Mental Health should receive the same care as physical health. Please also review AIHCP’s numerous healthcare based certifications
Mental health is health. Too many stigmas exist that prevent individuals from seeking help when signs of mental illness occur. Unlike physical symptoms of sickness that are addressed immediately, mental illness falls to the side due to stigmas and embarrassment. It is important to notice changes in emotional and mental health that persists longer than 2 weeks. Many minor things as OCD, ADHD, or minor stress and depression issues can be resolved through professional care.
Please also review AIHCP’s numerous mental health certifications within Grief Counseling, Crisis Counseling Spiritual/Christian Counseling, Anger Management and Stress Management Programs. The programs are online and independent study and open to qualified professionals. Remember only those within the clinical side of Human Services can treat mental illness. Pastoral counselors can refer or help others in non pathological issues.
When clients experience stress, grief or loss, sometimes meaning is critical to understand. The emotions and feelings need to find meaning in relation to the issue. Counselors need to have the helping skills to aid the client in finding meaning again. This is essential especially in Grief Counseling. In grief and loss, the individual needs to find meaning in the loss and be able to connect the past with the present to move forward to the future. New meanings in relationship to the loss help the person connect the dots and knit together the chapters of life into a logical story. When meaning is not found and emotions rage without direction, then the stressor or loss can lead to grief pathologies of depression or prolonged grief. Hence it is important for the counselor to be able to navigate the person through the emotion and find meaning. This is more than understanding the process of grief and loss, or dealing with stress, but also being able to help the client find meaning through good counseling techniques that help the client find meaning.
In previous blogs, we discussed the importance of meaning re-construction, as well as Cognitive Behavioral Therapy or CBT, as key ways to help clients tie together pass loss or trauma to the present to move forward. In this blog we will focus more on the micro skills and probing that is necessary to help clients find meaning via interaction, reframing and interpretation skills, and how to relate to the client. Obviously, many of the other micro skills of attending the client, observation, focusing, responding, challenging and confronting are all implied within this blog and found in other previous blogs.
Please also review AIHCP’s multiple counseling blogs as well as certification programs in Grief Counseling, Stress Management, Crisis Intervention or Christian and Spiritual Counseling.
The Importance of Meaning
Finding meaning is critical to life. When bad things happen, counselors can help clients discover meaning
Meaning is essential to human existence. This is why it is so important for individuals suffering from trauma, or abuse, or loss, or any situation to find meaning in their situation. Sometimes it involves regaining it because it has been taken away, other times, it is discovering it for the first time.
Logotherapy is a type psychotherapy that helps individuals find meaning. It is based off Victor Frankl, the famous Holocaust survivor, who utilized meaning in life, even in its darkest hours, as a prisoner in a Nazi camp, to find hope. Frankly administered to many of his fellow prisoners and helped them find also meaning despite the evil and trauma and abuse that surrounded them under Nazi rule.
Frankly believed everyone had a will to meaning. This meaning is what pushes all in will and action and even helps one endure suffering and pain. These beliefs persist in the value and uniqueness of each human person. It also is a platform for a person to move forward in life. This has numerous applications in counseling and helping others. It involves understanding purpose in life despite pain, but the importance to define and push forward. It involves understanding that life is far from fair but one can still find meaning through it. Purpose is beyond bad things (Waters, E., 2019).
Frankly summarized his philosophy in six basic tenets. Humanity is comprised of mind, body and soul but it is through the soul that we experience and find meaning. He continued that life has meaning in all circumstances, good or bad. He stated as well that humans have a will to meaning that pushes them. He also listed humans also have freedom to access this meaning no matter the situation. He stated in addition that true meaning is not merely an statement but something concrete that correlates with life and one’s values and beliefs. Finally, he emphasized that all human beings are unique (Waters, E., 2019).
From Frankl and his classic work, “Man’s Search for Meaning”, counselors, but especially grief counselors have an excellent way to help reconstruct meaning to clients and cultivate true change in a client’s life.
Obviously, much of the work associated with David Neimeyer and meaning reconstruction are found from the ideas of Frankl.. Meaning helps tie together past, present and future into something that matters to the individual. It helps make sense of the loss and allows the chapters of one’s life, even the bad ones, to have meaning to the overall story and book. Obviously, counselors play a key role in helping clients evolve the story told initially into telling the right story that correlates with reality. This involves intense counseling and sorting out feelings, but eventually these feelings can lead to a true meaning. Reflecting and reframing are keys in achieving this for a client.
Reflection
When individuals are discussing feelings and emotions, it is essential eventually, not initially, to guide them to meaning. In the very beginning, it is important to allow raw emotion to be expressed, felt and processed, but it needs to eventually find meaning within the grieving process. Counselors can help clients reflect on the emotion. Ivey refers to the term “reflection on meaning” as a way to help clients find deeper understanding regarding issues, purpose, feelings and behaviors (2018, p. 258). Ivey also points to the importance of interpreting and reframing these feelings. Interpretation helps the clients understand their feelings and add meaning to them through a variety of perspectives or multicultural or psychodynamic ways. The client is able to find new meaning, while the counselor provides the necessary reframing to explore new interpretations (2018, p. 258).
The counselor through reframing, can with empathy begin to offer different interpretations of the event itself, One skill a counselor can utilize is linking. Linking helps the client tie together two or more things that enables them to find new insight (Ivey, 2018, P. 265). A counselor can tie family history, values and talents to the client in relationship to the issue, or tie the event to psychodynamic issues that exist within the client. The linking helps the client find new perspectives on the issue at hand.
Counselors can help clients link and find self discovery through a variety of approaches. Some counselors may utilize decisional theory that presents outcomes and alternatives for action. Decisions need to be understood and made with the client understanding outcomes (Ivey, 2018, p. 268). Another approach is person centered. Linking is utilized to tie the problem together with the person’s strengths. CBT is another way to help individuals review old ways of thinking, acting and behaviors and re-interpret them. Reframing and linking can also be utilized with psycho-dynamic theories that help the person understand the person’s deeper subconscious past. Finally, multicultural therapy can help a person link to and also reframe an issue with ones’ own ethnic and cultural backgrounds
Reframing
A counselor’s response is key in helping one reframe and interpret meaning. In previous blogs, we discussed first attending the client, with basic responses, such as paraphrasing or summaries. How one reflects how one feels helps open new dialogue and understanding. Other ways to help discuss emotions and help build meaning and cultivation to change involves disclosures, feedback and consequences.
Counselors can help clients reframe and reinterpret events and emotions and help them find new meanings moving forward
Disclosures are excellent ways to involve oneself by sharing an appropriate story of one’s own life, but usually it involves oneself utilizing the phrase ” I think or I feel” in relationship to one’s issue or feeling or intended action. Feedback is also critical in cultivating change. It can be confirmatory or corrective. When corrective, it looks to help align a person back on track. It involves empathy and nonjudgment when being applied but helps the client again find the proper perspective and route. Remember, the client remains in charge and review how the client responds. Empathetic confrontational approaches should be utilized. Finally, logical consequences can be employed to help a client. It summarizes the possible positive and negative consequences of a particular action. The common phase includes “If you do…then…will possible result” (Ivey, 2018. p. 302).
Employing psychoeducation and instruction is also a key way to help push individuals to change and reframing. By making the client understand the science and philosophy of their feelings, one can better take ownership to change.
Whatever link the counselor can utilize through whichever therapy, or phrasing is good. Each individual is different. The key is to help the person find a new perspective on the emotion, situation, stressor or loss. This enables the person to form a new meaning which can help them tie the past with the present and into the future.
Fostering Resiliency
Through any change and new discovery, counselors need to foster resiliency. This helps the person emotionally and physically push forward into the new change and maintain the new meaning he/she has found. This can be accomplished through a multitude of stress management techniques that involves multicultural approaches, psychoeducation, social skill training, assertiveness training, conflict resolution, bio or neurofeedback, positive reframing, CBT, time management, relaxation management and active planning techniques (Ivey, 2018, p. 288). Ivey also lists the importance of Seven Therapeutic Lifestyle Changes. He includes exercise, nutrition, sleep, social relations, cognitive challenges, meditation and cultural health. Within these, he also lists the importance of prayer, hobbies, positive thinking, social outreach and avoidance of negative substances (2019, p. 288).
Egan, emphasizes that in cultivating change, counselors need to help client discover their own resilience. Egan points out the difference between process resilience and outcome resilience. In counseling, the counselor should be able to encourage clients to change in face of challenges, but also note outcomes. With outcome resilience, the counselor comments on the change and how one has returned to one’s own self (Egan, 2019, p. 263). Like a coach, the counselor hence cheers the person’s progress and ability to overcome. Counselors need to also help clients identify resources for resiliency, within family, friends or other social support systems. A counselor should help a client find ways to make better connections with families and friends as well. In pushing forward, a counselor can help a person reframe issues, such as challenges or crisis as ways to grow and to understand that change is part of life (Egan, 2019, p. 265). A client must continue, especially after loss, or trauma, to continue to keep things in perspective, maintain a healthy outlook, find new ways for self discovery and maintain care of oneself (Egan, 2019, p.265). A counselor can help a person maintain this progress.
Recall also, the previous blog which discusses the change scale in clients and how it is essential that the counselor discovers the level of acknowledgement and commitment to change a client may possess, as well as helping the client implement first order or second order changes depending on their situation. The counselor can help the client with goals to implement the change and also be aware of possible setbacks and pitfalls.
Conclusion
Please also review AIHCP’s multiple mental health certifications, including AIHCP’s Grief Counseling Certification
In helping clients change, reflection and reframing are key in helping the client link and find meaning in the trauma or loss. As time progresses, the client will be able to find meaning and connect the incident into one’s life narrative. Counselors can help this transition through a variety of skills mentioned in this blog and throughout other blogs written for AIHCP. These skills help the client understand the emotion and find linking to it. This helps them discover new meaning and ways to reinterpret the event. Furthermore the counselor helps the client move forward by fostering resiliency and helping the client continue to move forward.
Please also review AIHCP’s various mental health certifications. These certifications are granted to professionals in the health care field and human service field. Some may be licensed professionals while others may be pastoral in nature. Obviously such licensures or lack of, grant or prohibit the extent of certain counseling therapies and techniques.
AIHCP’s programs include Grief Counseling, Crisis Counseling, Stress Management Consulting, Anger Management Consulting and also Christian Counseling and Spiritual Counseling. The programs are online and independent study.
References
Egan, G. & Reese. R. (2019).”The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed). Cengage
Ivey, A. et, al. “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed( (2018). Cengage.
Additional Resources
Morin, A. (2023). “How Cognitive Reframing Works”. Very Well Mind. Access here
Caraballo, J. (2018). “Reframing is Therapy’s Most Effective Tool, Here’s Why”. TalkSpace. Access here
Ackerman, C. (2018). “Cognitive Restructuring Techniques for Reframing Thoughts”. Positive Psychology. Access here
Waters, E. (2019). “Logotherapy: How to Find More Meaning in Your Life”. PsychCentral. Access here
A driving force in recent years is a more counselor awareness of multicultural differences between people. As the world becomes smaller and more and more different ethnic and religious communities interact, the reality that individuals with very different views is becoming more and more common. Simply through social media, the interaction between different individuals with diverse backgrounds has increased over the years. Counselors also are coming into more contact with others of different beliefs and cultures and it is important for counselors to understand cultural issues within a client and how that affects the counseling process. How a particular person from one culture versus another culture can vary greatly how various emotions such as grief are displayed, or how certain emotions are seen as positive and negative. When working with a client, a counselor needs to be able to understand these differences. The counselor will also need to understand other sensitive issues that exist for a particular client that is tied to his/her culture or background. This involves many investigative and interviewing steps to have a full grasp of the client.
Multicultural Competence
When counseling, counselors need to be aware of cultural differences between themselves and clients
Many are sometimes rigid to ideas of multicultural issues and may see it as merely another “woke” agenda but this is farther from the truth. Multicultural competence is imperative to social skills, especially for counselors. It helps counselors better understand different clients to maximize helping and minimize harm. According to Ivey, it is ethically imperative that counselors become more multicultural competent in their care of clients (2018, p. 51). Hence any hesitancy by counselors to remain close minded to cultural realities is something contrary to the very nature of helping others. There are extremely important things to consider when helping others with different backgrounds and they play key roles in the therapeutic process.
Ivey lists the “RESPECTFUL” model which highlights key dimensions within a human person. Each letter of respectful correlates with something unique about ourselves as well as others. When looking at the counselor and client, it is important to identify not only the client within this model, but also the counselor and how the differences between the two could possibly manifest and side track the counseling process. We will briefly look at this model.
R= Religious or spiritual background. Obviously someone who is Christian would differ greatly from someone who is Hindu, or someone who is religious versus someone who is secular.
E= Economic and social background. A more wealthy counselor may have issues identifying with an individual with far less income and wealth.
S= Sexual Identity. Individuals who are heterosexual or homosexual have very different stories to tell in regards of acceptance within society
P= Personal Style and Education. Different levels of education can cause differences in how well communication and conversation is achieved.
E= Ethnic and Racial Identity. Different cultures and races have different experiences with situations. Sometimes counselor and client are two differently culturally and racial people
C= Chronological/Life Span. Depending on one’s age, the outlook on a particular situation can differ greatly.
T= Trauma. An individual based on their situation or culture may inherit various different levels of inherent trauma
F= Family background and History. A person’s upbringing can play a key role in his/her development. A person raised in a two parent home versus a one parent home
U= Unique Physical Characteristics. A person with various disabilities has a unique set of challenges.
L=Location and Language. A person’s land or origin, or where a person resides or the language a person speaks can all create unique difficulties
(Ivey, 2018, p. 33)
These types of differences all point to unique challenges a counselor may encounter with a particular client. When counseling, different cultural expressions can emerge in how one expresses or speaks or means a certain phrase. Hence it is important to be aware of the RESPECTFUL model and see how each element can possibly apply to a client
Soul Wounds
Different races, cultures and people face historical traumas and what is referred to as “soul wounds”
Different cultures experience different griefs or collective wounds that an individual has inherited. This can be referred to as social grief, but also according to Ivey, as “soul wounds” (2018., p.52), Historical trauma can play a key role in how an individual living in the present experiences the world and interacts with it. African American clients can experience quite a different situation from day to day interaction with others than White Americans. A simple traffic stop can have a greater traumatic effect due to racial profiling, police brutality, and social injustice. In addition, African Americans suffer the tragic legacy of slavery within their history. Following slavery, unjust and unequal economic restrictions prevented many African Americans from accumulating wealth leading to current poverty levels for many of them. These types of issues and a host of other microaggressions greatly affect African American clients.
Simple prejudice can also exist at the microlevel that many individuals do not notice. Microaggressions based on mere differences of culture and skin color exist within the world. Whether unintended or intended, these aggressions add up over time. Individuals face prejudices, looks, stares, or unkind words or opinions that can build up within them over time (Ivey, 2018, p. 52). In most cases, although, microaggressions are not intended to be harmful, they still can cause great harm and trigger the other party.
So whether it is the African American community, or the Native American community, or the LGBTQ community, various slights and soul wounds exist within their communities that affect them. Understanding these wounds and the importance of recognizing this diversity is critical in any type of counseling.
Counselor World View
Believe it or not, the counselor brings with him/herself a variety of inherent bias and world views that he/she must be aware of and attempt to filter out when counseling. Awareness of one’s own background is as key as awareness of the client’s background (Ivey, 2018, p. 52). Within this, a counselor of a particular background must be aware of his/her own beliefs and background but also how he/she appears before the client. A white male counselor may initially cause some distance between a black female client. The issue of creating trust and understanding may take longer. In this case, privilege and image play a key role. A young counselor may find struggles counseling an older client, so minimizing the status of oneself or the privileges associated with oneself can play a key role in a healthy counselor/client relationship. Unfortunately, sometimes, counselors and clients do not match, and through no fault of either, another fit may be best. Do not feel horrible if this is the case because in many cases the perception of the client regarding the counselor is key.
The client hence needs to show cultural sensitivity to race, religion, age, gender, sexuality or culture of the individual. This involves using political correct terminology (Ivey, 2018, p. 52). The counseling session should not include language that is non-inclusive that already exists in the outside world and causes distress to the client. The counseling should be professional and void of damaging language. In addition, the counselor must be extra careful in how he/she presents himself to different individuals with different backgrounds that may cause distress, either through posture, facial expressions, or words. The counselor also needs to be mindful of his/her own beliefs and maintain a neutral setting with those of extremely different views. The counselor should do his/her very best to be inclusive and open minded in listening and discussing issues that are different than his/her own religious or even moral beliefs. If bias exists, then it needs to be dismissed. A client can never be dismissed or set to the side due to cultural or moral differences. This goes against all ethical standards of counseling. If cultural differences are so great and there is no benefit in the counseling, usually the client will sense it, but if not, a counselor can help the client find a counselor that better matches the client’s needs, but again, this must be done with sensitivity, care and mutual agreement.
Conclusion
Ultimately it is the counselors job to be multicultural competent. Some counselors may be less open to this type of training but to better serve the client and cause no harm it is absolutely essential that counselors become multicultural competent.
Please also review AIHCP’s Grief Counseling and Christian Counseling certification programs and see if they meet your academic and professional goals
Counselors need to be aware of different backgrounds through the RESPECTFUL MODEL, be aware of soul wounds of a particular culture and also be aware of their own beliefs and values. The counselor needs to remain neutral but educated on different backgrounds. This is not only important ethically but it also permits the counselor to better understand how different people experience the world and how they communicate it. In addition, a counselor needs to be aware of his/her own values and appearance and how that translates to a potential client.
Please also review AIHCP’s Grief Counseling Certification, as well as its Christian Counseling Certification. AIHCP also offers a host of other mental health certifications for clergy, pastoral and clinical counselors, social workers and any individuals within the Human Service fields in Crisis Intervention, Stress Management and also Anger Management. All of the programs are online and independent study and open to qualified professionals seeking a four year certification.
Also for members of AIHCP with existing Grief Counseling Certifications, please review AIHCP’s Grief Diversity Counseling Program which focuses on such issues of grief and diversity within different cultural groups.
Reference
Ivey, A. et. al. (2018). “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed.) Cengage
Additional Resources
Seales, J., (2022). “Cultural Competence in Therapy: What It Is and How to Find It”. PsychCentral. Access here
Farook, M. “The State of Multicultural Counseling Competencies Research”. Society for the Advancement of Psychotherapy. Access here
Gillson, S. & Ross, A. (2019). “From Generation to Generation: Rethinking “Soul Wounds” and Historical Trauma”. Biol Psychiatry. 2019 Oct 1; 86(7): e19–e20. National Library of Medicine. Acces here
Berns-Zare, I. (2021). “6 Ways to Build Multicultural Competence and Combat Racism”. Psychology Today. Access here
Dissociation is a serious condition resulting from PTSD. When triggers of past trauma arise, the mind tries to shut the body down through dissociation. Sometimes it is through a flashback, or a disconnect from reality. These situations while in public or driving can cause injury to the person. So it is important to understand what triggers it and how to ground oneself when dissociation occurs.
PTSD can cause dissociation when certain triggers are pulled.
Please also review AIHCP’s numerous mental health certifications which include grief counseling, crisis intervention, spiritual and Christian spiritual counseling, stress management and anger management programs. The programs are online and independent study and open to qualified professionals seeking a four year certification.
Helping individuals from one point of need to the final point of self resilience and healing is the process of counseling itself, however, many times counselors helping others with grief, issues of loss, or problems in life become loss in the process. Maintaining a sense of direction when helping is key. While there is a partnership in the counseling relationship, the counselor still nonetheless is the guider within the partnership. The counselor directs the process and guides it to its eventual end point. Whatever counseling philosophy or model one incorporates, it is still essential to have a template of how to help resolve a particular issue. Problem Management is a key arrow and guiding modality to help counselors and clients stay on track and have a sense of direction. It is essentially the compass or navigation control in the counseling session. Good counselors understand its use and properly utilize it during counseling. In this short blog, we will review its essential nature in counseling and how to properly incorporate it with a client.
We will also note how Problem Management lays the foundation and structure for a counseling session and compare it to the 5 Stage Model of Carl Rogers.
Counselors help clients identify problems, offer solutions, and incorporate goals and ways to achieve them
Problem Management: Four Questions
When a client attends counseling, he/she is looking for guidance in a particular struggle. Whether it is more complex trauma or loss, or instead a simpler issue revolving around a decision to find a job or not, clients are seeking guidance. While the clients ultimately determine the outcome, they seek guidance with options and how to accomplish a given thing. Counselors can help guide clients through Problem Management and its four questions. The process involves the current picture, preferred picture, a way forward and action itself.
First, the counselor will ask questions about the current problem and current picture.. According to Egan, one should ask a client, what his/her issues or concerns pertain to (2019, p. 45)? Within this first stage of helping the client, the counselor can help the client discover and identify the issue. The first task involves the story itself. What is the primary problem and main concerns (Egan, 2019, p. 48)? When discussing the story, the counselor should help the client possibly see new perspectives to the problem and what may be really going on beyond the client’s initial story. Finally, the counselor should be able to direct the client to the right story and what he/she should be working on. This process leads to first listening, but then helping the client identify beyond his/her perceptions and find the right story and the keys surrounding it (Egan, 2019, p. 48). For example, a person who is obese may discuss multiple issues revolving around self image and poor diet/health. Discussing the primary problem and identifying perceptions of self image and directing the person to the core of the problem is important. Leading the client to the right story and issue sometimes takes time, but is essential.
After helping the client identify the right issue at hand, the counselor needs to help the client look beyond the current picture and propose a preferred picture. The primary question should include what does a better picture look like? Within this phase, according to Egan, the counselor helps the client determine problem managing outcomes and set goals (2019, p. 48). What are the possibilities for a better outcome entail? What goals and outcomes are truly the most critical and important? Finally, what is the client willing to do to achieve these outcomes (2019, p.48). Ultimately, these better outcomes and preferred pictures involve effort. In this phase, again the example of the obese client will see a preferred picture of weight loss, better health and higher self esteem.
Following the preferred picture, the counselor looks to guide the client forward. The counseling sessions look to help the person move forward with a plan. The client and counselor should brain storm with possible ideas and strategies to resolve a particular issue. The counselor will help narrow down the best fit strategies for the particular client and then help the client organize a way to accomplish these goals (Egan, 2019, P. 48). In the case and example of the obese client, the counselor will discuss diet and exercise strategies and then see which particular strategies fit best with the client’s work and life schedule. The counselor will then help coordinate first steps and possible times to put things into action.
These three phases of identifying problems, seeking better outcomes and making plans all lead to a call to action. How well will this call to action being implemented depends on many subjective factors within the client.
Clients and Change
Human beings, despite perfect plans, usually fail to accomplish goals the first time. This requires patient and flexibility by the counselor to help facilitate lasting change and resiliency within the client
Counselors can only direct, they cannot force a client to change. Hence it is important to help facilitate change but not to expect perfection. Change takes time. Some clients may be more resilient to let downs, or more focused in accomplishing a task. It is important to expect a back and forth wavering between stages. Clients when they finally become aware of a problem enter into various phases to push forward in change. According to Egan, individuals looking for change after initial awareness of a problem, will still waver, until the awareness leads to a heightened level (2019, p. 56). This leads to preliminary actions and a search for remedies. Within this, individuals estimate costs and weigh those costs of a change. They soon turn to more rational decision that is not only rational but tied to emotional change. This leads to serious action. However, these actions still require maintenance and the reality that relapse can occur (Egan, 2019, p.57-58).
It is the counselors job to help nurture positive change and guide clients through pitfalls. Those facing addiction issues, or in our example, one facing weight loss challenges, will wish to change but may sometimes not be emotionally tied to the rational decision enough to take the serious action. Others may do well for a few months and not be able to maintain what is demanded, or worst, yet relapse into addiction, or fall off their diet. Counselors are there to help guide in those cases and foster resilience. This may involve returning to the Problem Management model at an earlier stage to again find grounding and direction.
This is why counselors must ever remain flexible in their approach. Somethings may work for one client but not another. Counselors need to constantly “mine” various approaches or counseling philosophies that will help a particular client (Egan, 2019, p. 58). The counselor then organizes what works best, evaluates it and incorporates it into the various phases of the Problem Management Model (2019, p, 58-59)
Pitfalls to Avoid in Problem Management
When helping clients identify issues, outcomes and plans of action, there are some pitfalls that counselors need to avoid. Counselors need to avoid a lack of plan in their work. Some helpers go session by session without a uniform plan set into play. Others on the contrary attempt to implement to many plans at once. While there are many good models, not all models fit for a particular person, so each model and stage of helping, needs to be tailored to the individual client. Avoiding rigidness and being flexible in approach is key with an understanding that one can go back and forth between stages. It is also important to include the client in the process. Since counseling is a partnership, then it is essential to share the helping models with the client. This is an element of psycho-educational healing. A client who is part of the process understands the points of reference and can better track oneself in the healing and change process (Egan, 2019, p. 60-61). Finally, while important as it is to utilize flexibility, a good counselor can recognize lack of progress on part of the client and when to help the client push forward (Egan, 2019, p52).
Hence the process while simple in theory is more difficult when people become involved. People are complex and no one person is the same. This leads to the need of flexibility, testing and feedback, and trying other things within the parameters of the Problem Management model. Some clients may process the issue quicker, others may take longer. Some my engage in a certain stage a different way than another, while others will regress or progress. This is why counseling while a science is also an art. The individual talents of a counselor go well beyond the models and theories but also helping others implement what needs to be done through a variety of skills that involve evaluation and guidance.
Problem Management and Carl Roger’s 5 Stage Model
The great Humanist counselor, Carl Rogers, understood the importance of structure in helping clients find direction. At the source, he also made his care patient based and utilized empathy to help individuals find healing. In previous blogs, we discuss the Humanistic Approach.
In regards to Carl Rogers, the Problem Management Model shares many similarities with the 5 Stage Model. Carl Rogers listed 5 important stages within any counseling relationship that are essential in directing an individual towards healing. The first stage involves an empathetic relationship. Within this first stage, the counselor looks to build rapport with the client through empathy, trust building and establishing a goals and direction (Ivey, 2018, p. 194). This stage is so critical because many counselor/client relationships end because of a disconnect. Whether due to insensitivity or indifference that is purposeful or perceived, the relationship is never able to grow. The client does not feel the counselor cares or truly invests in the problem. Furthermore, in our previous blogs, it can be due to multicultural issues that are perceived by the client. The client may feel a young woman may not understand himself, an older man, or a black woman, feeling a white middle class counselor will not understand her issues of social injustice.
Rogers second stage includes understanding the story. Stage two is labeled Story and Strengths and focuses on the story itself. Collecting data, drawing out the story and establishing early goals are essential (Ivey, 2018, p., 194). Of course this stage demands good attending of the client. It involves active listening and good responding skills that emphasize reflecting feelings, paraphrasing and summarizing as needed to have a full understanding of the story. It involves empathetic understanding of the client and identifying strengths and weaknesses, truth and discrepancies, and helping to build up with the client.
Stage three involves in identifying and establishing goals that best fit the needs of the client. It is a collaborative effort where as a team, the counselor and client identify the best goals and options (Ivey, 2019, p. 194). This stage is very similar to the Problem Management Model, where after feelings are identified, then the client is asked beyond the current picture, what is the preferred picture? Hence, the similarities show a concrete plan in helping the client from one point to another and helping the counseling sessions move forward with purpose and direction.
Rogers’ stage four continues align with the Problem Management Model in continuing to identify the preferred picture. Within this stage, the Restory stage, the client is asked to identify alternative goals, confront issues and rewrite the narrative (Ivey, 2018, p. 194). It is the completion of the preferred picture and implementation of a plan.
Finally, the final stage, looks at action and how to achieve it and also deal with set backs (Ivey, 2018, p. 194). Hence one can see the similarities but also see a common art and science that should guide a counselor in helping individuals through problems. There is a common theme and way to do things. There is a general current that one should allow counseling sessions to flow. The flow may be different at certain times, but the general direction is essential.
Conclusion
It is essential to have a plan. Counseling is structured while also flexible. It has a purpose and a plan to reach a goal. The flexibility is how to reach that goal not the goal itself. Problem Management helps the counseling relationship stay structured in regards to the issue. It helps identify the issue, state the better outcome and help give the tools and plans to accomplish it. Counselors need to work their clients to the desired change but while doing so understand the nature of change within the human person and the need to keep trying when results do not appear. The counselor not only guides the client to facilitate positive change but also helps the client get up when the client falls.
Please also review AIHCP’s numerous mental health programs, including its Grief Counseling and Christian Counseling Certification Programs
Please also review AIHCP’s Grief Counseling Certification as well as its Christian Counseling Program. AIHCP also offers Spiritual Counseling, Stress Management, Crisis Intervention and Anger Management programs to help train professionals in facilitating positive changes in clients. Utilization of a Problem Management paradigm is essential in all of these models. AIHCP’s programs are all independent study and online.
Reference
Egan, G & Reese, R. (2019). “The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed.) Cengage.
Additional Resources
“Problem-Solving Models: What They Are and How To Use Them”. (2023). Indeed Editorial Staff. Indeed. Access here
Cuncic, A. (2024). “What Is Problem-Solving Therapy?”. Very Well Mind. Access here
Antonatos, L. (2023). “Problem-Solving Therapy: How It Works & What to Expect”. Choosing Therapy. Access here
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
The funeral and other death rituals across various cultures and religions play not only critical roles in spirituality for the deceased but also play key roles in mental and emotional adjustment to the loss for the family and living. Funerals for many help them acknowledge the loss and receive support and love from family and friends. This is critical in adjustment. Although it is the first step in a long journey, it does help individuals find some type of recognition of the loss itself.
The funeral helps one recognize the death. Please also review AIHCP’s Funeral Associate Program and Grief Counseling Program
Please also review AIHCP’s Funeral Associate Program and see if it meets your academic and professional goals. Also, please review AIHCP’s Grief Counseling Certification. Both programs are online and independent study and open to qualified professionals seeking certification to enhance a career.
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.”
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.
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”. J Epidemiol Community Health. 2006 May; 60(5): 376–381. National Library of Medicine. Access here
Grief is a life long process. Individuals deal with grief or loss to some extent on a consistent basis throughout life. The more significant losses remain with individuals and the ability of the individual to process the loss, understand it, incorporate it and exist with it are key to normal grieving styles. Those in the field of grief counseling on both the non clinical and clinical side need to sharpen their talents in helping individuals process the loss in a healthy way and be able to find continuing meaning in life. This involves not only understanding the various therapies on the more broad spectrum of treatment but how to micro handle daily sessions with individuals with minor positive interventions. Hence while one may employ CBT as the broad approach to help one heal, the daily encounters and how these encounters occur, allow the overall therapy to take root finds its productivity in certain skills and abilities. Some of these skills deal with how the grief counselor reframes thoughts, repeats words, shows empathy, or other verbal strategies to help emphasize certain parts of treatment, but positive interventions during treatment involve notation of certain parts of the journey within the inner dynamics of whatever treatment. As the person tells their grief story, finds self, relationship, memories and continuity within the grief story of one’s life, the counselor plays a key role in highlighting these points.
Grief Counselors can help individuals find meaning in loss through various strategies and interventions throughout the process.
Junietta Baker McCall’s text “Bereavement Counseling: Pastoral Care for Complicated Grieving” lists a variety of positive strategies and helpful interventions in chapter 7. She discusses how the therapists or grief counselors can help guide the person in the person’s grief story, sense of self and relationship, and the building of memories and continued continuity in healing through various prompts and interventions during sessions. These insights go far deeper than a general discussion of a therapy, or utilization of counselor skills, but look at certain points in therapy at a much more micro level where the grief counselor can better help the person through a particular session and goal. She states that specific strategies and interventions can be “used to respond to grief … and suggest possible ways to engage the grieving individual (McCall, J. 2012, p. 223).
Strategies in Narrative Therapy
Grief Narrative is a therapy within all overall models of CBT, Psycho Dynamic or Humanistic approaches. It is the re-telling of the person’s loss and trauma. It is where everything begins in the healing process. It permits the person to vocalize the inner feelings and share the loss. It permits communication and healing and allows for reframing and eventual change in understanding the place of the loss within the person’s life. Obviously for it to be successful, depends not only the story being told but how the grief counselor is able to guide the individual.
Counselors should utilize the story as a way to develop a caring model relationship that enables them to understand their client. The story needs to be encouraged to be told no matter the sadness and shared. In doing so, the grief counselor should grant the person space and time to comfortably tell the story. The grief counselor should repeat words that need repeated for the person to hear his/her own words echo, as well as show empathy and interest in the telling of the events. In this way, the grief counselor shows engagement and can later model future healthy grieving models (McCall, J. 2012, P. 225).
Throughout the story, it is important for the grief counselor to accept the therapeutic nature of the grief story. What matters most is the here and now of the story, not what others think. At this moment, the important part of healing is the subjective truth of the story to the person. How does the person feel at this moment in the here and now (McCall, J. 2012, p. 226). Remain empathetic throughout the story and remain an advocate for the person as the story continues and upon completion of the story within the session, ask the person if the story has been told to the person’s satisfaction. Upon completion of the story, share observations, address emotions and remain honest in assessments with possible referrals or information to help the person continue the story for next time (McCall, J. 2012, p. 228-229).
With guidance, the story’s initial subjective truths can correlate with objective reality. The person may recognize various issues within the story, such as blame, or guilt, or anger that once existed that no longer should exist. In addition, one can begin to reframe the loss within an objective truth as the person heals.
Regaining Self and Connection
Within the grieving process, many times, the person loses sense of self. One may have had such dependence upon the other that one can no longer function. Maybe one identified as a spouse, parent or position and when these things are taken, a person loses this important self image. Again, obviously various CBT or Humanistic Approaches to help cognitively reframe or heal broken images can be utilized, but it is within the smaller bits of communication with the bereaved, where one moves from one point to the next.
It is critical to address and measure a person’s sense of self within sessions. Asking questions that relate to a person’s self image and how a person may feel since the loss. Maybe the person is withdrawing from hobbies or no longer finds interests. These are important notations that can help one measure if one’s sense of self is damaged due to the loss. McCall recommends utilizing the term loneliness not to just mean when one is alone but a feeling that can occur in any circumstance. In addition, she uses the term isolation to refer to any inner experience to withdraw from others (2012, P., 237-238). The grief counselor while helping the person’s self re-find itself, needs to also help the person find relationship with others. The counselor can describe ways for the bereaved to reach out to others and in what ways
Reclaiming Memories and Meaning
Grief healing occurs when old memories are properly collected, understood, and properly recalled with the present and possible future. One is able to find meaning of the loss, no matter what it was, and able to tie the loss together within the chapters of one’s life. The loss has meaning but does not define completely the self or person. The person continues with the loss, albeit in a healthy way. The person is able to build new relationships and write new chapters, despite the existence of the loss.
Helping individuals understand memories and how they connect to meaning and healing are important in grief work. Please also review AIHCP’s Grief Counseling Certification
In helping individuals, whether through CBT or Humanistic Approaches, grief counselors can pay close attention to particulars and emphasize and carefully monitor certain aspects of this transition during sessions. It is important to see the gradual transformation of the bereaved throughout the process. A good grief counselor will see when certain parts are not lining up and where to intervene and help the client proceed to the next important step of adapting to the loss.
The grief counselor should utilize all mind, body, soul connections tied with ritual and belief. These ideals within the person can play key roles in anchoring the person with meaning in the loss. It is also at this point to ensure the bereaved understands the value of working through grief and that while the first step is to survive the loss, there is so much more beyond just surviving (McCall, J, 2012, p. 252-256). McCall points out it is crucial for the person to understand that surviving the loss is vital to growth but it still not quality of life. As the person recognizes this survival, the person will start to set aside other destructive maladaptive coping habits. These habits need addressed in any counseling.
The grief counselor can help the person progress by asking the client to discuss how it was before the loss. In addition, discuss current accomplishments, as well as offer encouragement. Ask the client to fantasize what one hopes life to be like in the future (McCall, J. 2012,. p. 257).
In remembering, teach clients that memories can be unbearable and that is OK. Ask the client what the memory means to him/her. Let the client know some events make no sense in life and cannot be made into order. Let the client know he/she cannot change the memory or event, but he/she can learn to grow with it. Use other examples of similar stories of how others coped, or present ways to help put an intrusive thought to the back mind. Helping individuals focus on issues when it is safe instead of intrusive and inopportune times helps the person handle emotion and bad memories (McCall, J. 2012, p. 260). As time progresses, help the person reframe bad memories for more positive outcomes and valuable ways to see the past so one may move forward to the future.
Finding meaning in the present and future also means recognizing healing. So many times, one only focuses on the trauma, but it is equally important to focus on healing and transformation. McCall recommends to help the person focus on the mystery of life. Let clients know that they have control of their lives and can dictate what the future holds. Help clients identify healing moments without guilt. Let individuals know beyond being aware of healing moments to embrace them, pray for them , hope for them and practice gratitude when they occur (2012, p. 265).
It is interesting to note that Aaron Antonovksy famous for his theories on “salutogenesis” which emphasizes health as something more aligned with well being than focus on pathology speaks of the importance of coherence in health. For well being and health to exist, he points out three key elements that I feel are important to reframing grief and finding meaning. He first lists comprehensibility as the belief that things/stressors/loss happen in an orderly fashion. Obviously, world views can be shattered with grief and any type of well being is destroyed initially after loss. Secondly, Antonosky points out manageability as crucial to well being in the belief that one has the ability and skills to cope with stressors or loss. In stress, when an organism is over-whelmed, then breakdown begins, so it is not surprising that Antonosky would point out that for well-being, one must be able to manage stressors or loss. Finally, he lists meaningfulness as source of coherence and well being. Meaningfulness is what defines a person’s existence and why one pushes forward. In grief theory, when meaning in life is loss, then well being suffers. It is the purpose of grief counseling to help the person adjust to loss by again finding meaning in life with the loss.
Conclusion
Helping individuals throughout the grieving process involves identifying issues and helping people one step at a time. Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals
Sense of meaning is critical to overall health. Without a sense of meaning, health itself can suffer. So when sense of meaning is restored and connected with past, present and future, then true adjustment can occur. Grief Counselors play a key role in helping individuals regain this balance and sense of health. It is sometimes in intense sessions where minor observations and interventions occur that grief healing occurs. It does not occur immediately, but results in multiple months and sometimes years, helping the person adjust to the loss in a healthy way.
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.
Reference
McCall, J. (2012). ‘Bereavement Counseling: Pastoral Care for Complicated Grieving”. Routledge
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.
