Attending Skills in Counseling: Listening and Observing

Attending skills and attending the client are the initial phases of patient interaction with a counselor.  It involves how well the counselor attends the client through listening, observing and feedback skills.  These basic skills set the table for productive counseling.

Attending to the client involves listening and observing skills that lead to better feedback. Please also review AIHCP’s Grief Counseling Certification as well as its Christian Counseling Certification

The fundamental foundation in conversation and communication is listening.  When others try to interrupt or speak over each other, the purpose of communication is crippled.  Listening is a key communication skill that helps one understand the other half of the conversation.  It allows one to learn about the other person and be able to make productive comments to the process of the conversation.  When listening fails, communication fails.  No wonder then, counselors, whether clinical or pastoral, whether in grief, spiritual or general counseling fields need to develop this skill in counseling.

When working with someone, whether in basic clinical interviewing where information is collected, or in counseling itself, where one hopes to help someone find healing or progress in life, listening is a key ingredient.  When counselors fail to listen properly, the counseling process itself fails.  Clients sense when their issues are addressed or if the counselor cares about what they are telling them.  Hence, listening and giving good feedback is key not only for providing help but also creating a relationship between counselor and client.  A counselor who listens is not only better able to help the client but is also better able to give the client a sense of meaning.  Through listening, the client feels someone cares about his/her problem and is willing to listen and offer productive advice and guidance in the process.

 

 

 

 

The Counselor and Client Relationship

The counselor and client relationship is key.  When the counselor makes him/herself available to the client, he/she invites the client into a professional and therapeutic relationship. Through this communication, a team evolves that works together for the benefit of the client.  In essence it becomes an alliance (Egan, 2019, p. 67).  Any good alliance is built upon good communication and listening.  The counselor builds the relationship first via listening.  Through listening, communication begins, through communication, trust emerges, and through trust, a relationship that can heal begins.

The Art of Attending

Attending a client involves both listening and also observing.  When attending to a client, the counselor reduces talk time and provides clients with the timeframe to speak (Ivey, 2018, p. 75).   Conducive to this is how a counselor attends to the client from four physical aspects.  These attending aspects include visual contact, vocal qualities, verbal tracking and body/facial expressions (Ivey, 2018, p. 75).  In regards to eye contact, when someone looks away, it denotes for many, a sign of disrespect or lack of interest.  Hence good visual contact involves eye contact.  This does not necessarily mean awkward staring, but it does denote eye contact during conversation.  This promotes the sense that one is genuinely interested in the story of the client and promotes the process of counseling itself.  Vocal qualities also play a key role in the attending art.  Tones and speech rate can be interpreted by the client as positive or negative based on the counselor’s speech.  A counselor who seems upset via a tone, can quickly scare away a client or embarrass a client from further discussion.  A calm and sensitive tone is essential to provide security to the client while his/her story is being told.  While listening it is also essential to track the conversation.  It is important to keep the client tied to the initiated topic (Ivey, 2018, p. 75).   Good listening helps keep the conversation in a good and purposeful direction.  Finally, one’s body language and facial expressions can play a key role in attending.  An awkward or angry face, or turning away from a person can have the same negative effects as the tone of one’s voice.   Egan recommends facing the person squarely, adopting an open posture and sometimes leaning forward as needed during the conversation (2018, p. 101).   Instead of folding one’s arms, or shifting and moving, one can create a safe sense of being for the client during the narrative.  Bear in mind also cultural aspects.  Some individuals may be from a different and diverse culture that utilizes different ways of expressing certain emotions.  This can lead to different postures or emotional ways of expression.  It is important to be aware of other cultures and their views and to also be aware of oneself and how one’s own appearance, race, faith or culture can affect the client one is attending and trying to help.

Dialogue and Listening

Empathetic listening is an important skill that lets the client know his/her story matters

A good conversation involves taking turns during it.  It involves connecting and mutually influencing each other (Egan, 2018, p. 100).  It not only a monologue but a shared story that each party invests in.  Good listening skills help the counselor make the most of the narrative but some types of listening miss the point.  Egan points out that partial listening is one type of listening that counselors need to avoid.  When counselors only partially listen, they only skim the surface.  They pick up parts of the conversation and miss others.  When questioned by the client, their response is less complete and can cause problems with the client (2018, p. 107).  Another poor listening skill, according to Egan, is an audio-recording style of listening, where the counselor simply parrots what the client has expressed.  In this case, the paraphrase adds no insight or questioning but merely repeats.  Sometimes, repeating something has power and can be utilized but if paraphrasing is utilized in parrot form consistently, then it only mirrors and gives no true insight.  Counselors need to listen to the client’s experiences, thoughts, behaviors and feelings and better respond to those things with insight (Egan, 2018, p. 108).  This insight should not be judgmental, but should be slowly integrated into the responses.  The response then should not merely always paraphrase or repeat, but the listening should produce a paraphrase that not only restates but also probes deeper, but without judgment or necessarily value based accusations.  The key is to help the client find the answer because ultimately the client is in the driver seat.  Finally, Egan points out that another form of bad listening involves rehearsing.  Many novice counselors are looking for the perfect answer or solution, or even the proper response.  During this, counselors can become dominated during listening as to what their response will be instead of what the client is discussing (2018, p. 107). Effective helpers  do not stop listening to derive a solution but continue to listen instead of preparing what they will say next.

Other Distortions in Listening

Egan points out a few other ways distortions to listening that can occur even to counselors who are fully paying attention.  Egan states that it near impossible to listen to someone in a completely unbiased way but counselors need to try their very best to filter these assumptions (2018, p. 125).  A counselor who is a white male may use filters from his own life that could distort cultural differences from a black female.  This bias could side track both parties.  Hence it is critical to remove types of subconscious bias when listening to the narrative of a person from a different race, culture, or faith.   In addition, during listening, it is important to avoid evaluative listening.  Egan defines evaluative listening as judgmental listening.  It involves seeing statements as good or bad, or right or wrong or acceptable or unacceptable (2018, p. 126).  Clients need to be first understood before productive change is introduced.   Another type of distortion involves stereotyping a client based on diagnosis.  This type of listening involves labeling the individual.  While diagnosis is important, when focusing solely on diagnosis of the individual, the counselor puts the client in a box.   Egan states the counselor can be correct in diagnosis but still lose the person (2018, p. 127).   Finally, it is important for counselors not to fall victim to sympathetic listening, where they become solely captivated and emotional about the client’s situation while missing the objective facts.  Sometimes too much sympathy can limit effective helping (Egan, 2018, p. 127).

Importance of Empathy and Finding Missing Cues

Counselors can discover various insights into a client through various physical cues

Empathy is crucial in human relationships. An empathetic person is able to understand the other person emotionally and feel what it may be like to experience certain things.  Empathetic listening allows the counselor to take a sincere and honest interest in the client but still remain objective. Carl Rogers, author of the Humanistic Approach in counseling, emphasized the importance of acute empathy and the utilization of it throughout the discussion.  Empathetic listening according to Ivey can be subtractive, basic or additive.   When subtractive, the counselor gives less back in response and the response is sometimes distortive and hence ineffective.  When the empathy is basic, it is an accurate feedback.  One needs to avoid completely audio-repeating but it sufficient to help the client.  Additive empathy is the best because it reframes but also may include past statements or include additional information to produce positive change (Ivey, 2018. p. 67).  Again, these rephrases, summaries or reflections are not meant to be commands but are used to guide.  They are not meant to impose judgment or value either, but awaken the client to other views or self actualizations.

Counselors have a wide variety of ways to respond through their listening and observing skills, some may include generalizing or summarizing, paraphrasing or reflecting on various issues.  Regardless, they need to be at least additive or basic in empathy.  Summarizing is a broad basic account of the dialogue.  Paraphrasing is more acute but it can be basic or additive.  Reflective is very additive in nature but connects the dialogue to self and offers insight and questions on the statement.

Empathetic listening is key in helping clients and is the basis for a client-based therapy (Egan, 2018, p. 67).  Through empathetic listening, one can become more attune to verbal and non-verbal cues that can reveal issues surrounding the story.   Counselors should watch for tone of voice in responses, facial expressions or body movements during the conversation.  How a client speaks or responds to a question can be a key clue (Egan, 2018, p.116).  Ivey recommends mirroring sometimes the client.  When movements do not clearly match and shifts and jerks within the client appear, then this could be a sign of an issue (2018. p. 99).

As noted, counselors need to watch for changes in tone of speech or physical movements.  Good observing skills, in addition to good listening can help counselors discover other missing pieces of the puzzle. In regards to some verbal behaviors, Ivey emphasizes that counselors should carefully watch “I” statements or “other” statements.  Are these statements positive or negative regarding “I” or “other” (2018, p. 93).  Ivey also recommends looking for words such as “can” and “can’t”.  Some clients as well are more concrete in their speech, while others are more abstract.  During listening and observation, a counselor needs to identify this.  Abstract clients are excellent at self analysis and reflecting on an issue, but may struggle with concrete issues.  More concrete clients may be able to provide specifics, but be less able to see the point of views of others.  Both types have their strengths, but it is important for a counselor to identify which type of speech one is listening and observing (Ivey, 2018, p. 91).  During interviewing or counseling, a counselor may be able to find cues to the issue through various discrepancies throughout the clients story.  Ivey points out that contradictions may occur between statements, or between words and actions, or regarding goals. It is important for the counselor to identify these discrepancies and in a non-confrontational way expose them to the client (Ivey, 2018, p. 99).

In listening empathetically and avoiding bad and distortions of listening , one can better hear the client’s experiences, thoughts, behaviors and feelings and not miss various cues of other issues.

 

Conclusion

Proper attending of the client is key for good counseling. Please also review AIHCP’s Grief Counseling Certification

Attending a client involves good listening and observing with feedback that reflects this.  Counselors need to develop good listening skills for the betterment of their clients.  Listening forms the foundation for any relationship and it is important to avoid bad listening habits.  Counselors can better attend their clients through a patient-centered model that is empathetic and humanistic.   Neuro-science studies portray that when clients are properly listened to and given feedback that show thought and reflection corresponding with listening, then certain parts of the brain light up in positive ways (Ivey, 2018, p. 77).  Listening plays a key role in making a positive effect on one’s client.  It lets the client realize someone actually is listening and cares and is providing feedback to produce positive change.

 

If you would like to learn more about helping other people or would like to become certified in Grief Counseling or Christian Counseling, then please review AIHCP’s certifications in these fields.  The programs are open to both clinical and non-clinical counselors who would like to earn a certification in these fields and add to their existing practice.  The Grief Counseling and Christian Counseling programs are online and independent study and lead to a four year certification.

References and Additional Resources

Egan, G & Reese, R. (2018). “The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (11th)”. Cengage.

Ivey, A. et, al. (2018). “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society (9th)” Cengage.

Sutton, J. (2021). “Defining the Counseling Process and Its Stages”. Positive Psychology.  Access here

“Reflecting Skills”. Counseling Education.  Access here

“7 Attending Skills”. Optimist Minds.  Access here

Stress Management and Salutogenesis

Stress and stressors erode a person’s ability to cope with life, whether in the workplace, school,  home, or with family or friends.  Stressors ignite within the human person a stress response to face danger.  The Sympathetic Nervous System within the body prepares the body from a physiological standpoint to physically withstand the danger or stressors by fueling the body cortisol and adrenalines to overcome the situation.  If the human body or any organism for that matter is overcame by the stressor, then weakness and possible disease and shock can occur. Only when the body or organism is able to overcome the stressor is it able to again return to normal functioning.

When a stressor overtakes a person or organism, then the person is no longer able to cope. The Sense of Coherence when exhibited illustrates an individual who can overcome a stressor

 

In most stress research, disease and weakening of the organism via poor health is viewed through the lens of pathogenesis and the reasons why individuals become sick, ill or die.  Obviously stress can play a key role in that.  With chronic influxes of cortisol, the blood pressure, constriction of vessels, and higher tension on the heart can have life altering affects on the body.  However, there is another angle to explore in regards to the body’s over health and its reaction to stress.  Aaron Antonovsky (1923-1994) reviewed how health and disease are not dichotomy of two states but a continuous variable based on health and coping. This includes various holistic approaches as well as diet, exercise and life views that help individuals maintain health.  Antonovksy’s famous concept of salutogenesis looks and focuses more so on the factors and practices that promote health instead of what destroys health.  Stemming from the Greek “salus” meaning health and “genesis” meaning origin, salutogenesis looks to maintain health by healthy practices and healthy origins itself.

In regards to stress and loss, this has great implications.  Many individuals under stress or loss are unable to maintain physical, mental and emotional health and can fall prey to the stressor.  As noted the stress kills and an inability to better cope with stress in a healthy way can be detrimental long term to one’s health.  Hence Atonovksy looks the concept of coherence as gold mark of individuals who maintain a stronger mental and emotional health in responding to loss or a stressor.  These types of individuals are far better equipped to cope with stress in the forms of loss, death, job loss, problems, crisis, or any bump in the road.  The resiliency of those who display coherence is stronger than those who do not.

Sense of Coherence

So what is coherence?  The Sense of Coherence forms a theoretical framework for how a person responds to stress and plays a key role in one’s ability to respond to it.   In Atonovsky’s work, “Unraveling the Mystery of Health, Antonovsky lists the key elements of the Sense of Coherence.  He states,

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that  the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”

Wikipedia.  Access here

Within this, one can see three key elements to coherence.  First the person has comprehension of the situation.  The person has an understanding of what is occurring and the person is able to predict and understand  the outcomes.  This understanding lays the foundation for the individual to better able to cope.  One can imagine when this foundation ceases to exist.  When something so so shocking, so traumatic and so meaningless occurs it shocks the system of a person.  It gives the person no rationale or direction to resolve the issue.  This is why it is so common in traumatic loss or witnessing senseless destruction that PTSD often occurs and the individual is unable to properly process the event.

The second element is manageability.  If a person has the experience and tools to properly cope with the stressor, then the individual has a better chance to overcome it. Having control in the chaos is so important.  Antonovsky in his work, “Health, Stress and Coping” coined the term generalized resistant resources to illustrate resources and tools an individual has to overcome stress and loss.  If these resources were not available, no matter the Sense of Coherence, a person would fall to the stressor or loss due to lack of these resources.  When lacking, the term generalized resistant deficit was employed.  A good example of this would be applicable to a person who lost his or her home in a fire.  An individual with little income or support systems lacks any resources to face the stressor, while a wealthy individuals with resources, insurance, funds and good friends will more than likely survive the stress and loss.

Finally, Antonovsky pointed to the importance of everything in life has meaning and purpose.  The good and the bad occur, but there is an overall sense of understanding and purpose.  Individuals who are not anchored by a world view, whether spiritual or practical, can sometimes float in life and lose purpose and guidance when bad things occur.  Having a sense of meaning helps individuals anchor one self in loss and stress and find orientation and purpose.

Hence, comprehensibility of the stress, loss or moment, manageability of the stress, loss or moment and meaningfulness of the stress, loss or moment, are critical to a Sense of Coherence and the ability of the person or organism to maintain health and resilience against stress or loss.   In times of crisis, pandemic, or war at the social level or at times of personal distress or severe trauma on the person, individuals who display a Sense of Coherence are better equipped to excel and survive during bad times.

Conclusion

Salutogenesis sees health as more than an absence of disease. Please also review AIHCP’s Stress Management Program

A person or organism that is able to adjust and react due to experience, manageability and understanding of a given crisis, loss or stressor has a greater ability to respond in a healthy fashion.  A healthy emotional and mental mindset can better prepare a person for crisis and loss.  This does not mean a person will not feel the effects of a loss, but it does point to the probability of healthier and normal outcomes or resiliency.  Antonovksy’s ideas and theories are important for a better understanding of stress management as well as grief and loss trajectories.

Within Stress Management, his ideals point to how one can better handle stressful situations and find resiliency.  In grief counseling, it can help grief counselors better predict grief and loss trajectories of individuals and who may be more likely for a complicated grief reaction.

Please also review AIHCP’s Stress Management Consulting Certification as well as AIHCP’s Grief Counseling Certification and see if they meet your academic and professional goals.  The programs are online and independent study and open to qualified professionals seeking a four year certification.

 

Additional Resources

“Aaron Antonovsky”. Wikipedia.  Access here

“Salutogenesis”.  Wikiepedia.  Access here

Hege Forbech Vinje, Eva Langeland, and Torill Bull. (2016). “Aaron Antonovsky’s Development of Salutogenesis, 1979 to 1994″. The Handbook of Salutogenesis [Internet].  National Library of Medicine.  Access here

Monica Eriksson and Bengt Lindström. (2006). “Antonovsky’s sense of coherence scale and the relation with health: a systematic review”. 2006 May; 60(5): 376–381. National Library of Medicine.  Access here

 

Grief Counseling Video on Journaling

Writing about our feelings is an important way to express in a positive and healthy way.  Within CBT it has numerous effects in helping the person reframe and identify troublesome emotions and behaviors. It allows one to express but also cognitively review and respond to the self.

The power of journaling. Please also review AIHCP’s Grief Counseling Certification

Instead of maladaptive coping, journaling helps the individual express without hurting oneself with damaging practices that lead to worst grief responses.  It grants the person privacy in expression but also grants the person control.  The person controls what is written as long within the confines of where the person writes, the person is able to safely release the pain in a positive way.

Please also review AIHCP’s Grief Counseling Certification and see if it matches your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.

 

Please review the video below

Neurotransmitters and Mental Health Video

Neurotransmitters play a big role in our mental health from a physiological view.  They are important chemicals without our brain and body that balance various moods.  Serotonin for example when balanced regulated mood disorders such as depression.  Proper balance and understanding of these transmitters play a key role in mental health.  Sometimes it is diet, other times it may require medication to find balance, but most licensed mental health care professionals can help individuals find the mental help they need if an imbalance occurs.

Neurotransmitters play a key role in mental health. Please also review AIHCP’s Grief Counseling Program

 

Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification.  AIHCP also offers a variety of other mental health certifications for other professionals as well.

 

 

Please review the video below

Counseling Pitfalls Video

Counselors can fall into pitfalls with clients and encounter ethical dilemmas often without knowing it.  They can sometimes be placed between two conflicting sources as well.  It is important to identify potential pitfalls and understand proper responses to avoid later ethical issues or possible termination by employer or suspension of licensure.

Counselors need to be aware of various pitfalls that can endanger their position and career. Please also review AIHCP’s various mental health certifications

 

 

 

 

 

 

 

 

 

The video below highlights and illustrates different types of scenarios and certain preventive measures to protect one’s career.  Please also review AIHCP’s various Mental Health Certifications for Human Service Professionals.  The certifications can serve both licensed and unlicensed professionals in advancing their careers.

Please review the video below

Counseling Ethics and Ethical Standards Video

Ethics in counseling has standards that counselors in the human service field must adhere to in regards to conduct with clients, other counselors, employers, students and other peers.  They are essential to ensure quality and standards within the field of counseling.  Various organizations such as the American Counseling Association offer lists of standards that the profession adheres to in regards to conduct.

Like all professions, Counselors also adhere to ethical standards. Please review AIHCP’s certifications for counselors

This video below reviews in more depth counseling standards and ethics.  Please also review AIHCP’s Certifications for counselors including Grief Counseling, Christian Counseling, Crisis Intervention, Anger Management and Stress Management.

 

Please review the video below

Grief Counseling: Assessment and Perception Problems for Grievers and Grief Helpers

Whether operating as a pastoral counselor, licensed counselor or a close friend and confidant in the grief process for a bereaved person, certain biases and perceptions from both the griever and grief helper can hamper the healing process or cloud assessment entirely.  In past blogs, we have talked about grief myths, grief bullies and both the griever and the grief helper’s own biases.  In this blog, we will put all together as one core unit in how these issues can culminate in preventing healing and also hamper one’s ability to help the grieving.

Helping others through grief is naturally composed of both healthy and unhealthy perceptions, biases and sometimes myths about loss itself.

 

Grief Myths

Grief myths exist in society and can attach to a particular griever, grief helper, or grief bully.  They prevent true healing because they mislead about the true nature of normal grieving itself.  They help form bias within the individuals toward a particular grieving process.  In Junietta McCall’s text, “Bereavement Counseling: Pastoral Care for Complicated Grieving” there are various problematic implications that occur due to bad perceptions.  Among them, McCall lists the denial of the necessity of grief work, the fact grief should always be simple, that any type of extended grief is due to immaturity or pathology, that grieving is feeling sorry for oneself or seeking attention and finally that grieving and any outward manifestation displays weakness in character or lack of faith (2012. p. 182-184).  When individuals believe grieving is not normal, or that is an attention seeking process, then these myths become problems that infect the person’s bias in both helper and griever.

Personal Bias

Grief bullies are particular guilty of personal bias.  They set timelines for grief and assert rules for expression of grief.  Most are harboring their own interior issues and cannot grieve properly themselves.  These individuals will assert that individuals are seeking attention, or weak in character.  Some may grow with a bias that “real men do not cry” or that it is simply time to “get over it”,  Others who are less bullies but more observers may dismiss other’s grief due to their own bias and simply state “the person never talks about it, so I leave it be” or “I avoid this person because it will turn into a sad and uncomfortable conversation every time” or “I would rather say nothing instead of bringing up the pain” or “She needs to simply have more faith” (McCall, 2012, p. 179-182).

From this comes a series of problems grievers face in their own perception of their loss.  They may question the amount or lack emotion displayed.  They may question if they have grieved or felt bad long enough or not enough.  Common exclamations such as “I should be over this by now” or “It is time to move on” or “I feel obligated to cry more” are all nagging pains within the person as the person encounters the grieving process over time.  Some may feel a religious obligation to feel happy that the person is in a better place and any crying is selfish or may question other emotions of anger or guilt. Others may feel ashamed they are angry with God or have not shown enough faith that the person is in a better place.

Others may feel conflicted based upon relationships with deceased or the nature of the loss itself.  They may feel guilty for not maybe noticing an illness soon enough, or not paying enough attention to someone who passed away and feel it is partly their own fault. The person may feel guilt for not visiting enough or appreciating the person enough.  This perception as well other perceptions can create future issues in the grief trajectory and how a person heals.  The only way these issues and emotions can be properly diagnosed is through talking and identifying them.

The Pastoral Counselor, Licensed Counselor or Grief Helpers Bias

Many times, even those who work as primary help of the bereaved enter into conversations with their own bias. While grief and loss are objective realities, everyone has  particular unique and subjective experience in their reactions to grief.  This incorporates a history of grieving that has good and bad things.  Some things may also be neutral and worked for oneself while one grieved but may not work for others.  This is not to say sharing experience and coping ideas are bad but it has to be done when invited.  Comparing grief and offering solutions that may have worked for one’s personal self may not work for others.  One should not be upset if one’s particular advice does not lead one to healing but understand that a grief helper is there to listen and sojourn with the bereaved and the griever’s own particular loss in the griever’s own particular way.  Biases of past experience hence can be helpful or detrimental based on a case by case basis.

Yet, biases inherently are part of the care and healing process and when used correctly can supply large doses of wisdom and knowledge to healing. The care process, according to McCall, involves both the griever’s bias and the helper’s bias.  This leads to two sets of perceptions, thoughts, feelings and beliefs (2012, p. 175).   In healthy outcomes, this feedback loop meets the needs of the given grieving situation and promotes healthy healing.

Grief helpers can play key roles in helping identify issues that relate to griever’s bias, beliefs or perceptions due to grief myths or personal complications within the grieving process.  McCall lists numerous ways pastors, counselors or friends can help the bereaved through difficult times.  McCall lists the critical importance of making careful observations, building healthy relationships, furthering necessary treatment and promoting professional and healthy behaviors (2012, p. 186).

Careful observations push the intuitive abilities of a helper to notate issues that may be arising during the grieving process.  This involves not only note taking but also looking for non verbal clues as well as understanding the person’s past history to better identify issues that may be affecting the current grief process.    Three key consultation questions arise.  First, what is the counselor paying attention to and what could he/she be missing or taking for granted? Second, is something unsettling oneself or making oneself uncomfortable about a particular griever and what is it about? And finally, is the counselor helping the person or getting in the way? (McCall, 2012, p,. 196).

Beyond observations emerges the importance of building a healthy and professional relationship with the bereaved.  One that is helpful and not leading to co-dependence but one that is promoting a healing process where the bereaved will be able to again move forward in life.  This involves identifying with the person and forming an understanding of their pain.  It involves empathy, listening, communication and helping the person form connections from past, present and future (McCall, 2012, p. 189-192).

The third key according to McCall is integrating treatment based upon perceptions.  These treatments are unique for each individual griever and may depend on the griever and the nature of the loss.  Treatments can range based on the person but it involves good note taking and documentation of challenges and issues that appear during the grief trajectory.  These notes and documents help the grief counselor make better assessments and plans of action.  Maybe a particular griever needs a particular therapy best performed by a specialist in it, or maybe the griever needs to be seen by a licensed counselor instead of merely a pastoral counselor.  Maybe CBT is a better resource than a Humanistic approach, or psychodynamic approach?  Maybe this individual would benefit from journaling, or instead of journaling, other forms of artistic expression?

Finally, a review of oneself is critical.  It illustrates how one is reacting to the griever and how effective one is being in terms of helping the individual in his/her progress in grieving.  In analyzing oneself, one is better able to see how one has been successful and not with this particular griever and what things may need adjusted or even if one needs to step back and allow another with more experience or expertise to resume the role in the care plan.

Conclusion

The grief process is about human beings.  The griever and helper are on a mutual journey upon the grief trajectory.  Perceptions, bias and process are all part of it.  Some individuals have unhealthy bias and myths about grief and their perceptions are detrimental while others have healthy perceptions which aid in healing.  The dyad process of two individuals and their past, perceptions and ideas all constitute part of the care model and ultimate healthy grieving outcomes.

The care model of helping others through grief is between the bereaved and helper. Please also review AIHCP’s Grief Counseling Certification

 

Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.

Reference

McCall, J. (2012). “Bereavement Counseling: Pastoral Care for Complicated Grieving”. Routledge.

Additional Resources

“6 Myths About Grief”. PsychCentral.  Access here

Williams, L. (2015). “64 Myths About Grief That Just Need To STOP”. What’s Your Grief.  Access here

Feldman, D. (2019). “Five Myths About Grief You May Believe”. Access here

Haley, E. (2017). ” “I should have known…”: Understanding Hindsight Bias in Grief”. What’s Your Grief. Access here

 

 

Humanistic Approach in Counseling and Grief

There are many schools of thought in treatment of individuals facing emotional and mental distress.  Psycho-analysis, behavioral and cognitive schools look at each different human lens of existence to help individuals find balance and happiness.  Psycho-analysis delves deep into the past to find answers to trauma, pain, pathology or issues plaguing a person.  In this venue, we see the seed of Sigmund Freud’s thoughts.   Behavioral strategies look how one’s behavior can be modified to alter mental and emotional issues.  Ivan Pavlov demonstrated the role of classical conditioning on the a person’s behavior.  Cognitive schools emphasized the rethinking aspect to helping others overcome mental and emotional issues. Aaron Beck in the 1960s would combine behavior and cognition as a way to help others via Cognitive Behavioral Therapy.

Another type of way to address human distress is Humanist Therapy.  This type of behavior which has success for many is holistic in nature and looks at the now instead of the past to find healthy balance within a person.  It is far more patient based and subjective in nature.  Due to its greater emphasis on self-happiness and subjective view of self, it focuses more on the person’s emotion in the present and its interaction with others.  It looks to restore and find balance within the person.  It finds its conclusion through authenticity with self and room for self growth in the present and relationships with others (Sherrell, Z,, 2023)

This has many implications within grief.  Grief can shatter a person’s self image and world view.  Humanistic approaches can help restore confidence and hope. It is very sensitive to the needs of the person.  While it may not alone suffice for all cases, it can definitely contribute to specific needs of the grieving person.  In this blog, we will shortly review the nature of the Humanistic Approach for grief, its strengths, its weaknesses, and how it can be incorporated.

Humanistic Approach

Humanistic Therapy is a more holistic and emotional direct therapy that focuses on emotion in the present and how to deal with those emotions in relationship to self and self worth

 

The idea of meeting human needs to find balance has many strengths in psychological thought.  Abraham Maslow’s famous hierarchy of needs sketched a thorough outline of how when human needs are not met, pathology and dysfunction can occur.    Carl Rogers, however, established the Humanistic school of thought.  Rogers wished to treat the entirety of the human person and felt the imbalance or lack of fulfillment in life constituted the biggest problem to individuals.  He labeled the term congruence to distinguish between healthy balance in life that reflected interior perceptions with the outside world.  When balance occurred, Rogers believed human beings display healthy mental and emotional behaviors.  When incongruence emerged or imbalance between self and the world, then person’s mental and emotional health suffered (Mcleod, S., 2024).

Rogers Humanistic Approach centered upon the needs and desires of the person.  It revolved around the now and the relationships within the person’s realm.  The first key elements were regarding self image and self worth.  A person’s self image correlated with how the person viewed oneself in life, his/her existence and relationship with others and how the person fits (Mcleod. S. 2024).  Self image focuses on a person’s perceived value (Mcleod, S., 2024).   In contrast, the existence of the real self, the actual depiction of the person’s existence can cause distress and imbalance.  Identifying the real self is essential in understanding oneself in all the good and bad that exists within.  It is the starting point to reaching the ideal self.  The ideal self is what one hopes and strive to become.  When the ideal self and self image are imbalanced, congruence is not achieved and a state of incongruence exists that causes unhappiness and discontent as well as unhealthy psychological conditions (Mcleod, S., 2024).

According to Rogers, it is hence important to have a high positive regard with self worth.  Individuals with a high self worth can grow and handle stressors and difficulties, while those with a lower self worth encounter difficulties in life and have a hard time growing from negative events (Mcleod, S., 2024).   Rogers believed that a full functioning person reaches a state of actualization when congruence occurs ands is able to better live a fulfilled life.  He identified five primary characteristics to congruent individual.  He pointed out that one is open to new experiences, living existentially in the moment, trusting one’s feeling, displaying creativity  and living a fulfilled life (Mcleod, S., 2024).

The Humanist Therapist hence needs to help the person cultivate a higher self worth and find congruence.

Humanistic Techniques

In cultivating higher self and congruence, unconditional positive regard is employed that accepts the person for who he/she is and offers little criticism.  Rogers felt that conditional positive regard later put conditions on love or behavior that could negatively shape an individual’s development.  This less structured technique embraces the authenticity of the person and looks at the subjective needs of the person.  It places the Humanist Therapist into a place more of guide and equal than true authority figure in counseling.  The counselor utilizes deep empathy and rephrasing skills to help the person find congruence and balance.

One critical technique employed by the Humanist Therapist is Gestalt Therapy.  Gestalt Therapy focuses on the present and its emotions and how to better understand and grow from them (Dexter. G., 2022).  It helps one be more mindful of current situation and emotions and how emotions interact with current relationships in life.   It helps an individual better identify emotions, utilize them and communicate them with others (Dexter, G., 2022).   Some common themes found within Gestalt Therapy includes the “Empty Chair” where one pretends to speak to someone and role playing with the therapist to communicate emotion (Dexter, G. , 2022).

In addition to Gestalt Therapy, Humanist Therapists utilize a very Patient-Centered approach that acknowledges the needs of the patient and places a great importance on equality between client and counselor.  The counselor plays a key role in building the person’s self worth and avoiding judgement.  The therapy again is focused on the present and is more broad spectrum holistic instead of focusing on one particular issue.

Other techniques include Narrative Therapy which identifies values, Existential Therapy which identifies place in the world, and Logotherapy which focuses on helping individuals cope with difficulties and trials in life (Cherry, K., 2023).

Benefits and Disadvantages

When Humanistic Therapy is utilized there are benefits and disadvantages.  Obviously, helping one’s self esteem can empower someone to retake one’s life and move forward in life.  Self image and how one perceives oneself is essential to mental and emotional well being.  This holistic approach treats the entirety of the human person, helps one find empowerment, self acceptance and confidence, and grants the client an empathetic and non-judgmental guide (Sherrell, Z., 2023). However, there are limitations and possible weaknesses to the therapy.  It has the potential side effect of creating a dependency on the therapist, as well as not addressing acute issues in one’s mental health.  The lack of structure can also be counterproductive to certain personalities, as well as being very intensive emotionally and time consuming than other therapies (Sherrell, Z., 2023). It is also very subjective in nature.  The ontolology towards happiness is not a particular code but instead revolves around what one needs and wants.  This can sometimes create a disordered approach to what is right and wrong versus what makes someone happy.

Humanistic Approach in Grief

I think the approach has many benefits for grieving, albeit, I do not think it should be the only way one works with the grieving.  Obviously, different people need different strategies.  Some grieving individuals may need more cognitive and behavioral guidance with structure, while others may greatly benefit from a unstructured and holistic approach on emotion.  Some may greatly benefit from a mixture and blending of strategies.

Obviously when dealing with depression and emotion, the self image, self worth and the ideal self is key for happiness. Many depressed individuals have major self esteem issues and the techniques and practices in the Humanistic Approach can play a key benefit in helping a grieving individual find congruence and balance.  It can help the person understand the emotions, their connections with others, and how one can grow from loss and find connection again in life.

Conclusion

The Humanistic Approach has many advantages but its ultimate success depends on the needs of the griever and what therapy is best. Please also review AIHCP’s Grief Counseling Certification

I feel the Humanistic Approach is  best utilized in an integrative approach with cognitive and behavioral practices to better help the person not only emotionally but also grant the person ways to cognitively reframe issues.  The grave importance of self image, happiness and balance cannot be overlooked and are essential aspects of finding long term emotional and mental health.  Different individuals have different needs.  Some benefit better from a singular approach, while others from an integrated approach. Ultimately, when helping the grieving, the best therapy for the individual is the one that best meets the needs of the person.  If a licensed counselor is not comfortable or acquainted enough with one therapy, then referrals should be encouraged, but for those with comfort in a particular therapy or multiple disciplines, then one can truly begin to help others from a multi-faceted angle.  The Humanistic Approach is definitely one that all licensed counselors or those in grief theory should be familiar with.

Please also review AIHCP’s Grief Counseling Certification. The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.

 

 

Additional Resources

Mcleod, S. (2024).  “Carl Rogers Humanistic Theory And Contribution To Psychology”SimplyPsychology. Access here

“Different approaches to psychotherapy”. APA. Access here

Sherrell, Z. (2023). “What is Humanist Therapy”. MedicalNewsToday.  Access here

Dexter, G. (2022). “What Is Gestalt Therapy?”. VeryWellHealth.  Access here

“Humanistic Therapy”. Psychology Today.  Access here

Cherry, K. (2023). “What Is Humanistic Therapy?”. VeryWellHealth. Access here

 

 

 

Purposeful Grief?

Grief - human hands holding black silhouette wordWritten by Dr. Paul J. Moon

Is grief purposeful? Perhaps one’s stance is that grief is merely a notion – a label and description – referring to humans’ reaction and response to perceived loss. Perhaps one’s view is that grief is something that is just ‘laid upon’ a person or something the person just needs to ‘get over’ or ‘get through’ in time. If this is the extent to which the phenomenon of grief is made out to be, then it is understandable not to think of it as having any purposeful trait or utility.

As for known grief conceptualizations in culture, Kubler-Ross’ stagic model explains the purposefulness of grief is to eventually reach the point of loss ‘acceptance’ (Kessler & Kubler-Ross, 2005). Per Worden (tasks of mourning model; 2018), the purposiveness of grief is asserted as finding ways to remember the person who died while continuing on in the mourner’s remaining life. Or perhaps, as averred by Thomas Attig (1996), the purposefulness of grief is (or at least compels a mourner) to engage in relearning the world. As may be observed in subsequent sections, the picture of relearning the world may serve as a relevant entry into yet another (arguably more contemplative) landscape concerning the purposefulness of grief.

Now, the claim that grief is purposeful may be pointedly supported by considering what it can produce in some mourners. For instance, a survivor of the Sioux City, Iowa plane crash (on July 19, 1989) stated, “I decided to live with as few regrets as possible,” and that the frightening experience “was like being picked up by the scruff of the neck and shaken, and God says, ‘This is your only life. Just be grateful that you’ve got these days…these wonderful people in your life. Just be grateful for that.’” She concluded: “One of the things that has followed me…wrapped me…is that feeling of gratitude” (for more on this survivor’s account: https://www.npr.org/templates/story/story.php?storyId=18007783). No doubt that brushing up against one’s mortality via personal involvement in such a major devastation (where 111 of 296 passengers perished), and living through it, will stir a range of reactions, including grief (perhaps traumatic grief for others who died in the wreck, survivor guilt, etc.). Yet, the graphic and unforgettable experience also incited needful realizations in this particular survivor concerning the importance of minimizing regrets in life as well as embracing gratitude for what one does have (and, perhaps also, shunning envy and complaints about what one does not have). It is not difficult, then, to see how this sort of processing can hold immense instructional value, stemming from a grief-inducing incident, for future living. Thus, it is argued that grief is purposeful in potentially prompting existential instruction: that is to say, grief can hold instructive value for mourners willing to duly engage, explore, and mindfully wrestle with associated dynamics toward discerning the offered lessons.

Further evidence of grief’s existentially instructive value can be seen in the research concerning posttraumatic growth (PTG). Tedeschi and Calhoun are key scholars in this area, and they point to how bereaved adults who appear to have experienced PTG express the following kinds of development in themselves:

  • positive changes in relating to others (e.g., no longer taking others for granted; more deeply valuing kinship, friendship, etc.)
  • better understanding of self (e.g., realizing personal capabilities, strengths, etc.)
  • deeper appreciation of life (e.g., increased gratitude; shifting life priorities/goals due to altered values, etc.)
  • more focus on spirituality, religious beliefs (e.g., revisiting life philosophy one holds and how meaning is made of life circumstances, etc.) (Tedeschi et al., 2011)

What is of essence in PTG is how learned lessons seem to come through and due to encounters with significant losses. In other words, the very pathway of grieving purportedly uncovered in persons who evince PTG elements of particular discoveries and findings concerning themselves, relations with others, and various facets of reality that compelled them to look at life anew and with renewed (clarified) perspectives. Apart from, and in absence of, the traumatic hardships, it may be queried if the same sort of instructive lessons might have been learned.

Now, the idea of gaining existential discoveries and clarity can usher in a prized concept in the human experience: wisdom. In the long line of writings and musings about what wisdom is (and is not), one definition asserted in modern times is that wisdom is seeing through illusion (McKee & Barber, 1999). According to these authors, one way to think about the application of wisdom is to be able to decipher the central actuality of a given matter among a pool of mixed data. In other words, being wise is going beyond mere appearances in order to access the underpinning verities of an item of focus; wise persons can separate ‘wheat from chaff’ (as it were) and glean the core truth of a matter.

In context of the claim of purposeful grief, learning carefully from one’s grief journey may potentially help break through layers of illusions one had adopted previously concerning issues related to, for instance, own and others’ mortality (i.e., now better realizing the truth of how death cannot be avoided or averted, that it must be prepared for, that it can occur any time to anyone, etc.), trials and disappointments in life (i.e., now better realizing the truth of how such need not be merely perceived as pointless, useless, vacuous, but rather be so lived through towards growing in self-knowledge, knowledge of objective reality, etc.), and an assortment of other vital dynamics in this life. When rudimentary acknowledgements as these can be keenly ascertained and held – via grieving reflectively and with a deliberate eye towards learning from emergent ordeals – then it is not difficult to imagine how an enlightened mourner may be compelled to pursue life with an approach that is more intentional, perspicuous, and wise. Indeed, illusions abound in this life, and so anything that can assist in discarding as many of them as possible could be viewed as a help, even if it is one’s own grieving process and bereavement journey.

In sum, William Cowper’s thought may be fitting here: Grief is itself a medicine. Cowper (1731-1800) was an English Christian and noted hymn writer, and he grievously struggled with deep depression all his adult life, including multiple attempts to suicide. Amid his (lengthy) poem, Charity, the pithy phrase of insight (and wisdom) can be found…

Oh most degrading of all ills that wait
On man, a mourner in his best estate!
All other sorrows virtue may endure,
And find submission more than half a cure;
Grief is itself a medicine, and bestow’d
To improve the fortitude that bears the load;
To teach the wanderer, as his woes increase,
The path of wisdom, all whose paths are peace;

Though space here does not permit an analysis of what Cowper might have intended in this small portion from the poem, the overall tone of ideas asserted in preceding sections may be captured in these few verses.

If grief itself can be received as medicine, then how purposeful it is indeed.

 

References

Attig, T. (1996). How we grieve: Relearning the world. Oxford University Press.

Kessler, D., & Kubler-Ross, E. (2005). On grief and grieving. Scribner.

McKee, P., & Barber, C. (1999). On defining wisdom. The International Journal of Aging and Human Development49(2), 149-164.

Tedeschi, R. G., Calhoun, L. G., & Addington, E. (2011). Positive transformations in response to the struggle with grief. In K. J. Doka & A. S. Tucci (Eds.), Beyond Kübler-Ross: New perspectives on death, dying and grief (pp. 61-75). Hospice Foundation of America.

Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner (5th ed.). Springer.

 

Grief Counseling and the Dual Process Model

The normal grieving process is one of ups and downs.  In the initial raw phases of grief, emotions oscillate from extremes.  One moment, one may be sad, or angry, another one may find some sort of peace, only to find oneself again in deep emotional turbulence.  As time progresses, the individual begins to attempt to reacclimate into life, find meaning to the loss, and form new stories and relationships in life.  When this is successful, adaptation occurs.  This does not mean acclimation means there is no scar, no memory, or occasional tears, but it does represent an ability to exist with the loss and live life at a functional and successful level.

Healthy grieving involves a dual process of loss orientated and restoration oriented stressors that help us balance the loss in life

Throughout the medium phase of grief, as one struggles with the pain and adjusting to the new reality, one begins to balance focus between the loss itself and reintegration into life.  Time to grieve, but time to move forward is both a painful process, but a necessary one.  According to Margaret Stroebe and Henk Schut, a griever experiences a dual process model in which one deal with loss-orientated stressors or the primary loss and restoration-orientated losses that are secondary. One within this process, will oscillate between grief orientated tasks as well as restoration orientated tasks.  This shows the non-linear reality of grief and how one navigates the tricky waters of adjustment to a loss.

Within the loss-orientated grief work, the individual naturally focuses on the loss.  A person may have a bad day and reflect on the past.  He/she may reflect on the broken bond and the pain it has caused.  This can be done through reflection, crying, yearning, pictures or regressive traits of denial or avoidance.  These are not essentially setbacks but crucial parts of normal grieving.    Those who deny these emotions, deflect or ignore them, ultimately become stuck in the emotional phases of grief and develop complications within the grieving process.  Hence, this part is an essential element in the natural process of grief itself.

Within the restoration-orientated work, one focuses on new roles since the loss.  Sometimes, these roles are a result of secondary losses.  Positions or tasks held by the deceased, may now fall upon the bereaved.  In this process, the bereaved must leave the pain of loss-orientation and gradually deal with the secondary losses and re-orientation into life.  Whether it is paying the bills, cleaning, cooking, going to work, self care or exercise, one is forced to distract oneself from the pain within.  This involves discovering new roles or positions in life and adjusting to these changes despite the occasional set back.  As one reclaims old hobbies and habits and explores new activities that accompany the new journey, the bereaved is able to adjust to the loss and the new narrative.  As time progresses, these two dual functions balance the person into a proper adjustment.  An adjustment that recognizes the past, feels the past, but does not allow it to destroy the present or future.

“What’s Your Grief” points out one important core concept in this process.  Lista Williams states,

“If there is only one thing you take from the Dual Process Model of Grief it is this: it’s okay to experience grief in doses. At times you will face your loss head-on, others you’ll focus on fulfilling practical needs and life tasks, and once in a while you will need to take a break or find respite. This is partially why we talk so often about self-care.”

Williams.L. (2014). “Grief Theory 101: The Dual Process Model of Grief”. What’s Your Grief. Access here

 

Hence, the dual process of Stoebe and Schut recognizes a key element in the stages of grief that illustrate the back and forth between certain stages and the oscillation of emotions.  Some days, one may grieve harder than others without explanation, while other days, one may feel stronger and more goal orientated.  This does not mean one is grieving pathologically or that something is wrong with the bereaved, but is a natural process of adjustment.  This represents a natural ebbing and flowing of human emotion in response to loss.  One should not feel terrible for being sad or that one is not progressing according to standards, but instead realize some days are worst than others and we grieve in periods that are more intense and less intense.  In addition, when one is adjusting and having a better day, one should not feel guilty for feeling motivated or happy as if one is betraying the deceased, but instead realize they are learning to adjust.

Conclusion

Ultimately grieving is stressful.  It represents a serious adjustment with numerous stressors and emotions that can sidetrack oneself.  Many feel rushed to recover or that they are experiencing pathology in their grieving.  They feel grieving too long is bad.  Others may feel extreme guilt when days seem better.  It is important to have a strong understanding of the grieving process itself, its stages, but also its natural biorhythms that flow and ebb with emotion.  The dual process model captures this essence of grief and reminds grievers that grief takes time but it also differs from day to day as one adjusts through this stressful situation.  It also reminds grievers that while one may adjust to the loss and understand its meaning, that it still always has the possibility to sting and hurt.

The dual process model is key to understanding grief.
Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals.

The American Academy of Grief Counseling offers a Grief Counseling Certification that trains those within the Human Service, pastoral, counseling, and education fields in grief counseling.  Within the training, one will learn many of the grief models, including the dual process model and how they all come together to tell a deeper and more concise story about grief itself.  Please review the Academy’s Grief Counseling Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification.

Additional Resources

Dembllng, S. (2023). “The Dual-Process Model of Grief”. Psychology Today.  Access here

Stroebe, M. & Schut, H. (1999). “The dual process model of coping with bereavement: rationale and description”  Death Studies.1999 Apr-May;23(3):197-224. doi: 10.1080/074811899201046.  National Library of Medicine. Access here

“Dual Process Model of Grief”. Counseling Tutor.  Access here

“The Dual Process Model:  An outline of Stroebe and Schut’s dual process theory”. (2021). Funeral Guide.  Access here