Few Brief Approaches to Counselling

Counseling and helping is the process of employing informal communication in which a person expresses their difficulties to a specialist (counselor) who is trained to listen intently to them and to put themselves in their shoes in order to understand what they are going through. Counselors have the power to relieve tension and encourage optimistic thinking in everyone.
In actuality, counseling is a planned-out, direct conversation between a therapist and the victim (client who is undergoing serious challenges). The whole matter once tabled by the bearer, the counsellor is left with the charge of advising the client in manner that wipes out the stress and bitterness that he or she could be undergoing. Giving positive side of the whole thing and showing the importance of life, positive thing about life and always being ready to face the challenges are some things that a counsel ensure that client has welcomed before the end of their sitting.
It is sometimes difficult to differentiate between counselling and psychotherapy. In most cases, both are used interchangeably. In some cases, counselling is rendered as a branch of psychotherapy while at times a counsellor might solve a problem psychotherapeutics. The major difference include counselling help people point out problems and make them adopt better handling techniques while psychotherapy assist persons psychological tortures to get back to senses after a moment of time. Psychotherapy generally enables easy examination of personal feelings, behaviour and minds. All the same both methods help to solve psychological problems among people. They play an important role of relieving people serious challenges they may be passing through which could even result to death or could make a person insane with no time. Though counselling is necessary for all, a myth exist about counselling and psychotherapy, many people feel that counselling and helping is only for the mad ones. Therefore, only those with depression will thus end up seeing the importance of the counselling but the reality is it is very much important for anybody with any type of pressure. Stress and depression could be as a result of a number of different and varied challenges which include family crisis, bereavement, and health challenges, stress from working place and also physically challenge issues and several others could result to self-hatred and in this situation counselling and helping is required.
To expound on this I shall restrict myself to stress as a result of bereavement.
1.1 Types of Bereavement
There are numerous cause of bereavement and people reaction to each of them is different. In this case, we are examining the bereavement related to the loss of the loved one. A loved one can be a spouse, child, or even a parent. The death of a husband or wife is widely recognises as the most devastating and is ranked as leading to most stress among all the possible losses. The death of one's spouse effectively end the relationship but not all relational bonds ends. There is normally persistence in the connection to the lost figure which often lead to exacerbating a sense of having been abandoned, occasionally leading to continuation of a relationship albeit with a partner who is not there. The loss of a child is another stressful experience as it conflicts with people's life expectations. This is especially so because in addition to being treasured, children take a great symbolic importance as far as generativity and hope for the future is concerned. The death of a parent during adult life is another cause of bereavement which lead to a measurable degree of symptomatic distress.


1.2 Bereavement Case
Bereavement means "to be robbed" or "deprived of something valuable"
In our society it commonly refers to the death of a significant person.
Bereavement can be expressed in various acts of mourning such as funeral ceremonies or the withdrawing from public activities
Grieving
Refers to the psychological components of bereavement, the feelings evoked by a significant loss, especially the suffering entailed when a loved one dies.
Mourning
The actions and manner of expressing grief (often culturally related).
In this case we evaluate the death of a loved one and the bereavement that is taken. Depending on love one lost and circumstances, bereavement takes several types. Abbreviated grief is short lived, but genuine form of grief can occur. Ambiguous loss is not very clear and is not seen, neither accepted as valid. On the other hand, anticipatory grief refers to exercising of grief and loss prior to the occurrence of actual death of the loved once. Loss of the loved one can also lead to chronic grief which lasts for prolonged or extended time periods. Complicated grief on its end goes beyond the "normal". Delayed grief refers to the postponed grieving while disenfranchised grief is characterised by sorrow that is not socially or publicly recognised.



1.3 Theory of loss and bereavement
1.3.1 Kubler-Ross model
In her theory expressed in her book "On Death and Dying", Dr. Kubler-Ross examined several stages that dying people have to go through as they realize they will be dying in coming days. According to her theory, the first stage is the Denial where the grieving people are unable and unwilling to accept that loss has either taken place or is likely to take place. To these people there is normally a feeling of experiencing bad dream or as if the loss is not real and expectation that things will restore to normalcy. According to this model, anger follows as people find the loss to be unfairness, which may often be directed to the person who is dying. Bargaining follows with people begging the higher power to reverse the loss on promise that they will change to better. However, when it becomes clear that anger and bargaining will not work, depression may set in as people confront the inevitability and reality of the loss and their inability to change. Acceptance follows where people accept their inability to change and start planning.
1.3.2 Sigmund Freud Model
According to Sigmund psychoanalytic theory, the behavior of human is influenced by the interaction of three component of the brain; the id, ego and superego. Great importance in this theory is placed on the way conflicts among these parts of the mind shape the behavior and personality. The behavior during bereavement can therefore be explained with the interplay of these there components. The id according to Sigmund is the most primitive of the three and concerns itself with instant gratification of the basic physical needs and urges. The superego on the other hand is concerned with observation of social rules and morals or what people may refer to as the conscience or the moral compass. The ego in contrast with id and moral superego, is the rational pragmatic part of the personality. It is less primitive compared to the id and is partly conscious and partly unconscious. This model was the pioneer in explaining the act of mourning.
1.3.3. Theory of Jean Piaget
Jean Piaget establishes that human cognition is an integrated set of reasoning abilities that develop together and which can be applied in various settings. According to this theory, particular psychological structure or schemas changes with age. Children in the preoperational stage according to Piaget have to create some sort of order in the view of the world and occasionally, causal connection made are not logical (Piaget, 1955). This type of thinking may also influence the way in which the child makes sense of death and bereavement that results.
1.3.4. Bowlby's Attachment Theory
Bowlby argues that attachments develop early in life and offer security and survival for the individual. When affectional attachments are broken or lost, individuals experience distress and emotional disturbances such as anxiety, crying and anger. He identifies 4 phases of mourning including; Numbing, Yearning and searching, Disorganization and Reorganization

1.4 Coping with Grief and Loss: The Five Stages
The stages of mourning and grief are universal and are experienced by people from all walks of life. Mourning occurs in response to an individual's own terminal illness, the loss of a close relationship, or to the death of a valued being, human or animal. There are five stages of normal grief that were first proposed by Elisabeth Kübler-Ross in her 1969 book "On Death and Dying."
Denial and Isolation
The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defence's mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.
Anger
As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us angrier.
Bargaining
The normal reaction to feelings of helplessness and vulnerability is often a need to regain control-
If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…
Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defences to protect us from the painful reality.
Depression
Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words.
The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.
Acceptance
Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.
Coping with loss is ultimately a deeply personal and singular experience; nobody can help you go through it more easily or understand all the emotions that you're going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.
A wealth of literature has described in detail the course of grief as stages (Bowlby, 1980; Kubler-Ross, 1969), phases (Ramsay, 1979; Sanders, 1989), components, tasks (Worden, 2003), or tracks (Rubin, 1981, 1999). In the normal grieving process, reactions are known to be intense immediately following the loss, and to decrease over time (Parkes, 1985; Parkes & Prigerson, 2010; Rando, 1984; Sanders, 1989). Grief has PSYCHOLOGICAL TOPICS 19 (2010), 2, 289-305 290 traditionally been seen as a healthy normal and universal process that is aimed at decathexis - abandoning or letting go of commitment to one's relationship to the deceased, a process known as "grief work" (Freud, 1917). However, evidence - based studies have not found support for the theory of relinquishing bonds with the deceased (Neimeyer, Keese, & Fortner, 2000). On the contrary, empirical studies repeatedly suggest that inner relationships with the deceased often continue throughout one's life (Klass, Silverman, & Nickman, 1996; Malkinson & Bar-Tur, 2004/2005; Rubin, 1999).
Grieving, based on this conceptualization, often includes the act of reconstructing a world of meaning that was challenged by the loss. The adoption of the continuing bonds perspective emphasizes grief and mourning as a lifelong developmental process that serves to maintain a continuing bond with the deceased. Moreover, the latter approaches have shifted from expecting a predetermined course and outcome of bereavement to emphasizing that there is no single predictable pathway through grief, and regarding it as an idiosyncratic process (Neimeyer, 1999). Similarly, the time framework of what is considered normal "grief work" has shifted from the "mythological" 12-month period resulting in individuals resuming "normal life" upon its completion and it is now recognized as a far more complicated process. Thus, the individual grief process often includes grief for the individual lost as well as a process of searching and constructing meaning to life without the deceased. Complicated grief is described as the intensification of grief which does not lead to assimilation of the loss, but instead to repetitive stereotypic behaviours as well as impaired functioning (Boelen, 2006; Malkinson, 2007). Risk factors connected to complicated grief include traumatic circumstances of the death, which in turn can result in additional reactions such as depression, anxiety states, and PTSD (Auster, Moutier, Lanouette, & Zisook, 2008). Often these coexist and overlap, stressing the importance of assessment prior to applying treatment. Research studies have set the stage for differentiating complicated grief (obsessional preoccupation with the deceased, crying, persistent yearning, and searching for the lost person) from depression (clinical signs of depression with preoccupation with self), (Prigerson et al., 1995a; Sheer, Frank, Houck, & Reynolds, 2005). The implications of these findings lend themselves to differential treatment interventions for grief (psychotherapy with a focus on caring and support) and for depression (combined psychotherapy and psychopharmacology). The transition to the idea of "continuing bonds" (Klass, Silverman, & Nickman, 1996) modified the view of grief, its process and outcomes from breaking (decathexis) relationship with the deceased to one that sees the grieving process as searching and constructing meaning to death and life in the absence of the deceased's image (Malkinson, 2007; Neimeyer, Keese, & Fortner, 2000), and the organization of the interpersonal relationship with its representations. Thus the outcome of the grief process is a balanced relationship with the deceased's representation, in which there is no denial or avoidance of their memory of the deceased's image, and without their flooding (Horowitz, 2003; Prigerson et al., 1995a). In contrast, in complicated grief there are difficulties in functioning and organizing the interpersonal relationship, especially the oscillation between PSYCHOLOGICAL TOPICS 19 (2010), 2, 289-305 292 avoidance response and flooding, as well as dealing with pain and yearning (Rubin & Malkinson, 2001; Stroebe & Schut, 1999). As a consequence of these changes, there are also advanced interventions in creating the conditions for the process of adaptation to life without the deceased.
2.0 Types of Therapies
In counselling and helping, the various method can be used to approach.Three of the main forms of counselling can sometimes be confusing. I hope to unravel and clarify some of the mystery surrounding these three types of counselling approaches by means of comparing and contrasting with reference to their differing theoretical rationale, therapeutic interventions and processes of change.
The Person Centered Approach (Originator: Carl Rogers 1902 - 1987) focuses on the belief that we are all born with an innate ability for psychological growth if external circumstances allow us to do so. Clients become out of touch with this self-actualizing tendency by means of introjecting the evaluations of others and thereby treating them as if they were their own. As well as being non-directive the counselling relationship is based on the core conditions of empathy, congruence and unconditional positive regard. By clients being prized and valued, they can learn to accept who they are and reconnect with their true selves. 
The Psychodynamic Approach (Originator: Sigmund Freud 1856 - 1939) focuses on an individual's unconscious thoughts that stem from childhood experiences and now affect their current behavior and thoughts. The urges that drive us emanate from our unconscious and we are driven by them to repeat patterns of behavior. Therapy includes free association, the analysis of resistance and transference, dream analysis and interpretation and is usually long term. The aim is to make the unconscious conscious in order for the client to gain insight.   
Cognitive Behavioral Therapy (Contributors: Ellis 1913 - & Beck 1921 - ) focuses on how an individual's thoughts and perceptions affect the way they feel (emotions) and behave. We are reactive beings who respond to a variety of external stimuli and our behavior is a result of learning and conditioning. Because our behavior is viewed as having being learned, it can therefore be unlearned. By helping clients to recognize negative thought patterns they can learn new positive ways of thinking which ultimately will affect their feelings and their behavior.  
When comparing and contrasting these three major approaches in relation to their differing theoretical rationale, I found the following similarities between the Person Centered Approach and Cognitive behavioral Therapy. Both deal with the conscious mind, the here and now and focus on current problems and issues the client may have. They both have a positive view of human nature and view the individual as not necessarily being a product of their past experiences, but acknowledge that they are able to determine their own futures. They both attempt to improve well-being by means of a collaborative therapeutic relationship that enables and facilitates healthy coping mechanisms in clients who are experiencing psychological pain and disharmony in their lives.
In comparing the similarities between the Person Centered Approach and the Psychodynamic Approach, it is possible to see some similarities and parallels between the concepts of the actualizing tendency, the organismic self and the self-concept to Freud's theory on personality structure. The id and the organismic self are both representative of that part of the psyche that is often ignored or repressed. The super-ego and the self-concept, both describe internalized rules and moral values which have been imposed upon us by significant others. The ego is similar to the actualizing tendency in that it is concerned with mediating between the id and the super-ego and the actualizing tendency seems to echo this.   
In contrasting the Person Centered Approach with Cognitive Behavior Therapy in relation to their differing theoretical rationale Cognitive behavioral Therapy sees behavior as being a learned response whereas the Person Centered view is that clients have not been able to have previously self-actualized. From a Cognitive behavioral perspective, human experience is viewed as a product of the interacting elements of physiology, cognition, behavior and emotion. The Cognitive behavioral Approach is based upon the theoretical rationale that the way in which we feel and behave is determined by how we perceive and structure our experience. In the Person Centered Approach, a person is viewed as having had various experiences and developing a personality as a result of these subjective experiences. 
In contrast to the Psychodynamic Approach, the Person Centered Approach focuses on the conscious mind and what is going on in the here-and-now whereas the Psychodynamic Approach focuses on the subconscious and looks to early childhood to examine unresolved conflicts. "Freud emphasized the need to modify defenses, to reduce the pressures from the superego so that the patient could become less frightened of the superego and to strengthen the ego".[1] The aim of the Person Centered Approach is self-actualization whilst the aim of the Psychodynamic Approach is insight. The Person Centered Approach focuses on the positive belief in the human ability to self-actualize whereas the Psychodynamic Approach focuses largely on the negative aspects.
In highlighting the differences in theoretical rationale between the Psychodynamic Approach and Cognitive behavioral Therapy, the Psychodynamic Approach encourages the client to uncover the past and early childhood in order to bring to memory significant events. Cognitive behavioral Therapy, however, focuses on the here and now and is goal orientated. The Psychodynamic Approach sees us as being driven by unconscious urges whereas Cognitive behavioral Approach sees our behavior as being a learned response.
Freud's structural model states that the human psyche is an interaction of the three forces: the id, the ego and the superego and he also assumed that we are driven by inherent sexual and aggressive drives. Cognitive behavioral Therapy sees functioning or dysfunctioning as being a learned response to external stimuli.
In looking at the similarities between the Person Centered Approach and Cognitive behavioral Therapy with regard to their therapeutic interventions both utilize the core conditions of empathy, unconditional positive regard and congruence but in Cognitive behavioral Therapy it is used mainly in the establishing of the working alliance. "The creation of a relationship of safety and trust is an essential first step in CBT, as in any form of therapy".[2] In both these approaches, the relationship between client and counsellor is similar by means of the counsellor being congruent and both would use the skills of reflection, paraphrasing and summarizing. In both these approaches, the client is prepared for the eventual ending a few sessions before the actual end of therapy. Both would use awareness techniques.
The therapeutic intervention of immediacy used in the Person Centered Approach could be compared to the technique of transference used in the Psychodynamic Approach however; in the Person Centered Approach, the emphasis on the present replaces the investigative perspective of the Psychodynamic Approach.
In comparison, the differences between the therapeutic interventions used in the Person Centered Approach and the Cognitive behavioral Approach, the Person Centered Approach is non-directive whereas CBT is 'taught' and is goal orientated. In Cognitive behavioral Therapy clients are taught skills which are needed and necessary for them to change which would in turn reduce their emotional angst and change their behavior. In the Person Centered Approach growth is self-directed. The number of sessions in the Person Centered Approach can be open ended whereas CBT has a set period.
When looking at the main differences between Person Centered Approach and the Psychodynamic Approach the Person Centered counsellor would encourage the client to seek the solution to their problem within themselves and would not attempt interpretation which is the major therapeutic intervention of the Psychodynamic Approach. The Person Centered Approach pays no attention to the issue of transference. The relationship between the client and the counsellor is also different in that in the Person Centered Approach the core conditions are a vital tool whereas in the Psychodynamic Approach the counsellor is a blank slate onto which the client can project.
There are however some similarities between the Psychodynamic Approach and Cognitive behavioral Therapy. Many of our schemas were put in place when we were very young and stem from childhood, this learned response and behavior could be linked to the Psychodynamic intervention of linking childhood events and associated feelings to current problems.
Looking at the differences in the therapeutic interventions between Psychodynamic Approach and Cognitive behavioral Therapy the key therapeutic interventions used in the Psychodynamic Approach are free association, Thematic Apperception Test / Rorschach inkblot test, parapraxis, interpretation of transference, dream analysis, hypnosis and regression. In Cognitive behavioral Therapy, the techniques used could be systematic desensitization, reinforcement techniques, forceful disputing, reality testing and the identifying of automatic thoughts. Cognitive behavioral Therapy is directive and is goal orientated and does not look at the clients past. In Psychodynamic Therapy, there is a danger that the client could become dependent on their counsellor whereas in Cognitive behavioral Therapy the client is 'taught' to be autonomous.
The similarities between the Person Centered Approach and Cognitive behavioral Therapy in relation to their process of change are that the core conditions used in both would bring about change in the client by the building up of trust and rapport.
When comparing the differences in the process of change between the Person Centered Approach and the Cognitive behavioral Approach, change would occur for the client in Cognitive behavioral Therapy through guiding and assisting them into firstly identifying negative thought patterns and then by changing their irrational beliefs. By changing thoughts, we can change the way in which we react to situations and events. In Cognitive behavioral Therapy, this process of change occurs by means of education, and by bringing these thought patterns into awareness behavioral change will occur. Change can also occur through reality testing in which the client's negative beliefs will be challenged and their subsequent negative emotions eliminated.
In the Person Centered Approach, change occurs with the core conditions of empathy, congruence and unconditional positive regard being in place. This relationship is all that is necessary to bring about change and with no threat of being judged, the client learns to perceive their world from a new perspective and gains the ability to self-actualize with felt senses connecting the different aspects of their particular issues.
In contrasting this to the Psychodynamic Approach, change occurs by means of uncovering repressed or significant events and their associated feelings. By this process, change will occur and the client will be better equipped to understand the connections between past events and present behavior. Change in the Psychodynamic Approach, occurs for the individual through the strengthening the individual's ego whilst in the Person Centered Approach the aim is to achieve growth through the individual's self-actualizing tendency. In the Person Centered Approach, it is a personal process for the client of being in a warm relationship but in Psychodynamic counselling the counsellor is a blank slate on which the client can project feelings. Transference is crucial in the process of change, requiring understanding and interpreting but the Person Centered Approach ignores the past events in a client's life unless these events affect the client's conditions of worth.  
When comparing the similarities between the Psychodynamic Approach and Cognitive behavioral Therapy, change could occur through the uncovering of schemas, which is similar to bringing the unconscious into conscious awareness.
In contrast, the differences in the process of change between the Psychodynamic Approach and Cognitive behavioral Therapy in the Psychodynamic Approach the process of change would involve encouraging clients to look into their past with a view to uncovering repressed or significant events and memories and their associated feelings. By gaining this insight the client will achieve a new perspective which will form the basis for healing and change. Cognitive behavioral Therapy deals only with the here-and-now, it does not address the past, deals only with presenting symptoms and could miss underlying problems. "The cognitive model assumes that emotional and behavioral change is mediated by changes in beliefs and interpretations."[3]
Cognitive behavioral Therapy sees the process of change as being a relatively short-term process whereas Psychodynamic Therapy is a long term process of change. The aim of Psychodynamic Therapy is for the client to gain insight and the aim of Cognitive behavioral Therapy is change. Cognitive behavioral Therapy believes that change is possible and focuses on behavior rather than on emotions. "A major difference between CBT and psychodynamic therapies lies in the degree of importance given to exploring early childhood experiences for the origins of maladaptive patterns of thinking and behavior. In CBT it can be helpful to explore early experiences to enable the client to place his problems in a historical context, but this is not seen as a major part of the counselling".[4]
In conclusion, each model has its own strengths and weaknesses and individuals may find one approach more appropriate than another, depending on their own personal preference or on the severity and depth of their presenting problem. Time factors and costs would also need to be taken into consideration while selecting which approach to use. Also the intensity of the problem should be taken into consideration.
3.0 Narrative therapy and bereavement (Wheel of Change)
Although grief and depression have m any similar characteristics, such as sadness, anger, withdrawal and an inability to enjoy life, I would argue that grief is not depression, although grief-stricken people do sometimes go on to become clinically depressed.
Perhaps one of the things which differentiates grief or grieving from depression is that grief should perhaps be considered as a perfectly natural and understandable reaction to loss. In contrast, the origin or etiology of depression may be more complex, involving any number of factors, not all of them immediately obvious. Indeed depressed individuals may occasionally not have anything obvious about which to be depressed.
Grieving is a personal and highly individual experience.  And if you try to explain how you feel, other people may not understand it. You might find this frustrating or embarrassing and this can sometimes lead to a sense of isolation.
The way we each grieve depends on many factors, most especially our previous experiences of loss and how these were handled in childhood. Clearly, the nature of the loss also impacts on the grieving process: you probably would not grieve in the same way in response to losing an aged parent who was in poor health, as you would to losing a son or daughter.
Other factors that can influence your experience of grief include whether or not you have religious faith and the extent to which you feel supported by others around you as you grieve. Research has shown for example that those who are members of a community of believers, such as a church or a mosque, cope better and recover faster following a bereavement.
"Time is a great healer" Actually, there is a lot of truth in this but saying it to someone who is feeling miserable is not a whole lot of help! Grieving is a process and yes, it does take time. How much time really depends on the individual? Quoting averages is dangerous because each situation is unique. However I would think of between 12 months and two to two-and-a-years as being a typical period of grief following the loss of a family member. That said, it can take much longer. The bereavement process following the loss of a child, even an adult child, can take very much longer than this.



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