From Philosophy to Practice: Navigating the Diverse Realms of Psychological Understanding

Introduction

For most of us, bereavement will be the most distressing experience or type of grief we will ever face. Grief is what we feel when somebody we are close to dies. People experience grief differently and there is no normal or right way of grieving (Jaffe-Gill et al., 2007). The Linden Centre, where I am training as a student counsellor provides counselling and support to adults, children and young people living in Blackpool, Fylde and Wyre who have, or are caring for, someone with a life-limiting health condition, or are bereaved. The Linden Centre offers a compassionate and comfortable environment that gives adults and children the help they need. This paper will explore the Person Centred Approach to grief counselling. As a trainee, I have significant personal experience with bereavement, owing to the fact that I have interacted with many clients suffering from bereavement and as such, I have journeyed with them and aided them to recover from their grief no matter how complicated certain situations usually are. My training emphasizes on careful and patient listening to clients as with at most empathy and exercise of unconditional regard, these are important and have created a suitable and free environment for the clients to share their grief experiences with me.

Grief therapy is a form of counseling that is aimed at helping a grieving (or bereaved) person understand and cope with the emotions they go through, to grieve in a manner that is considered healthy and to ultimately be able to move on with life. Grief therapy is usually undertaken if an individual reports or exhibits emotional experiences or issues that are well outside the “normal’’ range of responses as a result of their grief or bereavement. For example, a widow who finds it extremely difficult to cope with the loss of her husband even long after his death may need to undergo some grief therapy. Grief therapy is beneficial to those who find themselves struggling much more than they can cope (Mehta, 2013), and helps people who had suffered some distress before bereavement and those who experience chronic grieving which inhibits their optimal functioning to address their emotional imbalances and move through the healing process. There are different modalities of grief therapy or counseling, each with its benefits and working mechanisms. Breen et al. (2014) recognize that loss of loved ones may force a counselor to cherry pick on appropriate elements from different modalities or opt to work with completes and manageable sets of modalities or techniques to employ. Although all bereavement-counseling modalities have their advantages, some are more favorable for success than others. Comparison of appropriateness is based on effectiveness of treatment, duration of treatment, and focus of therapy on comfort of bereaved people (Tolan & Wilkins, 2012). This paper recognizes that in the event of loss of a loved one, friends as well as relatives suffer in numerous aspects of their lives and as such; this paper focuses on the importance of grief counseling in the course of grief and stresses on the most appropriate grief counseling modalities that are available. However, the paper’s main focus is on the person-centered therapy, cognitive behavioral therapy and psychodynamic therapy approaches to bereaved counseling.

Person-Centered Therapy

The Person-Centered Therapy, developed by Carl Rogers in the 1940s, is premised on his proposition that we strive for and are able to achieve our full potential and that we are always progressing towards being the best form of ourselves. Everyone, at birth, has the potential of achieving this form but may veer off this path due to some experiences in life. The person-centred therapy (or Rogerian therapy or person-centred psychotherapy or counseling) is whereby the client plays a crucial role in leading the discussions and focuses on their conscious perception of self, instead of how the therapist is able to analyze and interpret their unconscious thoughts or perceptions. The therapist therefore avoids, as much as possible, directing the direction taken by the therapy. This therapy does not view clients as people with flawed or problematic thought and behaviors to be treated, but identifies the resources within themselves that they can use to understand and change their attitudes, perceptions, behaviors or self-concepts (Roger, 1959). This approach is very lengthy and demands an established client-therapist rapport in which the therapist is charged with responsibility of enabling client’s growth (Breen et al., 2014), and the Rogerian theory identifies six factors that are required for this growth to occur (Roger, 1957).

The person-centered therapy has a number of benefits or advantages. Some of the very important benefits that clients could derive from this type of therapy include the therapists’ unconditional positive view or regard, their empathy and genuineness. This form of therapy also leads the therapist to demonstrate congruence, support, challenge and encourage the client, and the physical one-on-one interactions provide clarity and enhance the client’s understanding, thereby improving their progress towards self-actualization (Hazler, 2016). When put together, these factors positively influence the counselor-client relationship and help contribute to the overall effectiveness of the therapy. Furthermore, the client-centred counseling adopts and focuses on the here and now approach which helps encourage the clients to also think and concentrate on the present, and not the past or future. This therapy type is also advantageous to the client; it recognizes, appreciates and treats the client with importance, and helps them identify, understand reinforce their positive self-concept, values and perceptions (Bower et al, 2000). The concept and context of the therapy promotes self-expression, contributes to self-awareness and encourages a broader understanding of self and growth or self-development. By being self-aware, a client is able to develop a more positive outlook of the world and a less distorted perception of self (Hockenbury and Hockenbury, 2010). This type of therapy can be used singly or alongside other therapy types, and can be used for not only bereavement or grief, but also a range of other issues such as depression, anxiety, various forms of abuse, stress or any other mental health problems. It can be applied in the treatment of mental health problems among clients who exhibit moderate to severe manifestations of symptoms (Cooper, Watson and Hoeldampf, 2011) The person-centred therapy approach also helps people build healthy and effective interpersonal relationships and encourages them to believe and have confidence in their abilities and decisions.

Although highly regarded, the patient-centered therapy also has limitations and advantages. Despite being significant and beneficial, the three qualities- genuineness, unconditional positive regard and empathy- as identified by Rogers have been suggested by other studies not to be adequate and their influence on long-term change disproved (Sachse and Elliott, 2002). According to critics, the use of this type of therapy is not as simple and straight forward as it it seems, and may prove more beneficial if the clients are better educated, whereas the uneducated or less educated ones will have several challenges during the therapy. The therapy’s emphasis and overreliance on the clients’ abilities and positive view may lead to a range of other factors whose inclusion ma prove crucial to the success of the therapy being overlooked or given minimum attention. A number of researches have also argued that the therapy’s use of a non-therapist directed approach is overstretched and could not be effective or easy to implement: since in their trying to give the directive control of the therapy sessions to the clients, therapists may be unable to deduce and gather adequate information from them that would help them achieve the true purpose and goal of the therapy. Many therapists are also unable or find it really difficult to implement the non-directive approach as the therapy requires. The belief in the client as the expert and the one with the answers within themselves may lead to insufficient or mere superficial achievement of the set goals. A number of opponents also assert that the therapy’s unconditional positive regard and view of people as generally good is greatly flawed, and borders on dangerous. This view, they argue, could contribute to unintentionally promoting the maladaptive behaviors, which the therapy seeks to change in the first place.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is a talk therapy or an example of psychotherapy which focuses on enabling people to identify and drop or change various patterns of behaviors or thoughts that are deemed destructive or negative as a way of managing or solving the challenges that they go through as a result of or compounded by these maladaptive thoughts or behaviors (Hoffman et al., 2012). Notably, CBT, whilst using a complicated grief disorder (which is presently incorporated in the diagnostic, as well as statistics manual V and considered to be a medical disorder) is considered to be a form of effective treatment to individuals who are facing bereavement (Allen et al., 2013). Significant to note, CBT is conducted on a short term and precisely, this should be between 8-20 sessions. Focus is an integral aspect of CBT treatment of various traumas as it attends to specific issues related to the trauma McMullen et al., (2013). In its numerous forms (self-help, intensive applied psychological therapy, and mindfulness-based cognitive therapy among other forms), the NICE guideline notes that CBT is an effective tool that is useful for attending to bereaved individuals suffering from depression (Wilson, 2011). A number of previous studies have supported the effectiveness of CBT given its empirical evidence base as an effective method that helps people adopt more positive and healthier behaviors and thoughts without the necessity of introducing other psychotropic interventions.

The adoption and application of CBT have been recommended on numerous occasions largely because of the benefits and advantages it presents. There exists a large body of empirical evidence that supports the effectiveness of CBT as an intervention or treatment of not only grief, but also a whole range of different illnesses such as anxiety, depression, various phobias, eating disorders, personality and bipolar disorders and panic attacks (Kumar, 2017; Tsitsas and Paschali, 2014). CBT could also be useful as a treatment option, when used in conjunction with medical treatment, for chronic physical illnesses (Halford & Brown, 2009). Another advantage of CBT is that the counseling session is often completed within a relatively short time period, as compared to other therapies. Owing to the short sessions undertaken in CBT, most previous studies and research works point to the cost effectiveness of the treatment. CBT helps individuals learn and adopt strategies and skills which they could use to cope with, overcome or change their destructive behaviors, which contributes significantly to their recovery process (Butler et al., 2016). CBT provides various useful, as well as practical strategies, which are useful in the everyday life, even in instances where treatment has already been completed. These skills are advantageous in that they are not only important in the present, but could also be beneficial in future, and CBT can therefore be said to promote long-term change in individuals (Hoffman et al., 2012). It is also evident that the nature of CBT on bereavement counseling could be provided in varied formats and this includes in groups or in apps (whereby, an individual is in a position of finding mental health apps) (Hudson et al., 2018). CBT also allows for an extended level of flexibility in its application. Lloyd & Flaxman., (2013) stress on the value of flexibility in cognitive therapy so as to address issues arising during treatment and cut on sessions spent during CBT treatment.

However, CBT also has some disadvantages and limitations to it. One major disadvantage of this modality is that it does not focus on the capacity of the clients to change and that includes their thoughts, feelings, as well as behaviors. Aveyard (2011) recognises and it is worth noting that it fails in addressing wider problems in various systems or families, which often have significant effect on the health or wellbeing of an individual. So although CBT has been suggested as the most effective intervention, some researchers have provided various evidences to disprove the pervasive suitability or effectiveness of this therapy for all patients or cases or the perception of overall superiority to other interventions (Gloaguen, 1998; Cuijpers et al., 2010). While CBT does not address neurological trauma imprints, its effectiveness should be measured on its ability to treat several illnesses and full completion of therapy sessions by clients (Muse& McManus, 2013). Although not as much of a disadvantage, various researchers while measuring cost and outcome of behavioral Activation versus Cognitive activation found CBT to be just as effective as the other available applicable therapy options and not any less costly (Richards et al, 2016; Lydecker et al., 2010; Schmitz, 2008). Researchers have also suggested that CBT may not be holistically effective or adequately attend to the needs of its patients at all stages if it is used in isolation, thereby necessitating its application alongside other similar types of therapies.

Psychodynamic Therapy

Psychodynamic (or psychoanalytic) psychotherapy is a type of therapy that lays bare the manifestation of a patient’s current unconscious processes. Psychodynamic therapy focuses on the patient’s understanding or self-awareness of the influence that their past behaviors or thoughts have on their present behaviors and explores their deep inner urges, desires and needs (McLeod, 2014), unlike other behavioral therapies such as CBT which simply focus on mitigating or eliminating manifested symptoms. This form of therapy facilitates a patient to change their life story, perception of his past, present and future self and is capable of addressing their experiences in more depth (Gad, 2017). In particular, it is noted that they focus on the client’s childhood development, as well as stories and linking them to the current, as well as personal life of the adult client. In particular, they often focus on the client’s childhood development, as well as stories, and thus, linking them to the client’s present and personal life in his or her adult life (MacKinnon et al., 2014). The primary goal of the client is moving to a clear understanding that whatever was responsible for the client having a particular problem at childhood, may have resulted into the painful situation that the client is presently undergoing, thereby implying that the root causes of the problems, which their problems faces are from their past.

Psychodynamic therapy has shown to have some advantages in its application in bereavement and grief counseling. Psychodynamic counselling helps a bereaved person to uncover various hidden links, and this in turn, may allow them to have a great freedom of thought, action as well as choices (Clute, 2010). It is a common belief that in psychodynamic counselling, human beings have a tendency of repeat patterns of their actions or behaviour, and even in instances where they prefer changing; they simply find themselves unable to, as their actions are embedded within the unconscious process of their mind. Notably, such kind of patterns may be constantly repeated in the counselling room, and it is considered to be helpful, as it is considered to be aiding the client to perceive their behaviour, as well as relationship patterns without having the fear of being rejected in the process of the enhancing the therapeutic relationship (Barlow et al., 2010). Psychodynamic therapy also assists clients to make a good sense of their self-patterns of behaviour, whilst they respond to loss, as well as making various informed choices, which could be useful for the future. It also purposes to take both nature and nature into consideration, wherefore, nature includes the ego, and the super ego whereas nurture includes parents, and even childhood experiences (Aveyard, 2014)

This therapy also has a number of disadvantages. It is considered that psychodynamic counselling could often take significant time, in order to work through and therefore many people don’t find attractive or as effective to use (Clute, 2010). It is considered to be unverifiable, owing to the fact that its assumptions cannot be measured scientifically or even proved to be wrong. Moreover, it is noted to be deterministic, which suggests that the behaviors of human beings should be pre-determined, even when clients are opposed to it (Bager-Charleson, 2010). This opposition of clients to free association may make this form of therapy not useful or ineffective if the patients resist the idea of freely sharing information or intimate details with the therapist. This therapy may also bring about a memory of a rather traumatic event (abreaction) that could extremely distress the patient and potentially aggravate the current situation, rather than lead to the patient’s recovery. The therapy may also not make any meaningful gains if the therapist is unable to follow the patient’s lead and reach their unconscious processes or sources of distress.

Conclusion

The person-centered approach is non-directive and also an optimistic therapy, which primarily focuses on the ability of the client to make significant changes on their lives and also motivates them to strive towards achieving their self-actualization. CBT is widely regarded and has been accepted as an effective intervention which can be useful in the treatment of various mental health problems. However, it is evidenced that it may not be successful or rather, suitable for all individuals. Moreover, critics also present the argument that CBT only purposes to address various current problems such as anxiety, addiction and depression and only attends to specific issues, but does not address various possible underlying causes related to mental health conditions such as. It should also be considered that person-centered approach is better than the psychodynamic approach as it does not provide an adequate explanation meant for mental illnesses, owing to the fact that it fails to provide definitive evidence, meant for the bereaved individuals’ unconscious mind. This is to the disadvantage, as various studies that provided evidence, which suggests that childhood experiences are capable of affecting the mental health of bereaved individuals later in their lives, and thus, implying that they should be taken into consideration.

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