What is counselling?
By Jim O Shea
(Jim O Shea is a humanistic counsellor working from the Furze, Thurles Tel: 087-8211009 www.jimoshea.net )
In the coming months I hope to write some brief articles on the many issues that cause distress to people, which sometimes result in their resorting to counselling. In this first article, however, I would like to explain what counselling is all about, with a specific focus on humanistic counselling.
There was a time, and not so very long ago, when people felt ashamed of going for counselling. Their families almost saw it as a stigma. Thankfully, that has changed; and better still, more and more men now turn to counselling in times of distress. The person who comes to counselling is generally vulnerable, and it is important to stress that vulnerability is not a weakness, but one of the greatest strengths we have. It enables us to reach out to others.
Counselling is about helping people make sense of their lives. It creates a safe, confidential place for people to be vulnerable, to feel (or indeed to find) their feelings, and to explore distress. The counselling room can be a very challenging place, for it is only by challenge that we can change and move on. Challenge is not aggressive, but is gentle and direct.
There is nothing more healing than to explore issues, especially shameful ones, in the presence of a non-judgemental person. Hence, the person of the counsellor is extremely important. It is important that they be well trained and have done a significant amount of personal therapy themselves. It is the job of the counsellor to create the conditions, which will enable the client to feel safe enough to explore the issues and ultimately to lead an independent life. So many people are in controlling relationships (personal and work- related) that they lead dependent lives. A good counsellor can skilfully challenge them to change, to feel their power and to become more independent.
In the case of humanistic counselling, there are specific core conditions which the counsellor must strive to create, so that the counselling relationship with the client will allow this to happen. Humanistic counselling is about relationship. It is called the therapeutic relationship, which is a professional, but deeply human one. The core conditions are (1) a process of empathic understanding, (2) an attitude of unconditional positive regard and (3) a state of being called congruence (genuineness).
Empathic understanding means being able to step into the clients shoes and experience the clients distress as if it were the counsellors own. It is a process of being with the client. It is important for the client to feel understood, if empathy is to be an effective healing process.
It is also a process of being able to see behind the clients words and sense what is in the subconscious. This requires much self-awareness by the counsellor.
The attitude of unconditional positive regard is a difficult one. We are all reared in a conditional way. Our parents, teachers, clergymen, employers and significant others lay down the conditions for us and if we wish to be valued we must follow them. The humanistic counsellor must value (prize) their clients no matter what they are revealing, no matter how shameful it is. The counsellor may dislike the behaviours of the client and sometimes may not even like the client, but they must always see the client as a person of worth. This helps build self esteem, because many people who come to counselling lack self esteem.
The final piece of the core conditions is congruence or genuineness. This means that the outward responses of the counsellor matches how he or she actually feels. Anything else is merely a pretence or even a defence, and hinders rather than promotes healing. It means having real contact with the client. It is also important for the client to see that the counsellor is genuine.
All three of these core conditions must be present for therapy to be effective, and all three must be evident to the client. It is not possible for the counsellor to be perfect in having them, but they must be aspired to. The more personal therapy a counsellor undergoes, the more likely that these conditions will be present.
Bereavement and grieving
In the last issue I looked at what counselling means. As the anniversary of the death of my youngest son approaches, I would like to write a number of articles on bereavement, which I hope will help those suffering loss.
The emphasis is on loss. This does not mean only death. People may experience loss when they retire, especially if they are forced to retire through ill health, they experience loss if their health fails, if a relationship breaks down; children experience loss at the death of pets and so on. Indeed the word bereavement comes from the word reave, which means to be dispossessed or robbed of something.
In the first of articles on grieving I hope to explore normal grieving and later I will devote an article to delayed or complicated grief, which normally requires counselling to unravel.
People who are grieving usually experience 4 types of reactions - feeling, physical sensations, thoughts and behaviours. I have experienced these in my own life, and they are a painful and sometimes a devastating process. But it is a process that must be endured. There is no shortcut through grief. I recall that the pain was at times so great in my grieving that I often wondered if it would ever end or would I ever be happy again. There are many feeling associated with grieving. Not all bereaved people experience all of them.
The range of feelings involved in grief are as follows: sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief, horror, terror and numbness. Please remember that feelings are part of you. They are your friends. They will ultimately liberate you. Allow them
I do not have the space here to explore each feeling, so I will concentrate upon a few. The one that seems to be the most problematic to people, especially older people is that of anger. When I was learning the catechism, I learned that anger was one of the seven deadly sins. So I grew up with a feeling that anger was a sin; even more, a deadly sin! Anger is not a sin. It is a normal healthy feeling which should be allowed expression (not however in violent behaviour towards others). I recall stopping the car and shouting my anger at God, at my child for being o careless on the road, for leaving me bereft and suffering. God can take it.
Another feeling which is hard to bear is loneliness. In a sense it is a feeling of desolation that part of ones life is gone and will never return. I experienced this not only following tragedy in my family, but when I retired from a busy job. Then there is the feeling of terror. I found that this arose from my feeling of helplessness. I was unable to do anything to prevent the death of my child. I have mentioned the feeling of emancipation. This is also problematic for the grieving person to admit. But relief and emancipation are feelings that arise when the survivor is released from a life of cruelty and abuse inflicted by the person who has died.
In conclusion, it is only by allowing the feelings that arise that the grieving person can move on. It is possible to accept anything and to move on. What is the alternative? That does not mean that feeling of sadness and loneliness will return from time to time throughout ones life. Neither does it mean forgetting about the person who has died.
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In my previous article I focussed upon the many feelings associated with grief. My challenge to you was to allow those feelings and see them as your friends that help you to heal and to accept the loss you are enduring. In this article I would like to look at the other 3 grief reactions - physical sensations, thought and behaviours.
Some of the most commonly experienced sensations are hollowness in the stomach, tightness in the chest, tightness in the throat, over-sensitivity to noise, breathlessness and shortness of breath, muscle weakness, lack of energy and a dry mouth. Psychosomatic symptoms are also physical in nature and include headaches, dizziness, skin rashes and colitis. Some of these can be quite frightening, and being aware that they stem from stress of grief lessons their physical impact. I recall being extremely frightened one evening in the early stages of my bereavement. I was having my tea and suddenly felt a tightening in my chest. I was convinced that I was about to have a heart attack. I was greatly relieved when the doctor told me that my chest muscles had tightened because of stress. This stress also caused the skin on my hands to peel off.
Fatigue is another unpleasant side effect of grieving and for a long time I was extremely tired and dispirited. Nowadays we are all aware of what stress can do to us. The literature explains that stress suppresses the immune system and leaves us open to illnesses. The stress of bereavement can be extremely severe.
Another grief reaction relates to our thoughts, and these influence how we feel. The main thoughts associated with normal grief are disbelief, confusion (lack of concentration), preoccupation (thinking about the dead person. Such thoughts can be very intrusive if there had been conflict in the relationship), sense of presence (deceased watching over the survivor) and hallucinations (which can be visual or auditory).
Disbelief is one of the main grief reactions, especially when the death is sudden. I could not believe it that my child had been killed. He had been at Mass with us that morning and now was on a mortuary slab, never to be with us again. How could this happen to me? Unbelievable. I recall going into a shop for the first time a week after his death. I carried my dark inner world and my disbelief with me. My wifes disbelief was so intense that for a year she listened for the door to open at 4.30, when our child normally returned from school. I also suffered from confusion, lacked concentration, felt disoriented, and frequently it was dangerous for me to drive. There were times when I had to pull in my car and try to recall where I was going.
Finally there is the reality of certain behaviours following bereavement. These include sleep disturbance, appetite disturbance, social withdrawal, dreams about the deceased, avoiding reminders of the deceased, searching and calling out, sighing, restless overactivity, crying, visiting places and carrying objects that remind the survivor of the deceased and treasuring objects that belong to the deceased. I experienced most of these. One of the most difficult was being very restless. I remember one Sunday when I felt unable to sit, walk, lie or stand. I could not get any relief and I felt that I would not get through that day. I finally visited a healing priest and managed to struggle on. It was a question of a minute at a time.
To conclude - feelings, thoughts, physical sensations and behaviours are normal part of grieving. It is important to remember that the suppression of feelings can lead to depression, and depression can often be part of the grieving process. Some feelings are too difficult to face for a long time. Our thoughts, too can be morbid, and these contribute to depression.
The Four Tasks of Mourning
If grief refers to loss, mourning refers to the process that follows loss. It is often used interchangeably with grieving. most of the writers on grief explore what they call the circle of grief, which is a range of feelings that the survivor experiences, starting with disbelief and ending with acceptance. One excellent author, William Worden, gives another helpful perspective that might be useful for those that have suffered losses. This involves 4 tasks of mourning - (1) to accept the reality of the loss, (2) to work through the pain of grief, (3) to adjust to an environment in which the deceased is missing and (4) to emotionally relocate the deceased and move on with life. I suppose, given the terrible pain of mourning, the word task may sound a little harsh. So let us remember how painful it is for us to meet those tasks.
In this article I will briefly look at the first two. The immediate task is to accept the reality of the loss. The mourner who fails in this will become stuck in the grieving process and will inevitably suffer anger and perhaps depression. Accepting the reality of the death of a loved one however, is not easy. We can convince ourselves that we have done so, but we must feel this acceptance. Acceptance is not a happy feeling, but is one of peace, where the anxiety and confusion, mentioned in another article, have dissolved. Very often there is denial, and this is seen by some psychologists as a temporary healthy reaction, and a buffer to cope with sudden death.
My own acceptance of my sons death was immediate. I suffered the full crushing impact of the loss at once. However, I now realise that this was a biological and intellectual acceptance, rather than an emotional one. Emotional acceptance enables the survivor to properly grieve and move on.
I mentioned above being stuck in the grieving process. This can sometimes be seen by people who turn the deceaseds room into a shrine. How often do we hear people say that they have not changed a deceased childs room, but have left everything as it was. This is very understandable. Giving away possessions emphasises the finality of death, and it is only natural to postpone this. But, if it continues over a long time it is unhealthy grieving. I recall when we gave away our childs clothes and toys. It was extremely painful.
Other types of denial include minimising the loss, denying its irreversibility, selectively forgetting, resorting to spiritualism and even irrationally searching for the deceased.
Working through the pain of grief has already been dealt with in other articles. Some people try to avoid this by idealising the dead, using drugs or alcohol, or perhaps travelling to get some relief from their emotions. I brought my family with me to London in 1990 when my child was killed. My other son and I found work on a building site and my wife worked in a hospital. But my pain travelled with me. I carried it to my work each day. Grief is an inner tormenting ache, and we must carry it, and endure it, so that it will ultimately heal.
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I have already explored the first of these two tasks (to accept the reality of the loss and to work through the grief of pain). In this iss I will look at the other two - to adjust to an environment in which the deceased is missing, and to emotionally relocate the deceased and move on with life. Using the word task, as I have written in the last article, seems a bit harsh, but it does empower the bereaved person. It shows that he or she can do something to promote healing.
Adjusting to life without the deceased means different things to different people. For example, the quality of adjustment made by widows depends upon many factors, such as the quality of her relationship with the deceased husband, the quality of their sexual relationship, if there are any children to be raised, and her previous role in the management of domestic finances. Bereaved parents have to cope with their own pain, but also possibly with that of their other children. I was very worried about how my children were coping, and I found their pain hard to bear. I felt powerless to help them.
Other adjustments involve a new definition of oneself, even the development of self-esteem. The central question is who am I now?. There is also the question of spiritual adjustment, of finding meaning in the loss, regaining control and seeing the world as a benevolent place.
The fourth task is to emotionally relocate the deceased and move on with life. This can be most difficult. It is the same as acceptance in the so-called wheel of grief. If the survivor is unable to complete this task, it means being emotionally stuck, and holding on to a past attachment to the extent of being unable to form other attachments.
Doing this task means being able to preserve a realistic memory of the dead in a way that enables the survivor to live in a healthy and fulfilling manner. There was a time when survivors were advised to sever the bond and move on. But this interpretation has rightly been questioned in recent years. It is now accepted that the healthy resolution of grief involves a continuing bond with the deceased. When the theory of severing the bond was held by psychologists, the counsellin offered was nothing short of brutal and abusive.
Some bereavement psychologists explore different ways of keeping in touch with the dead, and at the same time moving on. These include sensing the prescence of the dead, having a spiritual relationship with them, talking to them and using symbolic places and things associated with them. Although I did not know him, I pray to my paternal grandfather every day and sense that he is somehow looking after me. It is a very comforting thought. I also feel strongly emotionally attached to my child. Serenity has returned to my life, but there are times such as anniversaries, and at Christmas, when I experience deep grief pain. And so it will continue to be. And that is ok. It is part of normal grief.
I once read a book by Judy Tatelbaum called The Courage to Grieve, which I found very helpful. It taught me what saying goodbye really meant. For long I was afraid to say goodbye to my child. Somehow I equated this to forgetting him. As Tatelbaum says, saying goodbye simply means emotionally accepting my childs death, and moving on. It means finding a place for the dead in our emotional life. This takes time. Indeed the maxim that people use, that time heals, is true. But we must allow it to heal, and in a later article I will look at what happens when we do not allow it to heal.
Do we all grieve the same way?
This is a very important question. By assuming that we all grieve in the same way, we can sometimes cause offence and pain to the bereaved by offering well meant but ill-conceived remarks. I used to be extremely angry when people said to me you have an angel in Heaven. I didnt want an angel in Heaven. I wanted my child on earth. People were projecting their own feelings onto me.
There are many factors that ensure that we all grieve differently. Counsellors call these mediators of mourning. One of the most important is that of relationship and kinship. Clearly a different response may be forthcoming at the death of an aged parent as against that of a child. The death of a distant cousin will evoke a different response to that of a sibling. And so on.
The nature of the attachment between the survivor and the deceased is one of the most crucial elements affecting the grief response. Attachment has been much written about by psychologists. It is a complex issue, but at its simplest, the stronger the attachment the greater the grieving pain. A counsellor called Mary Jones once wrote that grief is the price we pay for love. How often did Isay this when I was grieving for my child, when I prayed for relief from the torment. Of course, I found there was no escape. I loved my child dearly, and hence my pain was great. In a sense it was a contradiction for me to pray for release. It was like praying for release from the love I had for my child.
Bereavement writers, however, also caution us that, in some cases, love may constitute a level of dependency that is intolerant of separation. In such cases the survivor may experience intense anger at being left alone. On a contrary level, the death of a person may sometimes be a source of relief to a survivor. This, for example, has been called relationship relief following the death of an abusive partner. There is also a grief reaction called dual relief, i.e. relief for the survivor and for the deceased who had suffered a long, painful illness.
Another factor, which influences the nature of grief, lies in the mode of death. These can be broken down into 4 broad categories natural, accidental, suicidal and homicidal. Within each of these there are many variables that cannot be touched on in brief articles such as these. I would, however, like to look at some subtypes. In this article I will confine myself to a brief exploration of survivors following the death of a person with AIDS.
We do not hear much about AIDS nowadays, except in relation to the huge amount of people suffering from it in Africa. But, it is a reality in Ireland, and people whose relations or partners have died from AIDS related diseases suffer particular grief responses. Since AIDS is transmitted through bodily fluids sexual partners may be anxious about their own health, and may confuse some of the physical sensations or illnesses associated with bereavement with those stemming from AIDS. This can greatly add to their anxiety.
Survivors may also conceal the real reason for death because of the social stigma associated with the disease. This deception can lead to anxiety, anger and guilt. There is also the question of the lack of of social support, and the exclusion of a gay lover from the family grieving process. Because AIDS is essentially associated with the gay community, AIDS related deaths may impact heavily upon members of that community, who are often faced with multiple losses.
AIDS related illnesses can leave a person mentally and physically impaired, and survivors of these losses often experience intense guilt and prolonged sad memories of the deceased. Sometimes AIDS sufferers develop behaviours similar to Alzheimer sufferers, and this can lead to an early grief response in friends and family.
In conclusion, AIDS related deaths often evoke rage, fear, shame, isolation and lack of support. It can cause conflict in families, and encourages secrecy. In a sense, some survivors may be denied the social right to mourn and to seek consolation from others.
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In my last contribution I looked at some of the factors, which indicate that we all grieve differently. I would like to explore some more in this article. the purpose of this is to help mourners and sympathisers understand the complexity of grief.
Sudden death is one of the factors that profoundly affects the nature of our grief. This is especially true in the early stages. Some bereavement psychologists hold that grief work is not only difficult to start, but harder to complete in the case of sudden death. Some possible reactions to sudden death includes a sense of unreality about the loss, increase of guilt feelings, a sense of helplessness, a sense of being agitated and uneasy, a sense of unfinished business, and a wish to make meaning out of the death.
There is no emotional preparation for a sudden death. I have experienced this. I had no preparation for any type of death. I had never been bereaved, and did not even own a grave. I was only 45 at the time, my parents were youngish, and I never expected to need one for years. For a long time I kept asking myself how did this happen?, and for many years the ringing of the phone filled me with dread because I feared it might be news that something awful had happened to one of my other children. I was pervaded by a general sense of unease, and my feeling of helplessness was accompanied by a feeling of sheer terror. I felt powerless.
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Shock is the most palpable and immediate reaction to sudden death. It is natures way of numbing us so that we are not immediately overcome. It can sometimes come before the denial stage of grieving. Bereavement writers have described it as a physical and emotional illness with specific symptoms. it is a temporary anaesthetic. I experienced it fully, but I cannot really describe it. Somehow it was like a physical blast, akin to having a shotgun discharged in my face, and it rendered me helpless for several days. I suppose I was close to Post-Traumatic Stress Disorder for a brief period.
Dealing with all the aspects that make grieving different for different people would demand many articles, so I will list other relevant ones. These include the diverse medical, psychological and mental history of the bereaved. Under this would come age, gender and marital status of the bereaved. The type of personality is another factor, and some psychologists show that there are 16 types of personality. This in itself is a major study, because each personality type deals uniquely with problems. The degree of social support available is another dimension affecting how we grieve.
In terms of gender, there is evidence that women grieve differently to men. This can often cause tension and misunderstanding in a house where different members of a family are at different stages of grieving. In Western society men tend to suppress their feelings more than women, with the important exception of expressing anger. There is also the cultural context, and in an increasingly multicultural Ireland there is an even greater diversity of grieving.
Religion is a part of culture, and the use of ritual is important. In Ireland funerals are well attended, especially in rural areas, and this can be a great help to the bereaved. The funeral mass can have a powerful effect upon the bereaved, and I recall how vivid the words angels of the Lord take him into paradise were. They rang in my ears, and somehow sharpened my sorrow, and made me confront the reality of my loss.
I realise that I have merely touched upon all the factors that influence how we grieve. Some of these can be helpful to some people and some can hinder the grieving process. A strong religious belief, for example can be of great help, but for those who have a strong conviction of a punitive God, and the existence of hell, it can add to their pain if the deceased had not lived what they consider a good life.
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In my contributions on grief so far I have been looking at what is called normal grief. Now I would like to look at anticipatory grief and complicated grief.
Anticipatory grief occurs when a person has advanced warning of death. Such warning can help the bereaved cope better with post-death grief, especially if he or she has shared the anticipatory grief with the person who is going to die. But anticipatory grief does not necessarily reduce the amount of grieving the survivor has to do following the death. It really prepares the defences to cope better with the full bereavement experience. It is important to realise that anticipatory grief is never complete and if post death grief is not faced then the result can be complicated grief.
Complicated grief is generally dealt with in counselling, where the complicating factor is first resolved before the grieving can take place. Complicated grief is sometimes called pathological grief, unresolved grief, chronic grief, delayed grief or exaggerated grief. It has been described as too little grieving immediately after the death or too much grieving long afterwards. It is as if the grief filters become clogged, preventing normal grieving. Some bereavement writers see normal grieving as arriving from these three sources:- 1. A poor relationship with the deceased. 2. the vulnerability of the survivor, 3. very difficult circumstances surrounding the death. The crucial factors in deciding if grief is complicated are intensity and duration rather than the painful symptoms of grief. These vary from mourner to mourner. We can look at complicated grief as chronic, delayed, exaggerated and masked. Chronic grief is one of excessive duration, which is never satisfactorily resolved. The bereaved is aware of the unfinished business, but cannot get back to living.
Delayed grief reaction stems from an insufficient emotional reaction at the time of loss. It is a defence mechanism in the face of awful pain. How often have we heard someone say so and so is taking death really well. Not so. In such cases the grief is carried over and results in excessive reaction to some future loss. Exaggerated grief reactions occur when the the bereaved is overwhelmed with pain. Clinical depression is one of the signs of exaggerated grief, and I suffered from this following the death of my child.
Masked grief reactions are those where the bereaved is unaware that they are related to the loss. Repressed grief will however, somehow express itself. This can be a physical symptom, or some type of maladaptive behaviour. This behaviour may be delinquent behaviour in young people.
One type of death that invariably leads to complicated grief is that of suicide. Bereavement writers hold that it evokes more intense and longer lasting grief than other losses. Suicide leaves the bereaved with a struggle to create meaning from the loss. There was a time when suicides were not buried in consecrated ground, but hopeful such a cultural legacy has now faded from the public mind. It is held by bereavement writers, too, that guilt and perhaps a sense of punishment are felt by survivors following a suicide.
Some suicides occur in the context of difficult relationships, and this increases the guilt and anger. This can lead, also, to a feeling of rejection that may be accompanied by anxiety and self destructive impulses. Other factors, which add to the pain of suicide bereavement, are abuse and alcoholism.
While I had complicated grief, I managed to get through it without counselling; (My wife and I had two sessions). This is not always possible, and I would encourage anyone who feels that they are stuck in grief to get some counselling. Such counselling may not take very long, but will release the survivor from being stuck, and allow them to move to experiencing their grief. I will look at the death of a child in the next article.
Death of a Child (part 1)
The death of a child can lead to complicated grieving because it is a particularly painful loss. It is not the natural order of things that a child should die before its parents. There are so many hopes and dreams unfulfilled. My child,who was killed when he was thirteen, would be thirty now. I often wonder what he would be like as an adult, how would I relate to him, who would his wife have been, would he have been a good and kind husband, would he have had children, what kind of parent would he have been. It is natural to have such thoughts and memories, it does not mean living in the past.
People say that the death of a child is the saddest of all losses, but it is important to remember that every person experiences loss differently. I can certainly say that the loss of my child was immensely more painful that the loss of my father. I can say no more than that and I cannot project this onto other people. All people grieve differently. Sometimes the death of a child is so painful that some parents try to blot out the memory. I have met individuals who lost their children, and they seem to carry on normally in the very early stages of the bereavement, and show good humour and a sense of optimism about their lives. I am very conscious of the terrible pain that they have buried. Sensitive and skilled counselling is required to support them in bringing out this pain and in supporting them as they struggle with the reality of the loss of their child.
What I can say, however, is that the death of a child is what bereavement writers call an enfranchised loss. This means that the survivors experience widespread sympathy following the death of a child. I remember the huge crowds that thronged into the Cathedral in Thurles in February 1990 and the great amount of support I received from so many.
People who lose children have particular ways of expressing their thinking. They may talk about how the child was special, they try to make sense of the death, they have vivid memories of the death even after the passage of years and they use great pathos in describing the moment of death. They may also explore the `what ifs of the transition to being the parents of a dead child. They describe premonitions they may have had before the death and the chasm that exists between them and the rest of the world. These are very familiar to me. I was in Dublin on the day before my child was killed and I suffered from such a severe headache all of that day that I was unable to visit the shops and simply sat in a café until it was time for the bus to depart. I also have vivid memories of the death. I remember exactly where I was when the accident occurred. That day is etched on my brain and will never fade. I always worried that I would forget the sound of my childs voice and I often mentally listen for it. I can still hear that soft voice and it, too, will never fade.
My surviving children, despite their pain, always held that parental grief was the most poignant within our family and, even now, they are extra conscious of the preciousness of their children. So the death of a child can arouse anxiety in the siblings when they too have children of their own. Look at the special relationship between parent and child, a relationship that is forged in a biological and genetic way. Our role as parents is to keep our children safe and accidental death can give rise to complex guilt feelings.
Because the death of a child is so complex, I hope to explore it in a further contribution and I hope that this exploration will be of some help to any reader who has lost a child.
