Diploma in Counselling Skills and Theory: Unit 5, Module 7

Course Code: LONDO2S 18EAST

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

Death is ubiquitous. It is there with us from the moment of our first breath and although it is

lurking just below the level of consciousness the knowledge that one day the person that we are will

no longer be is incontestable fact. Death is the ultimate loss but all throughout life people

experience many losses and inevitably grief reactions. A grief reaction is a response to any event that

involves change, and the pain and suffering experienced after the loss, whereas bereavement is the

reaction to the loss of a close relationship. Any change in a relationship as it was once known,

through death, separation, divorce, rejection, abandonment, moving etc is a relationship loss.

Whenever there is a relationship there is a part of the individual self invested in it and an important

component of the grief process involves letting go of a former identity, grieving that part of one

which is forever gone, and rebuilding a new identity. People lose a part of themselves not only in

relationship with others but in relation with themselves as well as life happens and they move

through various developmental stages and life events; a baby may lose the security of the womb, a

child loses their favourite toy or innocence as they turn into a more cynical mature adolescent who

in turn can let go of the dependence they had on their parents who themselves may struggle with

many losses such as loss of hopes, dreams or a job or their own sense of identity as they retire, and

look for a new sense of meaning when their children eventually leave home. All the losses that one

experiences in one’s life overlap as any past losses will and influence potential present or future

ones. 3.1 In counselling for grief and bereavement it is important to discuss with the client the

history of these losses as it may impact the client’s reaction to their current loss and one should

always be mindful that people have their own idiosyncrasies and there will as many different grief

reactions as there are people. 3.2

Page 1 of 7
Diploma in Counselling Skills and Theory: Unit 5, Module 7
Course Code: LONDO2S 18EAST
Student: Mihaela Grecu
Word count: 2531

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

In the attempt to explain the complex process of grief and bereavement theorists have come up

with numerous and distinct models, from theories of attachment and loss, to concepts of acute grief,

to stages, tasks and psychological stages and processes.

Freud uses the concepts of ego and id to explain how the ego mourns and searches for the lost

object with the accompanying emotions of melancholia in an attempt to withdraw energy and let go

of multiple layers of attachment. Following a painstaking process, eventually the reality of the loss is

accepted and the ego accommodates the loss and searches for new attachments. 3.1

Grounded in Freudian concepts are the tenets of Kubler –Ross’s (1969) stage theory where she

discusses the five predictable stages that the bereaved are going through following a loss, i.e. the

stages of denial, anger, bargaining, depression and acceptance. The crossing a bereaved person

takes through these emotions and behaviours take a cyclical turn rather than a linear progression as

an individual may return to each of the stages several times through the process. 3.1

Another important landmark in the study of grief and bereavement is John Bowlby’s Attachment

Theory(1980) which facilitates a way of understanding the distress and emotional disturbance

people experience when affectional bonds to particular others are broken, where the normal human

response is that of anxiety and protest . In situations of loss and grief, attachment behaviour is

observed as a force that drives bereaved individuals to fill painful voids and make new attachments.

The loss of a loved one triggers a response of mourning and a variety of psychological processes are

set into motion with the four general phases of: numbing, yearning and searching, disorganisation

and despair, and reorganisation. 3.1

In practice Bowlby’s theory is structured around facilitating cognitive insight, where the client

explores the cognitive and emotional aspects of the lost relationship and moves into cognitive

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Diploma in Counselling Skills and Theory: Unit 5, Module 7
Course Code: LONDO2S 18EAST
Student: Mihaela Grecu
Word count: 2531

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

restructuring with the purpose of changing the cognitive constructs and creating a new internal

template of how one views one’s world. 3.2

Lindemann (1944) , in what is considered a milestone in the development of ideas about

bereavement , offered a description of various symptoms of normal and pathological grief ,

conceptualising acute grief as part of the process. He proposed six characteristics of acute grief:

somatic distress, preoccupation with thoughts/ images of the deceased, guilt related to the deceased

or the death event, hostile reactions, loss of function, and a tendency to assume traits of the

deceased one in one’s behaviour. The last characteristic could indicate pathology in a later part of

the process. ( p5, G. Humphrey& D. Zimpfer, 2008). 3.1; 4.1

Building on Lindemann’s approach, Worden (2002), with the intention of offering practical

interventions in the field ,identifies four types of tasks specific of grief where the bereaved accepts

the reality of the loss while working through the pain of grief, adjusts to a new environment where

the loved one is no longer a part of ,and emotionally relocates the lost person and moves on with

life. 3.1; 3.2

Rando broadens the concepts of tasks by elaborating the grieving tasks and including the phases

when they are most likely to occur, providing thus a more extensive base for assessment and

intervention strategies. There are 3 stages in her conception of the processes which she calls ‘The Six

“R”’: The Avoidance phase: to Recognise the loss and achieve a meaningful understanding about the

loss event; Confrontation phase: the bereaved must React to the separation from that which has

been lost. During this phase it is also necessary to Recollect and re-experience the deceased and the

relationship through reviewing and remembering. Lastly, during this phase, the bereaved must

Relinquish the old attachments to the deceased and the old assumptive world; Accommodation

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Diploma in Counselling Skills and Theory: Unit 5, Module 7
Course Code: LONDO2S 18EAST
Student: Mihaela Grecu
Word count: 2531

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

phase: includes the process of Readjusting to a new world without forgetting the old, and Reinvesting

in a meaningful life. ( p 7, G. Humphrey& D. Zimpfer, 2008). 3.1; 4.1

As seen above there are several depictions of the stages of grief, ranging from four to twelve

stages, however the general consent is that a bereaved person will go through is the following curve:

Shock, Separation and Pain, Despair, Acceptance, Resolution and Reorganisation. There are many

individual differences as to how people will follow this curve depending on their situation, previous

experience or the environment they are living in; some may spend more time in one stage or

another, others rock backward and forwards between these stages with many painful returns to the

beginning to start the process once more.

In the shock stage the person has not as yet assimilated the reality of the loss and they may even

appear as they are coping really well or doesn’t care however it is a defence mechanism that

somehow numbs the person allowing them to slowly come to terms and accept that the event has

indeed happened.

During the separation and pain stage one is longing and yearning for the lost loved one, often

reporting hallucinations and dream in which they report have seen the latter all the while displaying

great distress and wanting to be assured that the loved one is not really gone.

Despair follows with intense feelings of pain and depression and often people experience conflicting

emotions and confusion.

Intellectual acceptance is more often than not achieved before emotional acceptance and the

bereaved is prone to many mood swings where sometimes they seem to have accepted the situation

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Diploma in Counselling Skills and Theory: Unit 5, Module 7
Course Code: LONDO2S 18EAST
Student: Mihaela Grecu
Word count: 2531

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

but relapse into feelings of guilt should they engage in any behaviour that would be tantamount to

them having forgotten about their loved one.

In The Resolution and reorganisation stage people are gradually adjusting and accepting a new life

and are able to speak about their lost loved one with fondness and less distress. 4.1

Counsellors must understand the cyclical nature of the process and the trial and error that it

involves, supporting their clients through each stage, and helping them deal with the accompanying

feeling of frustration as they are going back and forth through the stages of grief in order to restore

their sense of ability to be in control once again. 4.2

The bereaved person enters a somewhat emotional rollercoaster as they move through the

different stages of the process and various emotions overcome them. Feelings of fear are often

reported where people are confronted with their own vulnerability and sense of perishment, feeling

out of control, questioning whether they will ever be happy again all the while fearing that all the

feelings they are experiencing will become too overwhelming to cope with.

Anger is a normal feeling that accompanies the grief process however people often have difficulties

accepting their anger which unacknowledged may turn inward and create further trauma for the

individual. It comes from people’s inability to change what has happened and the feelings of

helplessness that come along with it. Anger may be directed at people involved in the situation,

sometimes God or even the deceased person for “abandoning” the bereaved which leads to further

feelings of guilt. Guilt restores a pseudo feeling of control as the bereaved person lacking someone

to blame for what has happened blames them. The practitioner can assist the bereaved person to

understand where the feelings of guilt are stemming from and analyse the truth of these accusations

and what secondary gain they may be withdrawing from these feelings of guilt.

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Diploma in Counselling Skills and Theory: Unit 5, Module 7
Course Code: LONDO2S 18EAST
Student: Mihaela Grecu
Word count: 2531

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

The emotion of shock has the purpose of helping people deal with the sudden, unexpected change
because biologically one cannot emotionally assimilate it and may short circuit.

The loss of a loved one generates intense feelings of sadness and accepting these feelings is a very
important factor in the grief process and the path to healing. Unfortunately nowadays society
condemns sadness while promoting a culture of false gaiety where one can and must move on as
quickly as possible from anything that will even remotely resembles sorrow. The therapist can help
the client stay with the sad feelings and enable them to accept them rather than hide them in a pot
and put a lid on top.

Feelings of loneliness will be evoked in the bereaved person as the lost person leaves a painful gap in
their life that constantly reminds them their passage.

Grief often brings along a sense of fatigue and people report an existential tiredness accompanied by
a lack of power and desire to do anything they used to find pleasure in. It may be because the
energy used for enjoyable activities is now channelled towards dealing with the change and grief
process.

Yearning and longing for the lost loved one is seen in almost all bereaved people as the need to be
with the lost loved one lingers for a long time after they are gone. As this feeling gradually
diminishes it indicated that the person is moving towards acceptance. 4.1; 4.2

Alongside the emotional reactions to grief and loss, a person may also experience physical
symptoms. Throw back to Bowlby’s Attachment theory, the separation that accompanies the loss of
a loved one is a factor generating anxiety which brings along many somatic reactions such as
tightness in the chest and shallow breath, hollowness in the stomach, heightened sensitivity to
noise, weakness in body and lack of strength, dry mouth or a feeling of depersonalisation with a
profound sense that nothing is real and all existence is fantasy. Because the death of another causes
one to confront with one’s own mortality, the fear may translate the symptoms as a sign of being
sick and potentially in danger of death oneself. The therapist can explain the symptoms of anxiety to
their client thus helping them to relieve their hypochondriacal fears. 4.1; 4.2

Together with emotional reactions, the bereaved will be haunted by thoughts of disbelief,
confusion, preoccupations and obsessive thoughts concerning the deceased or hallucinations and as
well many questions which one doesn’t have an answer for.

There are many behaviours associated with grief where a person may experience sleep or appetite
disturbances, sleeping and eating too much or too little, absent –mindedness, social withdrawal,
some people will avoid any reminder of the deceased while others will over expose themselves to
object reminding them of their loss thus causing even more pain and suffering, searching and calling
out the lost one, restlessness or crying. 4.2.

Some circumstances or personal characteristics may lead to a person not dealing with their grief
which leads to unresolved or abnormal grief. Signs that will signal a therapist a person may be
dealing with pathological grief include a morbid preoccupation with worthlessness, prolonged and

Page 6 of 7
Diploma in Counselling Skills and Theory: Unit 5, Module 7
Course Code: LONDO2S 18EAST
Student: Mihaela Grecu
Word count: 2531

Essay Title: What are the necessary skills and competencies for a practitioner to have when
working with a client who is experiencing grief and loss?

marked functional impairment, severe depression, psychotic episodes, and unexplained physical and
psychological symptoms etc. In order to help a person deal with their current loss it is imperative to
address, past unresolved losses. Many of these represent repressed or unfinished business that
needs to be addressed before the current loss is processed. A thorough history of past losses will
help the therapist identify whether the person is struggling with unresolved grief and much patience
and excellent listening skills are essential in leading a person towards a path of healing. 4.1; 4.2

Clients may require counselling at any stage of the grieving process and since no person grieves on
the same timetable or in the same manner there is not set number of sessions as the issues that
need to be addressed and resolved vary from individual to individual.

Some people will understand the grieving process while others won’t and educating a client about
what they are going through can be very insightful. As people progress through the grief stages the
type of support a therapist offers will change as needs be. During early sessions most clients will
experience acute grief and an incredible sense of aloneness and meaninglessness and the skilled
therapist will provide much needed support through non –judgemental listening offering them a
space where emotions can be expressed and their personal narrative encouraged. Later on in the
counselling process people will start to exhibit a willingness and ability to accommodate to changed
realities and often people will need to be reassured that what they are going through is considered
normal as they go through the torment of adjusting and grieving an environment that is a poignant
reminder of their loss. As people move through the grief process a counsellor’s most effective tools
will be their empathy, active listening and supportive skills. Some people believe that one never truly
gets over a loss but rather learns how to cope and live with it in an attempt to integrate that which
has been lost in healthy memory. In later session the therapists can support the bereaved person to
address the experience of letting go of former identities and roles whilst integrating the past into an
inner reality and investing mental and emotional energy into the reconstruction of a meaningful life.
4.1. ;4.2.

Bibliography

Reeves A. (2018) An Introduction to Counselling and Psychotherapy, London: Sage

Sanders D. & Willis F. ( 2003) Counselling for Anxiety Problems, London: Sage

Humphrey G.M & Zimpfer (2008) D.G. Counselling for Grief and Bereavement, London: Sage

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