether your motive is to satisfy your own needs or is genuinely to help the person who is seeking your help. Where self-disclosure is used more than occasionally, its impact is lost, and the counsellor is certainly putting their needs before those of the person seeking help. Disclosure of information about other counsellors or other people is unethical and should never occur in the counselling process. COUNSELLING SKILLS TO USE When a person is grieving, all the micro-skills previously discussed can be used as explained in Chapter 16 to allow the person to verbalise their thoughts and feelings, to experience rather than suppress their pain, and to generally explore whatever is happening within them as they experience their loss. Additionally, it is useful for a counsellor who is helping a person who has suffered a loss to have an understanding of the process of grieving. This understanding will enable the counsellor to recognise and appreciate the person’s experience more fully so that an empathic counselling relationship can be established and maintained.

THE STAGES OF GRIEF People tend to go through a number of stages in the grieving process. For some people these stages follow a particular sequence, but for other people the stages overlap or occur in a different order. Everyone is unique and grieves in a uniquely personal way, so counsellors should avoid trying to fit a predetermined grieving pattern onto a person. However, if as a counsellor you know what the commonly experienced stages in the grieving process are, then you will be better equipped to deal with the grieving person. You may be able to explain to them that their experiences are not strange or unusual, but are normal for someone who is grieving. The stages of grief are commonly experienced in the following sequence: 1 shock 2 denial emotional, psychological and physical symptoms depression guilt anger idealisation realism acceptance readjustment personal growth. If a person is unable to work through the stages of grief, then they are likely to be stuck in a trough of hopelessness and despair. They may become neurotically obsessed by their loss, and become deeply depressed and possibly suicidal. The following paragraphs explain the stages of grief with the exception of depression. Depression was discussed in the previous chapter, Chapter 31. 3 4 5 6 7 8 9 10 11 SHOCK Often, the first stage of grief is shock. This may be particularly severe in cases of sudden loss, or where a person has not been prepared adequately for an expected loss. In this stage the person almost seems to stop functioning, is numb, is in a daze and is incapable of doing anything constructive. DENIAL Along with shock, and following on from shock, comes denial. The grieving person can’t believe that what has happened is really true. The denial process can be prolonged for people who separate from a living partner. Very often a rejected partner will deny that the relationship is over, even though the other partner is clearly saying, ‘It’s finished and Pm not ever going to come back to you.’ This is hard for a counsellor to deal with, because the grieving person needs to have time to move through the denial stage. Perhaps the most useful approach is to reflect back the person’s expectation that their partner may return, and to add to this concrete statements of fact that seem to indicate the opposite. 1 he counsellor might say, for example, 4 get the strong impression from you that you believe that your partner will come back to you. 1 also notice that she said to you that she would not do that, and that she has rejected all your approaches to her since she left. Do you think that it’s possible that she may not come back?’ This tentative statement and question may enable the person to stay in denial if they need to do that for a while longer, or to move forward. When a person is starting to accept the possibility that the loss may be permanent, it may then be useful to let them know that denial is a normal part of grieving. By doing this they can feel OK about their difficulty in not wanting to accept reality in its entirety. People who are dying often grieve in anticipation of dying and such people sometimes have real problems with denial. When a person is told that they are dying, they may try to convince themselves that what the medical practitioner is telling them is not true. They may look for and try unorthodox methods to find a cure, and may start to bargain with God in an effort to get an extension to life. EMOTIONAL, PSYCHOLOGICAL AND PHYSICAL SYMPTOMS Grieving people experience feelings of depression, despair, hopelessness and worthlessness. Very often they will exhibit symptoms such as insomnia, inability to concentrate, loss of appetite and physical ill-health. This is normal. There is little that the person can do but accept that such symptoms will pass with time as the pain of grief diminishes. Naturally if such symptoms are severe or persist, the person should be encouraged to consult with a medical practitioner. GUILT Guilt often occurs in the grieving person. A counsellor will frequently hear a person say how guilty they feel because they didn’t tell the deceased how much they loved them, didn’t tell them how much they cared for them, didn’t apologise for something they had done wrong or didn’t make peace over an issue where there had been a disagreement. If, as a counsellor, a person seeking your help describes such feelings, allow them to fully explore them. ANGER Often after shock, denial, depression and guilt, anger follows. Remember though that the stages often overlap, and sometimes a person will move forward from one stage and then go back to an earlier stage. In the case of a person who is dying, anger may be directed at the medical practitioners involved. The person may feel that they haven’t had satisfactory7 medical treatment. Maybe they will believe that their illness was diagnosed too late, and consequently that it’s the doctor’s fault that death is inevitable. Similarly, a person who has lost a loved one through illness may blame the medical practitioners who treated the deceased before their death. Additionally, a bereaved person may well experience anger towards the person who has died. They may feel that the deceased person 'had no right to die’ and has hurt them by leaving them alone to cope in the world. This may be especially so in cases where the deceased has committed suicide.

Feeling anger towards a deceased loved one can be disturbing and confusing

Often it is hard for a person to accept that they are capable of being angry towards somebody they loved who has died. This is especially so for children who have lost a parent through death and have not had adequate counselling. They invariably feel guilty and confused by their anger and resentment towards the deceased parent. Without counselling, these feelings may endure for years. People whose partners have rejected them often become very angry’ and yet, while being angry7, desperately' want to get back into the relationship. 1 hey inevitably make it hard for themselves to do this and probably spoil their chances of reconciliation, because while saying ‘I love you and 1 want to be back in a relationship with you', they may also be experiencing anger, and are likely to express it in some way. They might give mixed messages to their partner because they are simultaneously giving ‘Please come back’ messages and angry messages. The anger, of Course, can easily be understood as part of the process of grieving. Sometimes a person who has religious beliefs and is grieving will feel angry with God, and will blame God for the loss that has occurred. For deeply religious people this may cause feelings of extreme guilt. When counselling such people, a counsellor can explain that it is normal to experience anger in grief. The counsellor might also ask the person whether they think that God is capable of accepting, forgiving and loving someone who is angry with God. When counselling people who have faith in other religions, similar issues may arise. Here it is important for the counsellor to gain sufficient understanding of the person’s beliefs to be helpful (see Chapter 39 regarding cultural issues). IDEALISATION Idealisation often follows the angry stage of grieving. It is very common for people who have suffered loss through death or separation to idealise the lost partner. The grieving person temporarily forgets any faults or negative characteristics of the deceased and remembers only an ideal person. They remember every thing positive that the deceased did and convince themselves that they loved them without reservation, and never had any negative feelings towards them. This is idealisation, and once again it is normal. It takes time for a person to move through idealisation and a counsellor needs to be careful not to try to move the person who is grieving forward too quickly, but rather to let the grieving process occur naturally. When it is appropriate, a counsellor may ask tentatively whether the lost person had any bad points, any faults, and whether they sometimes made mistakes. Slowly the realisation will dawn that, yes, there were polarities in the deceased person. The deceased was a real person, a human being with both strengths and weaknesses. ACCEPTANCE, READJUSTMENT AND PERSONAL GROWTH A person who is grieving will hopefully, in time, come to terms with their grief and start to accept the reality of their loss. They will start to be more realistic about the person they have lost, and to accept the loss as a permanent reality. 1 hey are then free to move forward and to create a new life as an individual. This may be scary, particularly for those who were heavily dependent on a relationship that has been lost. In this stage of the grieving process the person needs to be active rather than passive, to try new experiences that will lead to personal growth. New experiences, by their very nature, involve some degree of risk, and so may understandably cause the person to be apprehensive, 'faking risks can be frightening and can also be exciting. Reframing risk taking as exciting may be helpful for some people.

ALLOWING THE GRIEVING PROCESS TO OCCUR Finally, as a counsellor, do not try to calm or soothe the grieving person. Do not try to cheer them up or help them to contain their sadness and fears. Instead, help them to express emotions freely, to cry if they wish, and to grieve fully. It is only when grief endures for an excessively long period that it becomes maladaptive. In such cases, professional help from an experienced counsellor, psychologist or psychiatrist is required. Know the limits of your own competence, and when appropriate, after consultation with your supervisor, refer the person who seeks your help to others who are more qualified and experienced than you are.

Learning summary People grieve for lost expectations, relationships, bodily functions, jobs and losses of all kinds. Normal stages of grief include shock, denial psychological and somatic symptoms, depression, guilt, anger, idealisation, realism, acceptance, readjustment and personal growth. It’s usually a mistake to try to calm or soothe a grieving person. Encouraging free expression of emotions tends to be more therapeutic.

Further reading Freeman, S.J. 2005, Grief and Loss: Understanding the Journey, Brooks/Cole ('engage Learning, Belmont. Humphrey, G.M. 2008, Counselling for Grief and Bereavement, 2nd edn, SAGE, London. Mallon, B. 2008, Dying, Death and GrieJ: Working with Adult Bereavement, SAGE, London.