Observing a client's grieving process: bringing logical positivism into qualitative grief counselling research

This positional paper originates from our need as researcher/practitioners to establish a meaningful epistemological framework for research into bereaved people's journey through loss and grief over time. We describe how the field of grief research has a long and established biological basis, in keeping with a positivist epistemology. However, there has been a diminution of the influence of logical positivism in twenty-first-century counselling research. We argue that in grief counselling research, naturalistic observation of the grieving process within a logical positivist paradigm, remains a valid and valuable construct. We posit an observational protocol for the grief counselling process which minimises the intrusion of research method into the therapeutic process. We offer this as a means of conducting qualitative research within a bereavement counselling service. Further, we suggest that the development of an observational protocol for a client's grieving process has potential implications for developing good practice in grief work.     

Counselling strategies for bereaved people offered in primary care

The aim of this study was to identify strategies that general practice-based counsellors used when offering support to bereaved clients. Over the last decade, there has been a rapid growth in the provision of counselling services associated with British primary care services. A study was designed involving qualitative methods of data collection (semi-structured interviews) and analysis (a grounded theory approach). Counsellors were recruited from two cities in Southern Britain (Plymouth and Southampton). Twenty nine (76% response rate) counsellors agreed to participate (Southampton n = 15, Plymouth, n = 14). Semi-structured face-to-face audio-taped interviews elicited information about their perceptions of the appropriateness of general practitioner referrals, counselling strategies and models of bereavement. Analysis indicated that counsellors saw bereavement counselling within a broader agenda of work concerned with loss and relationship management. Many drew on eclectic approaches to bereavement counselling and specific strategies included: facilitating telling of the 'story' of the loss; engaging in active listening and valuing allowing people to talk; establishing a supportive relationship; and enabling the bereaved person to deal with unfinished business and to say 'goodbye'. Counsellors drew on implicit stage/phase models of grief that assumed levels of distress reduced over time. The value of these strategies requires more exploration.     

Making use of the vignette technique to examine methods of bereavement counselling: An exploratory study

Aim: The principal objective of this small‐scale study was to examine methods of bereavement counselling because of their lack of clarity. Method: The study made use of the vignette technique along with six semi‐structured interviews analysed by means of thematic analysis. Findings: Results showed that bereavement counsellors are using a multitude of different and diverse methods of counselling, characteristic of postmodernism. Advantages of these postmodern methods are that bereavement counselling methods are rich, creative, supportive, pluralistic and attentive to otherness. However, disadvantages of these postmodern methods have led to a lack of consensus amongst experts, unclear methods and an anti‐methodological way of working by counsellors. Implications for practice: Postmodernism is inherent in bereavement counselling. As a result no two counsellors work in exactly the same way because of the difference in their background and experience similarly it can be said that no one counselling method has exclusivity due to the diverse nature of postmodernism.     

(Re)Searching for a client in two different worlds: Mind the research‐practice gap

A criticism voiced by counsellors and psychotherapists is that research does not truly reflect the complexities of therapy. Researchers, on the other hand, accuse practitioners of not attending to research findings and suggest that as a result they engage in an ill‐informed process. This polarised understanding can give rise to the situation where the client is missed, falling into the research‐practice gap. In reality the research‐practice gap gets smaller and smaller every time a practitioner employs — which is often the case — a complex and sophisticated construct system in search of a client's psychological distress. The metaphor of the ‘search’ seems to become a point of connection between the practitioner's search and the researcher's (re)search. As a way of exploring this issue, the paper briefly considers the research‐practice gap and the critique of current research. It argues that counsellors and psychotherapists are themselves engaging in research when they practise therapy since every counselling and psychotherapy session is basically a (re)search process.     

Moments of empowerment: A qualitative analysis of positively experienced episodes in brief person‐centred counselling

38 positively experienced episodes in brief person‐centred counselling with six clients were analysed. The Interpersonal Process Recall (IPR) method was used as the prime research tool. Clients were asked to identify positively experienced moments in the counselling session during a post‐session review interview. Clients and counsellors were invited to report on the feelings, perceptions and intentions they recalled experiencing during these moments. Three analyses were used to categorise the meaning and feeling quality of these moments, and a taxonomy of types of positively experienced episodes was also created. The most frequently reported positive client experiences were associated with empowerment, safety and insight. Other significant themes emerging from the analysis included: freedom in the relationship, shortcomings of the relationship, assurance of the relationship, unfolding of the client's personal meaning, and the importance of the counsellor's presence. Taxonomy of episodes revealed nine categories: four of them focused on the strengthening of the therapeutic relationship, and five focused on the empowerment of the client's self. These findings are discussed, and implications for theory and practice explored.     

Writing therapy in brief workplace counselling: Collaborative writing as inquiry

The purpose of this collaborative research was to reflect on one client's experience of using writing therapy during brief workplace counselling. The client/co‐researcher used expressive and creative writing between counselling sessions, the benefits of which are reported. A brief review of the literature on writing therapy is provided. The focus of the study is on investigating the process of writing therapy from the client's point of view. The epistemological assumptions and research methods are influenced by narrative inquiry. Feminist values inform both the therapeutic practice and research.     

Therapists' views of the relative benefits and pitfalls of group work and one-to-one counselling for bereavement

Aim: To explore therapists' perceptions of the relative benefits and pitfalls of group work and individual counselling for bereaved clients. Method: Semi-structured interviews with nine experienced bereavement therapists from a range of different contexts generated data which was analysed using grounded theory methodology. Findings: Groups were perceived as having a normalising influence, helping members make new social contacts and practice social skills. Individual counselling was seen as facilitating the initial telling of the story and the expression of extreme emotion. Discussion: The findings suggest that individual counselling may be useful as a primary intervention easing ‘emotional loneliness’ caused by the death of a spouse or attachment figure. Group work may be of more benefit later in the bereavement process, facilitating an engagement with the outside world and alleviating ‘social loneliness’. Implications for practice: This suggests that bereavement services might usefully combine group and individual provision. Initial assessment could help clients clarify their needs and facilitate their choice of service. This would be more cost effective and potentially ease clients' bereavement experience.     

Work-related counselling-a psychodynamic approach

Abstract

The paper sets out to stimulate interest in counsellors and therapists about the unconscious relationships which people form with their work, through describing and analysing what goes on in work-related counselling with a psychodynamic approach. The author draws on twenty-five years of experience to reflect on the changing nature of what was once termed ‘vocational guidance', and offers some short case studies, as examples of ways in which a person's world of work can become intertwined with their internal world in a confusing and disabling way. The core concepts and techniques which have evolved are identified and discussed; attention is directed particularly to the importance of the client's expectations, die effect of time limitation, the place of work in the whole life, and dealing with transference.     

The client as a self‐aware agent in counselling and psychotherapy

Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self‐awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over‐arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non‐directive and directive counsellor performances alike. Vignettes selected from the participants' reports illustrate the theme. Implications for the practice of counselling and psychotherapy are discussed.     

Working with movement as a metaphor: Understanding the therapeutic impact of physical exercise from a gestalt perspective

Although the therapeutic impact of exercise on depression has been well documented, studies usually evaluate long-term fitness programmes and relate improved psychological well-being to changes in metabolism and physique. That exercise may stimulate affective and cognitive awareness and exploration is rarely acknowledged. This case study explores the contribution that client-chosen physical activity made to the counselling process. From a gestalt perspective, the experience of physical exercise seemed to heighten the client's present awareness, promoted the recognition and integration of conflicting facets of the self and provided a deep metaphor, both expressing and satisfying the client's needs for movement and activity (rather than passivity). The case example is unusual in illustrating how physical sporting exercise may be used as a vehicle for affective and cognitive expression.     

Sensing the presence of the deceased: A narrative review

Researchers have reported that bereaved people often continue to sense the presence of the deceased. A particular collection of such experiences can be identified as instilling a perception that the deceased person is in some manner present in the company of the bereaved person. The aim of the current review was to synthesise the results on this topic to provide a comprehensive over-view for practitioners working with bereaved people who report these experiences. The studies were reviewed in terms of the nature of the experiences described, the provision of explanatory models to understand the significance of these experiences, describing any culturally specific aspects of these experiences, discussion of the personal impact of having the experiences, and for recommendations of how people who have these experiences can be supported.     

Philosophical Counselling, Truth and Self-Interpretation

Philosophical counselling, Ran Lahav and others claim, helps clients deepen their philosophical self-understanding. The counsellor's role is the minimalist one of providing the client with the philosophical tools needed for reflective self-evaluation. Respect for the client's autonomy entails refraining from intervening with substantive moral criticism, theories, and methods; the client's ways of working out fundamental questions like ‘Who am I and what do I really want?’cannot be assessed by the counsellor in terms of their truth-value, but only in terms of whether they reflect the client's autonomous choice to express him/herself in a certain way. I argue that this view, which is informed by an anti-realist account of self and life-history, undermines the distinction between self-knowledge and self-deception. Once interpretive and criteriological free rein is given to the client, and once personal, pragmatic and aesthetic considerations take precedence over truth-value, then the way is left open to clients to generate the most morally convenient self-interpretation to suit their current needs. I defend the view that truth matters in philosophical counselling; more specifically, that there is a basic distinction between true and false forms of self-understanding. To do this, I offer a broadly realist account of self and reflective self-evaluation. If this is right, then philosophical counsellors shoulder a significant burden of responsibility in helping their clients achieve an accurate, defensible, action-guiding and truth-oriented self-understanding.     

Peer Group Counselling with Bereaved Adolescents

An experiment is described which aimed to help bereaved teenagers through peer group counselling, and also to examine the related issue of how reliably we can measure the effectiveness of such counselling. This involved a systematic approach to the subjective impressions of participants, and also used objective measurement techniques. Subjects perceived the group counselling sessions to have had a high value, and certain consistent trends were revealed concerning participants' previous experience of their bereavement and concerning the medium-term effects of adolescent bereavement. Statistical analysis of the objective tests paralleled this with improvements in several areas, though the extent of the statistical significance of those improvements is debatable. Recommendations are made concerning the implications for the pastoral care of bereaved pupils in schools.     

Chickens or eggs? A follow‐up case study exploring links between physical and psychological impact of Tourette's syndrome and sexual abuse

This follow‐up case study highlights the complex relationship when working at the interface between physical and psychological symptoms. The paper draws upon conversations between an ex‐client and myself, held seven years after the end of our six year therapeutic relationship. Conversational interviews, based upon social constructionist beliefs, led to an unexpected exploration of the client's subsequent diagnosis of Tourette's syndrome (given several years after the end of therapy) and evolved into a struggle to reach a shared understanding of how she now makes connection between her problem with eating in public, her neck and facial tics, and childhood sexual abuse. Our research relationship provided both of us with a rare opportunity to reflect upon how she had made meaning of her counselling and its outcomes. The paper draws attention to the impact of counselling and therapy discourses concerning sexual abuse on the work we did at the time and asks how that work might be different today. It also helps us understand the layers of complexity and ambiguity contained within the client's stories. This multi‐layered case study represents the overlap and ‘messiness’ that mirrors the ‘lived experience’ of the persons involved, and provides an example of how co‐constructed research conversations can evoke stories that create meaning as they are told.     

Online counselling: The experience of counsellors providing synchronous single‐session counselling to young people

Kids Help Line (KHL) is a national Australian youth counselling service that provides free online and telephone counselling. This qualitative study examines the experience of 26 online KHL counsellors. Using a focus group methodology, counsellor responses were organised into categories: privacy and an emotionally safe environment; communication through text; and time. Counsellors reported the main benefit of the online environment to be emotional safety, due to reduced client emotional proximity to the counsellor, and the main disadvantage to be that reduced emotional proximity and the absence of non‐verbal cues could result in communication problems and difficulty in accurately assessing young people's concerns. Time proved a significant issue for counsellors, as the slow speed of text exchange could limit their ability to complete interventions. Methods that enhance both the process and effectiveness of online counselling are needed. Potential solutions to the challenges faced by online counsellors are discussed.     

Counselling marginalised young people: A qualitative analysis of young homeless people's views of counselling

Aims: This study explored young homeless people's views of counselling, with a view to considering how the counselling profession can better meet their needs. Method: A small scale qualitative research project was undertaken in two residential projects for young homeless people. Data was gathered through focus groups and then analysed using grounded theory. Findings: The study revealed a lack of trust in counsellors and counselling, as well as a dislike of the counselling process. Implications for practice: Some suggestions for how best to work with this particularly marginalised client group are discussed. These include ways of making counselling more engaging, raising the profile of the counsellor in the young person's environment and having an awareness of the needs specific to at‐risk young people.     

Does teaching a solution-focused model of counselling work? A follow-up of graduates

Objective: To explore the ways in which graduates of a university counsellor-education programme reflected on their career development, retained the programme's distinctive theoretical counselling model in their counselling practice and engaged in continuing professional development. The main aim was to discover whether or not teaching a solution-focused model of counselling was worthwhile. Method: A questionnaire, using primarily solution-focused type questions, was distributed to all graduates. Interest was focused on specific events, both inside and outside the training programme and beyond, that contributed to graduates' sense of development as counsellors. Results: Thirty four graduates (response rate 62%) provided responses indicating their recognition that their sense of competence and identification as professional counsellors develops over time, and is assisted by relevant feedback and supervision from lecturers and practical counselling experience. Graduates also indicated that their favoured working model was solution-focused and that, as a framework, it provided them with opportunities to integrate other counselling models and add complementary professional development education. Conclusion: The graduates' continued use of a solution-focused model supports the view that teaching the solution-focused model is working. The findings are considered alongside four models of counsellor development and implications for counsellor-education programmes are explored.