Later sessions do not declare that grief work has ended completely. There is no single right way to grieve and there is no set timetable for the specific experiences. There is some agreement in the field that at least two years is needed. However, even this time can vary, depending upon the loss; and this does not mean that counselling is needed for two years. Some may only need one professional visit, but will, on their own, take a full two years to experience their grief and begin to rebuild their lives. The basic guideline for assessment and treatment is to be aware of potential problems associated with personalities, pre-morbid functioning, and complications after loss; and also to reserve judgment on an individual's manner of grieving and the amount of time he or she takes to go through the process.
A major part of these later sessions addresses the experience of letting go of former roles and identities and making new choices to initiate new life narratives. Reinvestment does not mean replacement. Simply stated, it is the willingness and the ability to integrate the past into an inner reality and to invest mental and emotional energy into the reconstruction of a meaningful life. Since grief is considered to be a cyclical process, it is possible for many of the earlier experiences to re-emerge, in much the same way as the perspectives do. Often holidays, anniversary dates, and other special events trigger emotions and create reversions back to earlier experiences. The perspectives will indicate a process of integration of the loss and signs of future growth. Philosophically, the bereaved find meaning and purpose again in life. They feel connected to others and a larger system beyond themselves. They are aware that life is not fair, but they can appreciate the goodness of it. Spiritually, many who have been angry at God have seen past their anger and have reestablished their relationship with God or a higher being. Many experience growth in their spirituality and realize that even as adults they may have had childish views and expectations of God. Psychologically, they have made many new decisions and choices and understand the concepts of role realignment and new identities. Many have had to change their belief systems and accept new ways of thinking, such as the reality that bad things do happen to good people. Continued efforts to promote effective coping strategies and characteristics of resiliency provide opportunities for empowerment and growth despite significant loss and upheaval.
50 Counselling for Grief and Bereavement Table 3.7 Instructions for psychological needs
Needs Past Present Future
Love: Those whom I can trust and love me, and I can love in return (family, friends, etc.).
Belonging: List what you belong to/what you feel comfortable with/feel a part of and contribute to.
Worth: What do I do or like about myself, that makes me feel good about myself?
Recognition: Who appreciates me and gives me recognition? What do I do that I feel is worthwhile and important to me?
Fun: What did I do for fun - alone/with others? How much does it cost? How much of my fun is free?
Freedom: What does freedom mean to me? Time, money, what I eat, activities, choices, what I say.
1. Instruct clients to fill out how each need was met before the change (loss), illness, or death.
2. Write down (present) how these same needs are being met, or not being met, have changed or have been compromised in some way.
3. Facilitate clients to think about new ways/choices to meet these needs in the near future.
During these final sessions an adaptation of Glasser's (1990) psychological needs (Table 3.7) can provide a framework for exploration and rebuilding based upon specific needs. This is a worksheet, presented in Chapter 2 as an assessment tool, that identifies basic needs of love, belonging, power, self-worth, fun, and freedom. Clients identify how these needs were met in the past, what has changed in the present, and possible steps to take to meet these needs again. In a graphic way, it facilitates awareness of changes that have occurred because of loss, and encourages the search for new choices that will satisfy each need. New goals should be simple, realistic, concrete, and attainable in the near future. Longer-term goals can be set once there is a firmer foundation to build upon.
From a sociological/cultural perspective, many have new-found friends, new activities, and new support systems. Environments have changed somewhat, so the former ones no longer have the potential to exert such painful influence. Many have had to rethink their cultural backgrounds and accept different ways of coping with their grief. Some men have joined with their wives in counselling to be supportive, and later acknowledge (sheepishly) that they are there for themselves also. Many have been raised in families that are very stoic, where grief is seen as selfish or a sign of weakness.
Finally, from a physical perspective during the later sessions, symptoms diminish that once aggravated the grief during the early and middle sessions. Clients have learned the interaction between the various perspectives of grief and their physical symptoms. They have incorporated healthier lifestyles into their routines. Results are seen in their outward appearances, their changed attitudes, and their abilities to laugh again and show a renewed interest in life.
Ann was introduced in Chapter 1, 'The Journey of Ann'. As the vignette suggested, by the later sessions Ann showed evidence of being a client who had successfully progressed through her journey of grief. Although her motivation for counselling was to regain control in her life that was currently debilitated by chronic illness, she slowly learned and accepted the fact that she had never addressed issues in her marriage or her husband's suicide five years ago. She showed courage, character, and ability as she painfully went back over her dysfunctional family of origin, marriage at a young age to escape her family, total reliance on an addictive husband, her 18-year illness (that was currently debilitating), and the suicide of her husband. Her view of herself as a female was based on stereotypes of female helplessness. She never questioned her husband, although she suspected that he was not psychologically healthy. Until after his death she had no idea that his addictions not only destroyed him but also left a legacy of financial ruin for her and the four children. For the intervening five years she had coped by doing whatever was intervening necessary for the well-being of the children. Ongoing bankruptcy and legal issues of back taxes, her declining health, and most recently her father's heart problems were powerful motivators for personal counselling.
Ann: Once I stopped putting so many demands on myself to keep everything normal and perfect for the children, I began to think more about the questions you were asking me about my marriage. For the first time I felt a real anger towards Jake. I never had before because I felt I owed him so much for marrying me. He was the only boy I ever dated in high school. I never knew that a marriage should have been different. My parents were certainly not good role models. I think I have a lot of anger that's just beginning to surface.The other night I was looking at his picture and all I could say was 'Damn you'. Counsellor: I know this is difficult for you. Not only are you experiencing painful emotions that you are uncomfortable with, you are also being challenged to re-evaluate and change basic assumptions about yourself.
Three weeks later:
Ann: Last week I was 20 miles from home and I got a call that my dad was having heart problems and was being rushed to the hospital. I didn't panic as I usually do; rather, I calmly drove to the hospital. This made me think that perhaps you have been right telling me that I have a lot of inner strengths and resiliencies that I never realized I had. All these years I never thought I could manage or make a decision on my own. I am the person that you see.You will never know what your words have done for me.
Counsellor I realized your strengths the first time I met you. I felt confident then that I could safely guide you back to your past. Without a broader awareness of your life and a full expression of grief, you would not be capable of appreciating your strengths and reconstructing a renewed sense of your full potential.
One month later:
Ann: I went to the Mayo Clinic for a surgical evaluation of my illness.The surgery is new and has multiple risks. The surgeon assured me that I was a good candidate for it and that I should have it immediately because I am feeling good right now and my symptoms aren't active. He was domineering and he made me feel that I had to accept his opinions. But then I caught myself and firmly asserted that I needed time to think it over. This was the first time in two years that I was feeling good and doing things outside the house. It will be summer soon and that is my favorite time of year. I don't want to miss being able to enjoy it. I felt good saying this to him - like I wasn't allowing someone to further control me. My illness is not life threatening, so putting the surgery off is not harmful. I had to remind myself that I only went to him for an opinion so I could better evaluate my options.
Counsellor You have really taken ownership of your life. Over the past few months I have seen you grow in many ways. Your new life is just beginning.
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