Counselling for Grief and Loss: A Case Study Analysis - MC15 AIPC

This essay provides a comprehensive analysis of two case studies involving individuals experiencing grief and loss. The first case study focuses on Paul, a 54-year-old man exhibiting complicated grief following the death of his son. The assessment identifies his symptoms and suggests interventions such as cognitive-behavioral therapy (CBT), including cognitive and behavioral therapies. The second case study examines Jessica, a 32-year-old woman suffering from traumatic grief after her husband's suicide. The analysis proposes interventions like Brief Eclectic Psychotherapy and Acceptance and Commitment Therapy (ACT) to address her trauma and denial. The essay also discusses the importance of empathic presence, active listening, and building trust in the counselling process. Furthermore, the essay highlights the counsellor's challenges and personal support strategies during counselling. The overall goal is to provide effective strategies for counsellors to support clients through their grief and loss.

Running head: COUNSELLING FOR GRIEF AND LOSS 1
Counselling for grief and loss
Name:
Institution:
Tutor:
Date:

COUNSELLING FOR GRIEF AND LOSS 2
Introduction
In case study one, Paul a 54 year old divorced with his wife. Later on, his only son Daniel also
moved to her mother’s place leaving Paul alone. Eventually, Daniel dies from a road accident.
Two years later, he has not moved on and this is an indicator of complicated grief. In case study
2, Jessica a 32 year old is in grief after her husband committed suicide 8 weeks ago. She is
experiencing nightmares, anger and guilt. She is therefore experiencing traumatic grief. Several
studies note that grief is detrimental as it affects the mental health and well-being of those
affected and can even lead to suicide (Barnard, 2019). Counselling is the only recommended
therapy in cases of grief. Since counselling leads to psychological healing among the affected
individuals, it is necessary for counsellors and other physicians to comprehend skills of assessing
grief responses to come up with effective intervention strategies and formulate a plan for self-
care to the affected individuals (Aldwin, Park, & Spiro III, n.d.). Within the framework of this
essay, there will be an analysis of assessment of complicated and traumatic grief responses of
two case studies. There will also be an analysis of appropriate interventions and strategies
specific to the case studies provided. Finally, there will be a discussion on how to formulate a
plan of care and professional support and a conclusion that will summarize the important points
in the essay.
Discussion
Assessment of complicated and traumatic grief responses
There are two clients. One is Paul who is 54 years old. His lovely wife walked out on her after
years of marriage and they had one son called Daniel who later on moved to his mother’s place
leaving Paul alone. After sometime, Paul was involved in an accident and died. The turn of

COUNSELLING FOR GRIEF AND LOSS 3
events has led to Paul experiencing what is known as complicated grief reaction. According to
research, complicated grief is a situation where an individual fails to move on with the loss of a
loved one for more than a year (Canfield, 2005). In this case study, it is 2 years since the death of
Paul’s son but he can’t move on. This therefore qualifies to be a complicated grief reaction.
Studies by Canfield further explain(Canfield, 2005) that it can be exhibited through difficulties
accepting the death, a feeling that life has no more meaning and inability to enjoy life. All of
these signs and symptoms were evident with Paul.
In the second case study, the client is Jessica who is 32 years old with three young daughters.
The client is in grief since she lost her husband of 10 years through suicide 8 weeks ago. From
the explanation or the signs and symptoms exhibited by Jessica, she is experiencing traumatic
grief. Traumatic grief according to studies by Carr in 2004, is the difficulty in adjusting to the
death of a loved one. Traumatic grief is occur as a result of unexpected death like an accident
and suicide. It also occurs as a result of an anticipated death after battling with sickness. In this
case, Jessica’s husband died unexpectedly after committing suicide and this warrants traumatic
grief (Canfield, 2005). Among the many signs and symptoms of traumatic grief are feelings of
futility about the future and Jessica has expressed this since she explained that the future is
doomed without her lovely husband. Other features include insomnia and nightmares, excessive
irritability and all of which were expressed by Jessica.

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Interventions for grief
Cognitive-behavioral therapy (CBT)
Different studies propose different approaches or strategies to clients experiencing complicated
grief like Paul. However, most of them agree or acknowledge psychological interventions and I
would also utilize the same approach to assist Paul. Psychological interventions are broad (Carr,
2004). It can be further subdivided into cognitive, behavioral and finally exposure therapy.
Cognitive therapy assists the counsellor to identify undesirable thinking patterns in relation to the
loss of their loved ones and then come up with ways that can assist the patient to revive their
thinking. Fishman propose that cognitive therapy involves one on one interaction between the
counsellor and the client in a number of sessions (Fishman, 2013). A study by Gross propose 10
to 25 sessions (Gross, 2018). Each session is expected to last not less than an hour. During these
sessions, the client will be expected to categorically state or explain the event that led to
complicated grief. This can be done through writing, verbal talking or even visiting the scene.
Furthermore, the bereaved should also explain or state the unfinished business they had with the
person who died (Gillies, Neimeyer, & Milman, 2015). In this case for example, Paul would
explain his plans for his son Daniel. Finally, the patient and the counsellor should talk about the
future and come up with ways to positively think about it.
Besides cognitive therapy for complicated grief, behavioral therapy can also be used. In this
intervention, the counsellor is expected to come up with activities that can aid the client to
engage with the world (Fishman, 2013). The activities should also focus on assisting the client
take part in pleasurable activities and establish goals for the future. In this case, I can assist Paul
engage in sports or games or come together sessions with his workers so that he finds a reason to
enjoy life and get over the grief.

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The Basic Benet is the guiding principle in CBT during counselling. According to studies, the
basic Benet describes that thoughts affect feelings. This is in contrary to common sense notion
that associate events with emotions. What the Basic Benet implies is that if an individual thinks
about an event in a distorted manner, then he/she is likely to develop intense and inflamed
emotions (Kasun, 2017). If on the other hand our thinking is balanced, the emotional reactions
will also be balanced. In this counselling theory, the counsellor should assist the client to move
away from the common sense theory of emotion. The common sense theory implies that a
grieving client cannot engage in something better like socializing until he/she feels better.
Furthermore, Bill Glaser states that there are four parts that leads to our behavioral and the
include thoughts, actions, feelings and the physical state (Kosminsky, 2016). He further likens
the four to four wheels of a car where the front wheels stands for thoughts and actions that
determine the state of the back wheels of feelings and physical state. Therefore, the focus of this
approach is to assist the client think and act well to positively influence his feelings and physical
state.
Stages theories
Fishman illustrates that there are different stages of mourning. They include shock and
numbness, denial, despair and finally adjustment and personal growth (Fishman, 2013). Shock
and numbness occurs immediately the loved on dies. The second stage is denial and this where
the bereaved cannot believe that the loved one is truly gone. The bereaved person can actually
report talking to the dead person. The third stage is despair and this where the bereaved have to
confront the reality of the loss (Malone, 2016). They experience diverse emotions such as guilt,
anger, sadness and anxiety. From the two case studies, this is the stage that both clients are since
Jessica is anxious about her future without the husband while Paul is guilt for not having stayed

COUNSELLING FOR GRIEF AND LOSS 6
with the family. The final stage is adjustment and personal growth and this where the bereaved
adapts to the loss and moves on with routine duties. Unfortunately, none of the clients is at that
level and this is why counselling is recommended.
Interventions for traumatic grief
Eclectic psychotherapy
In case study two, the most helpful intervention that can be used is the Brief Eclectic
Psychotherapy. Several studies recommend this approach in patients or clients experiencing
traumatic grief like for the case of Jessica (Malone, 2016). This technique or strategy
incorporates different elements from psychodynamic, cognitive-behavioral and finally the
directive therapy. In this approach different means are used to assist the client express the
traumatic events. This includes writings, exposure and memorabilia (Neimeyer, 2015). Much
emphasis is laid on vulnerability of human beings. According to a study by Fishman, (2013) the
Brief Eclectic Psychotherapy model of counselling has 16 sessions where the counsellor and the
client interact one on one (Fishman, 2013). It is recommended that a third party or partner to the
client should also accompany them but not necessary like in this case since it is the partner who
is dead (Littlewood, 2014). After the sessions, a fare well ritual is normally conducted to signal
the end of the therapy and allow the client to move with his life. The plan for the therapy can be
illustrated in a table form as shown below.
Acceptance and commitment therapy
The most effective counselling intervention for traumatic grief as experienced by Jessica is
acceptance and commitment therapy abbreviated as ACT (Neimeyer & Smigelsky, 2018). From
the case study, the client is in denial and thinks that she cannot do anything in the absence of her

COUNSELLING FOR GRIEF AND LOSS 7
husband who committed suicide some few weeks ago. ACT can be of importance. This approach
argues that thinking is a natural process and we cannot control it at any level. In fact, it states that
thoughts assist us to plan for the future as well as learning from the past (Newsom et al., 2017).
However, thoughts are also dangerous since this model states that they can anticipate danger
leading to pessimism and judgmental. Unlike CBT that insists on disputing our thinking, ACT is
of contrary opinion since it states that it is almost impossible to control our thinking by shunning
and challenging our thoughts. This is because the brain is meant to produce thought and we can’t
therefore control whatever we think. Therefore, the baseline of this model is that we should not
control our thinking rather dispute or don’t believe whatever we think (Peck, 2016). Like in this
case, it is correct for Jessica to think that she cannot do anything in future in the absence of her
husband. However, she should not be meant to believe such. In summary, the ACT illustrates the
importance of not believing in everything we think.
A good approach to the CBT and ACT counselling sessions is likely to elicit a positive response
from the patient. A good approach in this case would include or involve empathic presence. This
involves active listening, being silent and supporting the client while they are telling their stories.
A gentle conversation is also key and this involves expression as well as remembering (Stephen
J.Freeman, n.d.,). Furthermore, the client should also provide available space. The counsellor
should also be very patient. Finally, engaging trust during communication is key. The counsellor
has to exude confidence so that the client trusts him her during the entire process.
The goal of counselling
CBT, Eclectic and ACT theories of counselling have two major goals or objectives. First of all,
is seeks to aid the client think accurately. The second goal is to assist clients manage their
thinking so as to generate emotions that are not overwhelming (Stroebe, Schut, &Finkenauer,

COUNSELLING FOR GRIEF AND LOSS 8
2013). Other goals for counselling include assisting clients come to terms with the loss of their
loved ones, supporting clients in processing and expressing their emotions that are associated
with grief.
Personal Reflection and a plan for personal support during counselling
The counselling process is not always smooth. It is associated with different challenges that the
counsellor should always strive to overcome. In the case of Paul, my own unresolved grief on the
counselling process might affect the entire counselling session (Stroebe & Schut, 2015).
Furthermore, I might also collude with the patient and avoid certain topics and this is likely to
hinder the counselling process. This is due to the fact that I have also lost my loved ones and
clients and I don’t like talking or thinking about such scenarios. The important thing is that I am
aware of these issues and I am able to park my own thoughts to the side as I attend/assist clients.
There are different self-care strategies that I can utilize. One of the techniques is self-
responsibility which is taking care of my own feelings. This includes involving in other
activities, taking lunch as well as other healthy breaks (Strom-Gottfried & Mowbray, 2006).
Another strategy is peer support and this can be sought from supervisors and other colleagues
who can offer empathy and encouragement. Finally, I would utilize group models where a group
of therapists would review deaths and discuss about stress management techniques.
Monitoring progress and evaluation
It is the desire of each health care practitioner or the counsellor to achieve their set
objectives or goals. The same case therefore applies to the counselling sessions in this case
study. The objectives as explained earlier include assisting the client to come to terms with the
loss of their loved ones (Walsh, 2007). The counsellor can use different mechanisms to monitor

COUNSELLING FOR GRIEF AND LOSS 9
and evaluate the client’s response. First of all, the counsellor can look out at the cognitive and
behavioral functions of the patient. If the client is thinking and feeling accurately or positively,
then the therapy is effective (Waller et al., 2015). Furthermore, if the patient is willing to engage
in other activities such as work or social functions, then that is a sign of improvement.
Additional support
Apart from the routine counselling sessions, the counsellor can offer extra services to the client
so as to assist them adapt to the loss quickly. Some of the additional support recommended by
studies include having healthy breaks or lunch together with the client (William Worden, n.d.).
Furthermore, the counsellor can accompany the client to their preferred social sites such as
religious places or where their favorite joints that they converge during family meetings. All this
is just done to ensure the patient adapts or moves on quickly from their grief or loss of their
loved ones.
Conclusion
Death is inevitable and no one is immune is to it. The only difference is the manner in which
death occurs since it can occur unexpectedly like in the case of suicide or an accident. Death
comes with a lot of feelings of grief that eventually lead to grief. Different clients or patients
react to grief in different ways. There are some who adapt easily or quickly while others take
time. The manner and time the clients respond to grief constitutes different grief reactions or
responses which can either be adaptive, traumatic or complicated. In this case study, complicated
and traumatic grief reactions were exhibited through Paul and Jessica. Grief affects both the
mental and physical states of those who are affected. They are therefore encouraged to seek
counselling from qualified experts. During counselling, different theories or models and

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techniques are used. The most common ones include CBT and ACT. It is therefore important
that healthcare practitioners are acquainted with necessary counselling skills to assist such
patients get over the grief and engage in healthy activities.

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