Counselling Psychology team.

Transcription

1 Counselling Psychology team

2 Pleased to meet you Currently on doctoral training in Counselling Psychology, at the University of Manchester. 2-year placement at The Christie Clinic (cancer care). Volunteer on the Samaritans helpline for 5 years. Background in biochemistry. 14 years in pharmaceutical research (drug development).

3 The Christie Clinic The Christie NHS Foundation Trust Europe s largest single-site cancer centre. Pioneering research for 100 years. 44,000 patients treated each year. The Christie clinic A partnership between the Christie NHS Found. Trust + HCA International (the world s largest private hospital group). Comprehensive patient-focused cancer care.

4 The Counselling Psychology service The team: Dr Kate Harrison, chartered Counselling Psychologist. 2 Counselling Psychology doctoral trainees. The service: Existing Christie Clinic patients (cancer) and their families. Individual support. Group support and smoking cessation help currently under development.

5 What I will cover today Take home points Psychological perspective - 3 models of grief - Complicating factors - Anticipatory & pathological grief What to say, what not to say Counselling perspective - Counselling - Person-Centred approach - Grief counselling Talking to children Resources for bereaved patients

6 Take home points - communication Use open questions. Keep eye contact. Offer brief summaries of what you hear. Talk clearly and honestly - Talk of the deceased in the past tense. - Use the words died and death rather than euphemisms. Reassure your patient that their reactions are normal.

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8 The 5 stages of mourning Denial Anger Bargaining Depression Acceptance Seen as universal process, common to most situations of dramatic change

9 The 5 stages of mourning Denial Anger Bargaining Depression Acceptance 5 stages identified from interviews with terminally ill patients. Describe their adaptation to an end-of-life diagnosis. Not identified as a model of grief. Not necessarily discrete, consecutive stages. (Kubler-Ross, 1969)

10 The 4 tasks of mourning William Worden (1983): mourning as a process of adaptation involving 4 tasks Accepting the reality of the loss Working through the pain Adjusting to life without the person lost Transforming the emotional attachment to the person lost (Worden, 1991)

11 - Talk of the person who has died in the past tense - Use the words died and death rather than euphemisms. The 4 tasks of mourning Accepting the reality of the loss Discussing the funeral arrangements can help here. Adjusting to life without the person lost Working through the pain Reassure your patient that their reactions are normal, that they are not going mad. Transforming the emotional attachment to the person lost - Give patients a chance to talk. - Listen. - Refer for counselling if appropriate.

12 Conception of grief

13 The dual process model LOSS RESTORATION Reappraising and processing the loss Adapting to the consequences of the loss Confrontation AND avoidance Confrontation AND avoidance Time out from grieving Oscillation is necessary for adaptive coping Reassure your patient that their reactions are normal, that facing and avoiding are attitudes to be expected. (Schut, 1999; Stroebe & Schut, 2010)

14 When is mourning finished? - Multitude of answers, from 1-2 years to never! - Worden: when thinking of the deceased still brings sadness but not pain. - Long process, not ending with feeling as before the loss. (Worden, 1991)

15 Complicating factors The relationship with the person lost: - Ambivalent, unexpressed emotions. - Past history of abuse (death of the abuser). Personality factors: - Intolerance of strong emotions (avoidance of feelings). - Identity built on being strong ( the strong one in the family ). Social factors: - Loss feels unspeakable (suicide, AIDS, drug overdose). - Loss is not socially recognised: the relationship was not known or accepted by friends and family (same-sex, divorce, big age gap ). - No support. (Worden, 1991)

16 Anticipatory grief Grieving can start before the actual death, in anticipation of the loss to come. Common in cancer and in other diagnosed terminal illnesses. The mourner prepares for their future loss by anticipating its consequences. Explain why they may be reacting as they are. Explain this is normal and actually potentially beneficial. (Humphreys & Zimpfer, 1996)

17 Pathological grief (prolonged or chronic grief) - Reactions to the anniversary of death or major events: not considered pathological for 10 years or more. Not chronic grief - Persistent Complex Bereavement Syndrome (DSM-5): grief persists over 12 months (6 months for children) with clinical intensity. - The person is usually aware that they are not getting through the mourning process. Is your patient stuck rather than experiencing different reactions over time? (APA, 2013) (Worden, 1991)

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19 Counselling Multitude of therapeutic approaches, with widely varying aims and methods. Most recognise the importance of the therapeutic relationship (between the therapist and the client). The Person-Centred approach is the basis for what is most often meant by counselling.

20 The Person-Centred approach 3 core conditions for the therapeutic relationship to be effective: - Empathy: seeing the world through the other s eyes. - Unconditional positive regard: whatever the client has done or whatever was done to them, meet them as a person, deserving of respect. - Congruence: therapist behaves in line with their own inner sense. (Rogers, 1951, 1961)

21 Person-Centred communication Don t try to guess, or assume you know, what they think and feel. Ask them and listen. Use open questions: How do you feel? How are you coping? Try to experience what they say, as they describe they do, not as you would if it happened to you. Don t judge them. You don t have to say much, if anything. Keep good eye contact. Be warm. Offer brief summaries of what you hear: You are worried about You feel and you wish you could do Speak professionally but as a person first. Access your own emotions.

22 Grief counselling Offered individually or in groups. Overall aim: to resolve any unfinished business in relation to the 4 tasks - Increase the reality of the loss can conflict with the client s need for denial. The context of counselling is important here. - Help the client identify and express their emotions. - Facilitate the client s ability to live without their loved one. - Facilitate change in the client s attachment to the lost one, saying goodbye and reinvesting emotional energy in other relationships. (Humphreys & Zimpfer, 1996; Worden, 1991)

23 How you can help Counselling is a specific therapeutic process. The part that can be replicated elsewhere is helping patients get feelings & thoughts off their chest. Give them a chance to talk. Explain how counselling /psychology can help. Explain counselling is not for people who are mad or mentally ill. Help them overcome the social stigma and access the help they may need. Refer within & outside the NHS, consider charities & private counselling.

24 Talking to bereaved children Talk normally, clearly, honestly. Children under 5: - limited comprehension of what dying is. - lower concentration span Children aged 6-10: - aware that dying means forever - fear of abandonment Give them a chance to ask questions. Do you have any question about? Teenagers: - resent shortened life for a parent. - can become rebellious. (Humphreys & Zimpfer, 1996; Worden, 1991)

25 Learning points /Grief Grief is a complex process, not linear. Stages and tasks are limited simplifications. Each grief is a personal experience. Many more emotions than feeling the loss. Historical feelings : bereavement makes existing emotions towards the deceased more complex as they are not present anymore to be faced with those emotions. Factors of complication go far beyond the circumstances of the death or who the patients have lost.

26 Resources Cruse Bereavement Care: Grief encounter (for bereaved children): Winston s wish (for bereaved children): Local hospice: Macmillan (for cancer): Private counselling: usually about 35 per 1h session, see BACP Samaritans free and open 24/7 - free phone: Jo@samritans.org - face-to-face at local branches

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28 References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5 ). Washington, D.C.: American Psychiatric Publishing. Humphreys, G., & Zimpfer, D. (1996). Counselling for Grief and Bereavement. London: Sage Publications Ltd. Kubler-Ross, E. (1969). On Death and Dying. New-York: Touchstone. O Connor, M., & Breen, L. J. (2014). General Practitioners experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education, 14(1), 59. doi: / Rogers, C. (1951). Client-Centered Therapy (Kindle ed.). London: Constable. Rogers, C. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. Journal of Consulting Psychology, 21, Rogers, C. (1961). On Becoming a Person (2004 ed.). London: Constable. Schut, M. S. H. (1999). the Dual Process Model of Coping With Bereavement: Rationale and Description. Death Studies, 23(3), doi: / Stroebe, M., & Schut, H. (2010). The dual process model of coping with bereavement: a decade on. Omega, 61(4), doi: /om.61.4.b Worden, J. W. (1991). Grief Counelling And Grief Therapy (2nd editio.). London: Routledge.

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