Advanced Counseling Techniques: 861.712.01
September 6th, 2001
The presenting problem is one in which Ms. Davis=s mother passed away almost two years ago. This occurred rather suddenly after her mother had a stroke. Upon hearing the news she went to be with her mother immediately and stayed with her a week. Her mother began receiving physical therapy and appeared to be improving. Approximately two months later, her mother had another massive stroke from which she never recovered. The loss was very sudden and she reports difficulty dealing with her feelings of loss.
Recently Ms. Davis went to clean out some things in her mother=s house and to make some changes in her bedroom. Her visits to the house had been infrequent in the past two years. She took some pictures to preserve memories of the way the house was before making changes. During the course of this visit she was overwhelmed with her feelings of loss. She now reports feeling as if she should have moved beyond experiencing such strong feelings given that so much time has passed.
She and her mother were very close, and she describes their relationship evolving over the years into more characteristic of friendship than that of parent and child. She reports that some days are worse than others. On days when she is particularly stressed, she feels the loss more strongly because she cannot just pick up the phone and call her mother, who had always been there for her in the past.
Ms. Davis appears groomed and well dressed. Her speech pattern and affect appear normal. . Eye contact was good until she became emotional and began crying. At that point eye contact became minimal.
The following statements illustrate one point in the session when an attempt to convey empathy was particularly effective.
CL: I guess as neurotic as it may sound, I went home two or three weeks ago and we got rid of her clothes. I went into her closet and I could smell her clothes and her perfume. It was very difficult.
CO: It must have been hard for you.
CL: It was very hard.
CO: It takes a lot of strength to do that.
CL: Yeah, it does. I tear up when I get started talking about her, it=s difficult.
CO: You miss her.
CL: I do, an awful lot.
Ms. Davis was referring to the feelings that came rushing back after two years. My intent was to reflect those feelings. Additionally, there was a sense earlier in the session that she was critical of herself for not having moved beyond such feelings. Providing an affirmation that pointed out her strength in going home and facing such feelings seemed indicated. The reason this example was chosen to illustrate particularly well reflected empathy is due to the fact that it was at this point that she began to cry. When her feelings of missing her mother were subsequently reflected, her crying increased even more.
At this point in the session, I believe a fairly good holding environment had begun to develop. I had managed to convey warmth, positive regard and respect for both Ms Davis and her feelings. I could sense how much she was hurting and my responses were genuine and sincere. Furthermore, in order to make sure I was understanding her and to communicate she was being heard, I had done a fairly good job of reflecting back to her the things that she was saying.
Concerning issues of diversity, the reality is that I am a Caucasian male and the person I am counseling is an African-American female. Despite this, any cultural issues that might have been present were not glaringly obvious. I felt comfortable in communicating with her. Given that cultural differences are often manifested in one=s inability to understand another, the fact that I did fairly well in establishing a holding environment in which I was trying to understand her probably went a long way in minimizing such differences.
However, I do believe some gender issues were apparent. While overall I did pretty well in attempting to feel and reflect her loss, there were times when her feelings were so intense that it was somewhat uncomfortable. Furthermore, I strongly suspect that I did not Afeel@ her pain at anywhere near the intensity that she felt it. Almost as if at a certain point, I shut it off and would not feel it anymore strongly. At one point, which is described below, I even attempted to Afix it@ by shifting the focus from her pain to good memories.
I target this as a gender issue because, in general, males are socialized to handle feelings differently. We are not expected to often give full expression to our feelings, and there may even be the tendency to down play those feelings that we experience. Additionally, as male we tend to be problem solvers. Women often complain that they just want their husbands to listen to them, and not offer solutions. Therefore, even though I am a counselor trained to listen, the fact that I am a man may sometimes interfere with my ability to be fully open to intense emotions.
Given the limitations imposed as a result of being unable to ask open-ended questions, I was not able to gather as much information that could possibly be useful in describing her concerns from a theoretical perspective. However, using the information that I have, one possible way of perceiving her emotions surrounding the death of her mother is from a client-centered perspective. Some of the characteristics of client-centered theory is that people have a self-actualizing tendency that innately moves them toward health, and that given a safe environment in which certain conditions are provided, this self actualizing tendency can flourish.
As stated above, Ms. Davis lost her mother two years earlier. When recently visiting the house she was overwhelmed with feelings of loss, almost as fresh as they were two years ago. Furthermore, she expressed dissatisfaction in still experiencing such intense feelings after so much time has passed. This dissatisfaction could be viewed as her tendency to move in a positive direction and toward health. In other words, it is her self-actualizing tendency seeking to express itself.
Again keeping the lack of information in perspective, a possible hypothesis about why she has not moved further along through the stages of loss might be that there does not exist in her social network the necessary conditions that would allow her to explore, experience and process her grief. For instance, she may have family members that handle pain differently and tend to discourage overt expression of such emotions. If this is true, then providing the conditions of unconditional positive regard, warmth and empathy might allow her to move forward and beyond much of the pain that she reports experiencing.
The following example illustrates a point in the session where the focus was shifted as a result of my response.
CL: It was a real shock when I was called at work and told that she had a stroke, and I called the hospital and was able to talk to her. I went down immediately and stayed with her awhile - a week. She was recovering and going to therapy, but then she had another massive stroke and she never did recover. And within about 2 months she passed away.
CO: That=s fast. You have a lot of good memories of your mother.
CL: Oh, we have a lot of good memories, but I guess the hardest thing is the loss and the emptiness.
In this example, she is describing her experience of losing her mother. In response, I attempted to focus her on the good memories that she had, rather than the loss. However, it was clear that she wanted and needed to focus on the loss and her current feelings of emptiness, demonstrating this by coming back to it.
Two aspects of importance in this shift of focus are the accuracy of the client=s statement, and the motive prompting it me to shift focus. As she had been talking about her mother, I began to get the impression of how close they had been, and how much she still missed her. It was an assumption on my part that there were good memories. The reality may be that there existed more bad memories than good. What may be more important is the possible unconscious motive behind the shift. This was the first time she had actually described her immediate experience surrounding her mother=s death. Her description of the shock in losing her mother was vivid. By my response, it was as if I was trying to reduce the intensity of the feelings that were being expressed. As it turned out, this attempt at shifting the focus possibly affected the session less than it otherwise could have. This was due to the fact the client shifted it right back to where she wanted it, and we went on from there.
I think my greatest strength in this session was my ability to provide empathy through reflection. This allowed me to both check my understanding, as well as communicate to Ms. Davis that she was being heard. Of particular importance was my ability once or twice to provide advanced empathy, going beyond her stated words to the implied emotions beyond her words.
Concerning my weaknesses, my inclination to shift the focus at one point in the session from intense emotions to that of good memories is obviously the most glaring weakness. In the wake of the recent tragedy experienced in America, there has been much talk about grief counselors. To some degree, I have felt in the past a sense of inadequacy in counseling those with loss, as well as the need for more specific training in doing so. Maybe what is really needed is an attempt to increase my ability in sitting silently and feeling more comfortable in the presence of such emotions.