BACP: Working with

bereaved clients

John Wilson
john@moorsidecounselling.co.uk

www.bacp.co.uk
Working with bereaved clients

• Applying theories of grief to practice: John Wilson

• Senior Bereavement Counsellor and Trainer: Saint Catherine’s Hospice
Bereavement support Service
• Counsellor and clinical supervisor in private practice
• Doctoral student: York St John University
Models of grief & how they relate to
bereavement reactions

• In this session we are looking at theories of grief, and how they relate
to reactions following a loss.
Work ethically with grief

We need to be sure that working with a bereaved client is appropriate.

Robert Neimeyer (2000) has suggested that for people grieving normally,
grief therapy may be unhelpful, even “deleterious” (p. 541).

Although this has been challenged (Larson and Hoyt 2007), There are
others who have suggested that “unwarranted optimism is as dangerous,
if not more so, than an overly cautious pessimism”

(Bonanno and Lilienfeld 2007 p. 377)

Work ethically with grief

Harmful or not, we as practitioners striving to work ethically, do need to

think very carefully before engaging with bereaved clients who are
grieving normally.

Schut, Stroebe, Van den Bout and Terheggen (2001), concluded that
routine referral for bereavement counselling is highly unlikely to be
effective.
Work ethically with grief

On the other hand, they found that intervention offered to bereaved

persons at risk of developing complications was found to be modestly
effective, but only short term, while grief therapy for persons suffering
from complicated grief was proven to be effective, also longer term.
(ibid)
Assumptive World Theory

David presents in a distressed state following the death of his wife.

“My world has been turned upside down. Nothing seems the same any
more”
Assumptive World Theory

Each of us has our own Assumptive World. It can be seen as a successful

evolutionary adaptation: a personal world that we know well enough to
survive in.

If it changes suddenly we are threatened until we re-learn our

environment and assimilate the changed circumstances.
Assumptive World Theory

Whilst Colin Murray Parkes’ work originally centred on Attachment Theory

and a theory of grief stages,

he has called his second theory of grief Assumptive World Theory.

Assumptive World Theory

Each of us lives in our own unique assumptive world which can be

challenged by sudden and disastrous live events.

Bereavement not only shakes our attachments, it also turns our

assumptive world upside down.
Finding meaning, making sense

Many researchers and other commentators on the grief process have

noted the human need to find meaning and make sense of loss, including
loss through bereavement.

Thomas Attig (2001, 2011) effectively links Assumptive World theories

with Meaning-making. He writes of grief as the relearning of a complex
world through the interplay between meaning making and meaning
finding. The relearning involves how to be and act in the world without
the person we loved. We come to terms with our shattered assumptions
and reconfigure our interactions with others.
Finding meaning, making sense

• “I need to understand what happened.”

• “I can’t get my head around things.”
• “I need to know why he died.”
• “Nothing has a purpose any more.”

“I feel so guilty!”
Finding meaning, making sense

One of the leading research practitioners in the field of meaning-making

research is Professor Robert Neimeyer.

Neimeyer (2009) refers to “The storied nature of human life”. He

believes that our life is accompanied by a continuing self-narrative, by
which we organise our understanding of (and reactions to) day-by-day
events. Significant loss or trauma disrupts the self-narrative process so
that it may become totally disorganised.

In some circumstances the grieving person may even dissociate from their
self-narrative. At other times an unhelpful self-narrative about the loss
may dominate, leading to rumination and depression (Neimeyer 2009).
Finding meaning, making sense

Yasmeen shows evidence that she has made sense of her father’s death:

“As much as I miss him, it helps to know that he is not suffering any
more. He wouldn’t have wanted to live like that and I would be selfish if
I wished him back.”
Grief and growth

Lois Tonkin (2007)

Grief and growth
Grief and growth

“Looking back over my grief, I think I have emerged as a more

compassionate and empathic person. I feel I want to help others in the
same position as me.”
Working with grief

Finding a balance

Judi tells you that she avoids her grief by keeping busy.

Susanne is so immersed in her grief that she finds it difficult to think of

anything except her dead husband.
Working with grief

Finding a balance

“So long as I keep busy and don’t think about it I’m fine. I can’t look at
photographs or listen to his music and I avoid places we’ve been to
together.”

Compare this with the opposite behaviour:

Working with grief

Finding a balance

“ I think about nothing else. I’ve watched our wedding video over and
over. Sometimes I sit on the bed and talk to him, even though I know he’s
gone. Sometimes I put my face in the wardrobe and smell him on his
clothes. I’m so depressed I don’t have the energy to do anything. I just
stay at home and cry.”
Working with grief
Finding a balance

Reproduced here with permission from the authors

Working with grief
challenging gender self-stereotyping
Malcolm was fighting back tears when he talked to you, and broke down
when you were kind to him. He apologised for being “weak”.

Katrina tells you she wishes she could cry like her sisters, and worries she
“hasn’t grieved”.
Working with grief
challenging gender self-stereotyping
In their book Men Don’t Cry…Women Do, Transcending Gender
Stereotypes of Grief (2000), Martin and Doka challenge many of the
classic assumptions of Grief work, including the Stage Models of grief.

They see the phenomenon of dissonance as being a principal complicating

factor in grief.
Working with grief
Finding a balance

Martin and Doka (2000) have identified three distinct major patterns of
adaptation

• Intuitive Grief,
• Instrumental Grief,
• A blend of intuitive and instrumental
Working with grief
Finding a balance

Dissonance occurs when an individual gets locked into the grieving

pattern that is not really their style:

“These grievers are not only expressing grief differently than it is

experienced, they are truly at war with themselves.” (page 58)
Working with grief
range of responses to loss
Clients’ coping styles

Linda Machin (2013) has researched the range of responses to loss. This is
a useful way to identify clients who are overwhelmed by their loss and
vulnerable to its effects. It is also a useful tool for identifying clients who
are exhibiting a possibly unhelpful level of control over their emotions.
Working with grief
Finding a balance

Linda Machin (2013) observed that clients tend to Either overwhelmed Or

controlled by their grief.

Bereaved people able to balance the two extremes are seen as being
resilient, whilst those with an unresolved tension between the extremes
are vulnerable. It is the counsellor’s role to help individuals reach a
healthy balance.
Working with grief
Finding a balance

Resilience is characterised by the ability of the client to oscillate

between being overwhelmed and being in control.
Machin 2013

Overwhelmed Controlled

There are clear links with the Dual Process Model

Continuing bonds

“People tell me I need to let go. I don’t want to, ever. Why should I? I
want to keep them close.”
Continuing bonds

Those of us who work daily in the field of bereavement recognise the

limitations of any model of grief that insists or even implies that the
client must get over their grief and move on.

Many clients need our support in re-defining their relationship with the
person who has died whilst maintaining a bond with them.
Continuing bonds

Klass et al (1996) suggest that, in many instances, the grief process does
not end but rather undergoes ongoing adaptation and change.

Klass, Silverman, & Nickman, (1996)

Continuing bonds

They believe that we cannot look at bereavement as a psychological

state that ends and from which one recovers.

They propose that rather than emphasising ‘letting go’ the emphasis
should be on negotiating and re-negotiating the meaning of loss over
time.

Klass, Silverman, & Nickman, (1996)

Continuing bonds

Memorializing, remembering, knowing the person who has died, and

allowing them to influence the present are active processes that seem to
continue throughout the survivor’s life.

We are not talking about living in the past, but rather recognising how
bonds formed in the past can inform our present and future.

Klass, Silverman, & Nickman, (1996)

Continuing bonds

If the client shows an inclination towards a helpful continuing bond, the

role of the counsellor may be to negotiate ways of making this possible.

One way is to encourage the client to memorialise the loved one they
have lost. Photographs are very helpful.
Much more in my book

Wilson (2014):Supporting People through Loss and Grief: An introduction

for counsellors and other caring practitioners. London, Jessica Kingsley
Publishers.
 Thank you
John Wilson
john.wilson@st-catherineshospice.org.uk
john@moorsidecounselling.co.uk

Twitter: @JWilsonOnline