BRIEF APPROACHES IN COUNSELLING AND HELPING 17
BriefApproaches in Counselling and Helping
BriefApproaches in Counselling and Helping
Thereare various reasons why individuals may opt to go for counsellingwith the hope of feeling better after the same. People may go forcounselling because they are stressed, depressed, and anxious or arein grief because of the demise of loved ones. The primary aim of thesame is to create an atmosphere where support is the main element. Itis believed that the appropriate technique for alleviating variousproblems especially among the bereaved clients is through theemployment of narrative therapy. Narrative therapy helps thecounsellor interact efficiently with the client particularly ifbereaved (Zimmermanand Dickerson 1996, p. 47).The process as psychologists point out and it facilitates the clientsto relate openly to their problems especially since it incorporateslots questions that are considered interactive. In other words, it isa technique capable of separating the client from his/her nightmaresor rather bereavement in this context. The narrative therapy approachto counselling and helping is an efficient mode of dealing withbereavement (Launer2002, p. 24)because its traits mostly are usually externalized therefore eithergiving people an opportunity in preferred identities especially increation and performance or, assist in definition in directions thatare alternate involving a person`s values in life. The narrativeapproach is the best technique to employ in a bereavement contextsince the client is given an opportunity of pouring his/her heartout. The counsellor, on the other hand, has an easier time sincehe/she indirectly offers comfort by using the client`s skills,beliefs, and values to solve the problem (Cacciatoreand Defrain 2015, p. 79).Itmeans that narrative therapy tends to separate the individual fromthe various attributes whereby the client is in a position to see theway he/she can cope with the loss. Narrative therapy in counsellingespecially for a bereaved case is considered appropriate since theclient is in a position to inter-link or merge events in an accuratesequence and then to develop a sense out of the same. Hence, I wouldconsider narrative therapy for the bereaved is the appropriate if notthe best course of action in counselling and helping.
Lossof a loved one especially in gruesome incidents will always affectthe bereaved party. Many struggles in incorporating their losses intheir lives told through stories as they try to conserve theconsistency from time to time from what they have undergone (Wolfelt2006, p. 45).To maintain the perception, the type of therapies that try to go backto the past events of the bereavement usually use high precautionshould be responsible for the justification and go into the problemsthat that the bereaved are faced with. It is mostly importantespecially when those bereaved to them were so close (Ferrelland Coyle 2010, p. 94).The technique usually puts its focus on the most hurting events. Inaddition, it suggests that the bereaved should be given the companyup to the time when the bereaved can handle the memories of the lostwith much ease (Sell2010, p. 6).The technique also acts as a crucial element in naturally successfulcures for the type of grief that is usually problematic to thebereaved. For the type of therapies that will involve interaction todifferent types of upsetting occurrences the re-narration of thosewho were lost encourages the understanding of difficult memories thuswill have a large impact on getting along with solitude an indicationthat the technique is becoming useful. Furthermore, more study on therelevance is necessary (Gilroy2006, p. 13).Hence, the procedure can still assist in pinpointing the traitsrequired. It might sometimes be clear from the other side of thetherapy that one might be still hurt and traumatized with continuouspain of a lost loved on and might at times try to put on faces thatlook stronger. Some complications may sometimes occur during thisapproach since the bereaved always have a belief that one holds forsomeone is not always the same as that held by a spirit.
Aclient and therapist can give emphases on the certainty of theindividual belief of spirits (Gleason2001, p.69).The status of a lost one usually defines the level of grief one willexperience. The good thing about this technique is that it makes abereaved person open up to the thoughts that make the feel they can`tstay without those lost, mainly relating to memories. The critique isthat it tends to revive the lost memories of those lost and sometimesmay be hurting since the client may perceive to look into futurewithout the loved one and feel depressed.
Despitemany counsellors treating individuals suffering from bereavementusing this technique, many therapists still fall for the previoustechnique, narrative therapy, as the best approach to bereavement(Steeleand Kuban 2013, p. 40).Thetechnique may take up diverse designs including writing in light ofthe lost by the bereaved client from a sympathetic perspective,writing their history recounting how the bereaved lived with lost oneand through reconstruction interviews whereby the bereaved get eventsof the lost to get a different implication from them. The limitedinformation that may be relevant to the interviews reduces therelevance of this type of design. The technique may have differentresults according to how the bereaved views his perception of thelost person.
Thistechnique might have an impact on the understanding that thebereavement occurred and helped one to progress with the hurtingmemories of the lost one, hence enable one to gain the courage toshare stories that are usually held deep down their hearts with thoseclose to them.
Tocope up with the situations that have to be undergone despite lackingwords to tell people, it becomes more efficient to use images sinceit may act as a summary of all you would have wished to talk of.Sometimes one can get visions of situations that might not beavailable when our minds think of the lost.
Itmight be an effective way because it simplifies a lot of words in onesingle thing an image. In this situation, the therapist is notassumed to be a person practicing the power to his subject with theirimplications. Again it becomes relevant to use in situations of alarge group that has suffered bereavement. During this time,discussions might arise concerning the lost person. It can in thesame situation make one relate another`s feeling about the loss.Furthermore, in this case, one`s opinion to the metaphor does notmatter to the other individual.
Despitethe other techniques being so relevant to bereavement situations,they do not portray the real feeling that usually faces individuallyas per the status of the lost one. Poetry becomes different fromtherapeutic writing and public speech because it is mostly centred onportraying emotions of the lost one. A poem too can be used to conveya message or authenticate an emotion about the lost one that in aparticular rhythmic flow creating a mood. As a result of thistechnique, the therapist might act in an unprofessional manner in aneffort to recognize the effort taken to create the poem. Thecounsellor is therefore always expected not apply any corrections tothe original piece written because it is not an artistic activity buta therapeutic one. One disadvantage is that when the therapist doesnot have respect for the client, he might be persuaded to share thepiece of literature when using in other counselling sessions.
Accordingto usual types of therapy, we always expect a person in grief tovisit therapist so as to overwhelm the feeling of grief in thembecause of the discomfort they experience. The diverse techniqueshave different modes of how they deal with the grief situationenabling the person in grief to overcome the unwanted mood.Regardless of the many different methods in use they all poses theclients position in the thought that the feeling can be done awaywith. There are other forms of therapy that take a different approachfrom the others. They involve the usually expected pain to beexperienced in the current situation as it is. It will then progressto another stage where the problem is made essential to beexperienced regardless of its implication on someone. Coherencetherapy inhibits practices that still portray the definition thatmakes the continuous observance of how the problem is usually facedand treated. It so far incorporates a more practical form of dealingwith a problem so as the client can address the problemintentionally. The client is usually left with two options on theprinciples since they are wide open either to have a direct orreverse resolution. The impact of this mode of therapy is that ittends to expose the client to more pain at the loss he/she hasundergone.
Aconsiderable number of authors in psychology point out that thebereaved in most cases require particular needs to be met in theperiod after the bereavement. It hence can be considered imperativeto undertake bereavement work in an attempt to cope with the demiseof a loved and mostly factors presumptions or hypothesis. Usinghypothesis in an attempt to try to resolve a problem may beconsidered ineffective by realists or individuals in other fields.Apparently it is correct to point out that there are differentopinions when it comes to the kind of counselling offered to thebereaved clients and its effectiveness. It is true to point out thatthere is proof suggesting that bereaved work in counselling in thecontext of narrative therapy may not mostly be as imperative tofuture changes as perceived. Using the examples of widows andwidowers, it can be presumed that those who never wanted to come faceto face with their predicaments and, in this case, the loss neverdiffered in depression scores from widows who dealt through theirbereavement. Hence, it means that counselling in such a case was notpivotal to their recovery in other words counselling by the means ofnarrative therapy does not guarantee that the client will recoverfully. Though a number of studies and also social experts may tend todiffer with the same bringing about a heated debate as to whether thesame is necessary. The absence of a relationship between bereavementand narrative therapy in various individuals may reveal that there isthe need for counselling and more testing despite it being anoversimplification. Narrative therapy in bereavement may at timesfail to capture various aspects of age and gender. Gender variationsexist in the expression of bereavement, and mostly women may desireto focus on the emotional task of grieving after bereavement whilemen on the other side on the day to day problem alleviating aspects.In regard to the same, it can, therefore, be pointed out thatnarrative therapy in bereavement may not assist everyone who hassuffered a loss. Nonetheless, the process may bring about minutechanges and relief in a number of individuals in the process despitenot being in a position to alleviate the pain that is most pivotal.
Narrativetherapy counselling in bereavement is at time times critiqued by theemployment of various theories in the process. One of the theoriesused is the task and stage theory. The presents a robust perceptionas to how people need to move on via the phases of death. The theorypoints out that there exist a number of reasons for bereavedcounselling in a narrative context. First, it is done in an attemptto increase the reality of the loss. Second is to assist the bereaveddeal with imminent loss. Thirdly, to aid the client not fall prey tothe impediments of readjustment after the demise and finally tosupport the client search for the means of recalling the deceased butstill be at comfort and pushing on with life. The process accordingto critiques is quite cumbersome and involving since the bereavedwill have to be made to actualize the loss in an attempt to acceptreality. The means of accomplishing the same according to variouscounsellors may involve the depressing process of conversing aboutthe events surrounding the demise or even visiting the place ofburial. At times, the clients during the narrative therapy may lashout at the counsellor since majorities are full of anger as well assadness. To some extent, they tend to impose fear among counsellorssince they might not be aware as to how the client may reactespecially when asked negative things about the dead. The process canbe criticized for being more of a police inquiry and tends to makeclients have a feeling as if they are being blamed for the demise oftheir loved ones. Hence, the clients may at times use their skillsand hold back relevant information since they feel as if whateverthey say may be used against them especially if there happens to bean investigation into the same. The counselling process usingnarrative therapy may involve pointing out to the affected that theyneed start making decisions on their own now that their partner isdead. The process at times may not provide elaborate ways or answerson how to handle the same which leaves the survivor more depressedrendering the counselling process ineffective.
Apparently,grief tends to mostly re-emerge during anniversaries that may beconsidered a drawback to the counselling process. The anniversariesmostly open up healed wounds and in the process render the previouscounselling process obsolete.
Counsellingin the context of narrative therapy may be considered ineffectivetowards the bereaved in a case where the client views things from areligious and spiritual perspective. Such a client may disagree withthe counsellor on various issues especially when it comes to thebeliefs on death and hence bringing about arguments due todisagreements though it`s a rare case. Narrative therapy in thecounselling of the bereaved may at times involve the convincing anindividual to make newer relationships in order to move on from thesame (Guilfoyle2014, p. 97).The same may not work since bereavement is not like being‘dumped/divorced` by a girlfriend or boyfriend or a spouse. It ismore weighted and very impactful and, above all, non-comparable inthis context. It is not a mere relocation of emotions of the deceasedto another place or someone else. The counsellors are mostly forcedto act as reassurances. It may not be helpful since the client mayend up blaming the counsellor in case does not go as anticipated andhence the reputation of most counsellors is mostly at stake and ifthings go bad and so is the career.
Anothertheory that may be utilized in the process is the attachment theorywhich points out that an effective recovery entails coming up withtechniques to maintaining and securing bonds while simultaneouslyidentifying that the affected is not in a position to give comfortand love. During the counselling process while employing narrativetherapy, people with anxious-avoidant attachment style tend to beclingy and experience prolonged grief (Shapiro,Kaslow & Maxfield 2007, p. 79).Counsellorshave a hard time especially the inexperienced, and may not handlesuch cases properly and in the process not offering any help at all.Individuals with such a style do not quickly establish relationshipswith others. The narrative therapy may to some extent involve thecreation of relationships with the counsellors so that help may beeasy to come by (Bertrando2007, p. 27).Hence, counsellors in the process may not be in a proper position orrather may have hard time dealing with such individuals and in theprocess fail to assist appropriately. The theory (attachment) insupport of bereavement and counselling using narrative therapy can becriticized as it tends to bring about hallucinations since it pointsout that people may still have that connection event though notphysical (Webb2010, p. 77).Despite narrative therapy which according to the theory may bringabout a clear comprehension of the bereavement, the wound never healsespecially if the bereaved played a part in the demise (Malchiodi2012, p. 41).Despiteresearch pointing out that through narrative therapy individuals mayassist in dealing with grief, finding the means of keeping therelationship with the deceased alive is impossible meaning that thereis no alternative path that may bring into being hope and sustenance.
Theproblem with most narrative or simply stories in the counsellingprocess is that they tend to bring forth various elements of realityand ignores others. An individual whose dominant narrative points outthat they are ugly and unentertaining tend to recall a number ofevents from their life that bodes well with narrative therapy.
Ina number of scenarios during the counselling process based in thecontext of narrative therapy, there is the element of accepting andaffirming to the bereaved (Oliver,2013). However,it is considered ineffective for a counsellor to allow the client toaffirm what they say.
Narrativetherapy can be termed as an effective technique employed by a numberof counsellors especially when dealing with matters to do withemotions and bereavement and finding hope and a new meaning to one`slife (Carter2010, p. 29).Through the same, the bereaved are in a position they have a say onwhere their life is headed and are wise enough not to makeundesirable and hasty decisions in the process. Narrative therapy asevident helps the affected to identify their unique strengths, assetsand assert a new meaning to life in the scope of the human state(Ingram,B. L. (2006 Brown and Lent, 2008).However, there are various setbacks associated with the process(Payne,2006).The setbacks mean that the process may be headed for extinction incase multiple failures are recorded in the process. Dealing withbereaved individuals is quite a burden which means that counsellorsemploying narrative therapy need to be efficient leaving no room forerrors (Sharf2012, p. 18).Apparently, it is true to point out that the process has borne morefruits than failures. In other words, I tend to agree that despitethe considerable number of disadvantages accruing to the process, theadvantages have outweighed the disadvantages and hence the process byall means should be advocated.
Motivationalinterviewing involves empathizing with a client instead of justallocating time or searching for strategies to conduct counselling.The counsellor provides assistance to the patient in the recoveryprocess. Professional assistance is essential in that they help thepatients to overcome potential ambivalence that obstructs clientsfrom attaining their personal goals. The interviewing strategy isbased on both Carl Rogers’ humanistic and optimistic philosophies,which argue that humans have the liberty to make a free choice aswell as undergo change through self-actualisation process. However,the treatment relationship in both motivational and Rogerianinterviewers is autonomous. As such, the primary objective of atherapist is to offer positive determination to uphold a recoveryprogramme (Resnicow & McMaster 2012).
Inthe case study provided, Lyme (2013) conducts a motivationalinterview with a woman who is vulnerable to alcohol abuse. Thepatient takes a glass of wine every day to help her suppress her lifestress and emotional anxiety facing her. However, she discovers thatshe is becoming alcohol tolerant as she takes just a glass of one atthe beginning, but gradually starts consuming up to four glasses pernight to achieve the original relaxed feeling. The patient realisesthat she is susceptible to become a binge alcoholic, so she seeksassistance from her physician on practical ways to overcome thestressors and anxiety she faces (Resnicow & McMaster 2012).
Consequently,the expert the doctor recommends the patient to see prior toprescribing stress and anxiety related assistance intended to helpthe patient overcome her depression problems. In my view, theinterview is a reflective commentary because the patient identifiesthat she began taking one glass of wine, but the consumptionincreases gradually to over four servings per night to attain similardrunkenness level. The doctor begins by inquiring the patient thereason she has visited the clinic. The purpose of the query is tofathom the underlying issue that needs to be addressed (Lyme, 2013).
Inthe present case, the patient suffers from dual diagnosis. Shesuffers from stress and anxiety that her previous doctor has beentreating. However, she is referred to the motivation counsellor aftershe confesses that her rate of alcohol consumption has increasedsteadily (Resnicow & McMaster 2012). The woman in questionconsumes alcohol to overcome life stressors, which includes thefinancial burden of her children. However, the problem deterioratessince she prefers the high-end wines to the cheap varieties.Subsequently, her financial strain increases because she now needs toaccount for alcohol expenses (Rollnick 1991).
Accordingto Lundahl and Burke (2009, p. 1236), Motivational Interviewing (MI)is an efficient treatment approach mainly used in public health,psychotherapy, addiction and medicine fields. One of the criticalaspects of MI that enhances its efficiency is the fact that it isbased on a conceptual base. As such, therapists follow stipulatedguidelines when addressing a given challenge. In my perception, atreatment approach that contains well-defined treatment plans providea resourceful method for resolving the problem. In the case studyvideo, Doctor Lye starts by inquiring the reason the patient has beenreferred to him. Once the patient informs him that she has a dualdiagnosis problem, the therapists proceed to determine the risk levelof risk of the patient. He uses a scale ranging from one to forty tounderstand the seriousness of the problem. The second phase isestablishing the reason she is unwilling to change. She claims thatshe consumes alcohol in order to suppress anxiety and stress.Finally, the evaluation associates her deteriorating alcoholism habitas a contributor to the stress because it is straining the patient’sfinancial resources (Lundahl& Burke 2009, p. 1239).
Knowledgeleads to change. As such, the MI theoretical evaluation approachtherapists use valuable because it begins with investigating commonproblems that patients experience and then proceed to developtechniques to overcome the problem (Lussier & Richard 2007, p.2118).
Nonetheless,MI sometimes has drawbacks because some good advice may fail toproduce a fruitful outcome. For example, the woman in the filmunderstands that she is becoming alcohol tolerant as she takes morethan four glasses of wine a day while the healthy limit is one glassevery day. However, she informs the therapists that she is notwilling to quit the wine (Lussier & Richard 2007, p. 2119). Inher case, alcohol increases her stress because she takes theexpensive brands, and she is already struggling to provide for herchildren. As a result, the drinking habit would make her conditionworse since it both strains her financial status as well aspredisposes her to diseases associated with alcohol consumption(Lundahl& Burke 2009, p. 1241).
Luckily,the treatment approach offers motivation, which is an essentialingredient to achieving change in a person. The relationship thattherapists establish with patients determines the enthusiasm of apatient to undergo positive change. In order to reduce resistance,the professional allows the patient to serve as his or her expert(Rollnick, 1991). For example, the therapist in the video inquiresthe patient whether she is willing to stop alcohol consumption.However, she admits that she has not contemplated stopping the habit,but she can either minimise the intake or even refrain from the drinkif it is necessary to avoid contraindication. Since the treatment isstrategy is voluntary, the doctor asks the patient questions that areintended to motivate her consider alternative stress-relievingmethods. For example, he asks the patient if she has ever consideredan alternative method of suppressing stress. She claims that she hadpreviously exercised to overcome stress (Lussier & Richard 2007,p. 2020).
Incase a therapist is assisting a patient who is unwilling to changethe status quo, he or she can propose a menu options to help themmake informative decisions. Nevertheless, therapists should requestthe permission from the permission to avoid imposing medicalprocedures they are not comfortable with. Besides, therapists need toengage their patients as much as possible in order to build rapport.As such, the treatment is aimed at achieving specific goals. In thecase study above, the patient asserts that she is willing to eitherreduce or cease alcohol consumption temporarily for the medication towork (Rollnick, 1991).
Onthe other hand, the doctor motivates the patients to change througheliciting the extremes. For instance, Lyme (2013) warns the patientthat she is taking a risk when she consumes more than seven glassesof wines in a week. He further points out that alcoholism enhancesher financial stress and anxiety because she has to include its costin her already strained budget (Lundahl& Burke 2009, p. 1244).
Lundahland Burke (2009, p. 1245), real life experiences in MI sessionsenhance the compliance of the patients with the treatment programmes.Personally, I believe the provision of knowledge and motivation todeal with the primary challenges a patient is facing reducesresistance. Subsequently, the information suppresses resistance thatin turn lead to positive life changes required to reduce riskybehaviours while improving healthy life habits.
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