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Presenting issues for the client

Discuss about the Consolidative Therapeutic Sessions.

In counseling, grief can be considered as a notable element within any given modality or consolidative therapeutic sessions. However, the elderly people experiences grief in a different way than the adults. Older people think more about death than living as life is all about the reflection than about looking at the future. Grief counseling to the elderly people mainly focuses on guiding those individuals to overcome their feelings of sadness as well as depression. Counseling can be done in professional one to one setting as well as it can take place in-group situations (Supiano and Luptak 2013). In this report the first two sessions of the client Maya Angelou’s grief counseling therapy is stimulated.

The client in the session was by profession an American poet named Mary Angelou. She had an untold story, which she unfolded in her autobiography as an American Negro, a writer, a single mother, performer and a poet.  From her autobiography it is known that she was raped in her childhood and after the victim was sentenced to death she did not speak for five years because she though as she confessed his name so her own voice killed that man. She became a single mother and has hardly being inactive. However, now that she has reached her old age, she has been suffering from health issues like chronic obstructive pulmonary disease and one of her lungs being collapsed. However, recently, there was fake news of her death in the media and this incident where she had to hear her own death news made her become very upset. Her grandchild as well as other family members from Europe and Africa ringed her in tears just to confirm the news if she is alive. Thus, at the age of 81 years after leading a life that she considers full of daring acts, she still hopes to work as much as she can. Thus, for this client her grief is surrounding the fear of her health as well as because of the slowly approaching death.

In the 1st session engaging and connecting to the client is important and this can be done if during the initial therapeutic session the older clients are responded appropriately. At the very beginning, forming a respectful relationship with the client is important which means that the client should be treated as an important person, which is followed by acknowledging their physical reaction to grief. They can further be educated about the other emotions as well as reactions other than grief like helplessness, guilt, sadness and yearning. To be connected with the client as a counselor it is important to make her feel that yes, there is someone to assist her as thus, the gift of presence is important making her feel that you are listening. Then trust is build for which more focus should be on the client’s body language as well as non-verbal communication which will show that how much the client wants to share in the first session. Client should be provided with helpful feedbacks as well as encouragement. Counselor should be alert and grasp the communication style of the client and being competent while dealing handling the client in the first session. Thus, following these a connection can be built with the client in the very first session (Waller et al. 2016).

Engaging and connecting to the client

Goal and Objectives-

The main goal of this grief therapy is that to identify as well as solve the issue that the client is having which is for this client the grief of approaching death. However, getting the death news of her own at the age of 81years, it is natural that anyone in her place will come up with strong emotional reactions like her. Thus, the main objective of grief therapy is to bring a notable improvement in the client.

Idea and plan of the sessions-

However, as per the case planning is concerned in these two sessions mainly in the first one the preparations will be done for assessment along with the beginning of the assessment process. In the next session, which will be the follow up session, it will be the closure of the assessment. During the session the as a skilled counselor the therapeutic interventions that can be used for this client can be psychodynamic, CBT/ REBT therapeutic interventions.

There are certain therapeutic models, which further informs about the therapies that needs to be applied for the client. However, the models are discussed below-

  • Posttraumatic growth model
  • Posttraumatic growth outcomes
  • Machin’s narrative process model

Along with the above models, there are other therapeutic interventions like psychodynamic, CBT/ REBT, Rubin et al (2012)’s comprehensive therapy and Worden’s model of counseling. According, to Rubin who integrated the model of Psychodynamic Psychotherapy, Rational Behavior Therapy (CBT), Strategic Meta-therapeutic Interventions and Systemic Family grief Therapy actually supplies with valuable combination as well as comprehensive analysis of counseling interventions (Rubin, Witztum and Malkinson 2017). REBT however is a humanistic and existential model of CBT, which is mainly concerned with the individual as a whole along with the experiences that exist including the sufferings (MacLaren, Doyle and DiGiuseppe 2016). Angelou who is having difficulty with the transition of aging and her ill health can be benefited and will be able to manage her emotions, find new places of joy as well as meaning and new support systems. As applied for Angelou in this Case study, is mainly psychodynamic and REBT/CBT therapy and their aims are as follows-

  • The aim of psychodynamic therapy in this case is to bring the unconscious mind of the client into consciousness so that it can help her to unravel experiences as well as understand her true, deep-rooted feelings so that it can be resolved.
  • On the other hand, CBT-REBT therapy will mainly focus on the solutions so that the client gets the encouragement to challenge her twisted cognitions and modify her destructive pattern of behavior. REBT mainly is a part of CBT therapy, which will help the client to understand her unhealthy thoughts and beliefs, which are creating emotional distress in her.

Interventions have been distinguished between primary, secondary and tertiary by Schut and his colleagues in (2001). Primary intervention mainly focuses in all the bereaved people, the secondary interventions focuses on those individual who are at a higher risk of developing problems and lastly, the tertiary intervention, which focuses on those who have developed problems (Burke and Neimeyer 2013). Therefore, for this client tertiary intervention would be appropriate. Counselor will maintain a compassionate and informed approach throughout the session. The demonstrations are mainly that the counselor is here to help the client rather than just being sorry for her grief. Interventions which reach out to the client are mainly shows them a desire from the counselor’s side to engage the client in a meaningful way. Spending time with the client as well as listening to their story can be helpful at this age. The majority of the elderly people who are suffering from grief often require sound information along with someone who can willingly listen to their issues and supply them with valuable advice and help. As indicated by Jacobs and Prigerson (2000) that there are a wide range of therapies which are affective as well as appropriate elderly suffering from grief (Shah and Meeks 2012). Nevertheless, for this client CBT and psychodynamic therapies are applied. CBT is viewed as an ideal therapy for elderly individuals suffering from grief. In general, it is very much effective in treating anxiety and mood disorders.

Case planning

Therapies are a unique and ongoing relationship, which is created in a safe atmosphere, which can lessen the pain of the client, empower her, and further direct the client towards inner peace and happiness (Bond 2015). However, the basic obstacles in these two sessions that might arise are as follows-

  • Client not working in between the sessions- many a times it is found that clients have wrong assumptions that only showing up in the sessions with bring significant improvement in their lives. However, the actual scenario is that improvement will take place if the work is continued both in and after the therapy.
  • The client may resist change- maximum of the times client want their feelings, circumstances, relationships as well as their thoughts in their life to get modified but obstacles takes place when they want to continue the same things like engaging in the same thoughts and feelings and yet expect a change to happen without in actually modifying anything.
  • Stigma and discrimination- another important obstacle can be the stigma of mental illness. Research has found that there is stigma towards mental illness, which is evident in Unites States and many other nations. Because the client is aboriginal thus, there are changes of discrimination from the counselor’s part, which can act as an obstacle.

As a therapist, the homework must be assigned to the client or the client may herself practice what is done during the session on his or her own. If the therapist is not assigning work then the client can ask for homework. The client must pick up someone whom she trusts and can process the session and can ask for feedbacks. This way the obstacles of the client not working in between the sessions can be minimized. Another obstacle identified is the resistant to change in the client thus; the client should start believing that they are worth bringing the change in their life. Therefore, the client needs to be honest to them, taking the information in as well as guidance that are provided to him and applying them properly. They should practice as well as apply what they are learning in the sessions. Therefore, the counselor must keep in check if the client is showing any changes or is the same as she was in the very first session and accordingly must take further steps. Lastly, the last obstacles can come from the side of the counselor that when he should neither disseminate among their clients not show any kind of perceived stigma towards any kind of mental illnesses. A good counselor should never have stigmatizing beliefs because it can act as an obstacle during the therapy. Therefore, before the session the counselor should leave all such negative thoughts outside (Sue and Sue 2012).

Self-care is anything that can help the client to maintain her physical, mental or emotional health. Therefore, self-care is important for the client because it can help keep up the healthy habits by doing something she enjoys for instance reading books. This will distract the client’s mind as well as body from the stressful life events. It can further recharge the client if she can meditate for some time (Stephen, Wilcock and Wimpenny 2013). Another importance of self-care is that for many people it can help manage health issues, as it is very much effecting for coping with mental as well as physical problems. Thus, self-care helps people to live their lives as fully as possible. However, for this particular the strategies of self-care that can be applied are as follows-

  • She must not give up her usual daily routine
  • They should talk to those whom they can trust
  • Find herself some time so that she can relax by meditating or by reading books
  • Regularly eat her meals
  • Develop appropriate sleeping habits
  • Caffeine containing drinks she must avoid because it can affect her sleep cycle (Alexander and Klein 2012).

Conclusion

To conclude this report, it can be said that the chosen character Mary Angelou who is herself an American Poet is suffering from grief after hearing her dead news being alive. At the age of 81years when her health is already not permitting many activities that she still want to continue, meanwhile this sudden news has actually affected her mentally. However, in the initial two sessions the client need to be engaged with the counselor then based on the presenting complaints her interventions are selected to be CBT-REBT and psychodynamic therapeutic interventions, which can be attempted from the next sessions.

References

Alexander, D.A. and Klein, S., 2012. Mental health, trauma and bereavement. Grief, Loss and Bereavement: Evidence and Practice for Health and Social Care Practitioners.

Bond, T., 2015. Standards and ethics for counselling in action. Sage.

Burke, L.A. and Neimeyer, R.A., 2013. 11 Prospective risk factors for complicated grief. Complicated grief: Scientific foundations for health care professionals, p.145.

MacLaren, C., Doyle, K.A. and DiGiuseppe, R., 2016. Rational emotive behavior therapy (REBT): Theory and practice. Contemporary theory and practice in counseling and psychotherapy, pp.233-263.

Rubin, S.S., Witztum, E. and Malkinson, R., 2017. Bereavement and Traumatic Bereavement: Working with the Two-Track Model of Bereavement. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 35(1), pp.78-87.

Shah, S.N. and Meeks, S., 2012. Late-life bereavement and complicated grief: A proposed comprehensive framework. Aging & mental health, 16(1), pp.39-56.

Stephen, A.I., Wilcock, S.E. and Wimpenny, P., 2013. Bereavement care for older people in healthcare settings: qualitative study of experiences. International journal of older people nursing, 8(4), pp.279-289.

Sue, D.W. and Sue, D., 2012. Counseling the culturally diverse: Theory and practice. John Wiley & Sons.

Supiano, K.P. and Luptak, M., 2013. Complicated grief in older adults: A randomized controlled trial of complicated grief group therapy. The Gerontologist, 54(5), pp.840-856.

Waller, A., Turon, H., Mansfield, E., Clark, K., Hobden, B. and Sanson-Fisher, R., 2016. Assisting the bereaved: A systematic review of the evidence for grief counselling. Palliative medicine, 30(2), pp.132-148.

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