The aim of this essay is to demonstrate my view of the place of loss within the human experience, discussing what it means for a person to grieve a loss and how a person-centred counsellor may facilitate the process. I will consider some ways in how people may experience loss throughout the course of their life spans. I will go on to discuss and critically appraise a model of the grieving process hypothesised by Elisabeth Kubler-Ross. I will then go on to examine the above in relation to the Pesron-Centred Approach. I will consider how the counsellor may facilitate the client’s grieving process, finally discussing personal issues that may impinge on the counselling process.
In order to consider ways in which a person may experience loss, it is first necessary to define its meaning. Loss is considered to be the: “losing of a person or thing or amount” (The Oxford Minidictionary, 1988, p.298). There is no clarity in how loss is defined as humans can experience many different types of loss, and of which can vary in magnitude. Due to the limit of this essay I feel that I can only give some examples of the ways in which loss is experienced. Humphrey and Zimpher state that: “Loss is an integral part of life. It is not something that happens to us as we live; rather, it is life itself” (Humphrey and Zimpher, 2008, p.3). This implies that there is inevitability about loss. That it is bound to happen, whether it is the losing a person through death, the loss of youth as a person growing into adulthood, or even the loss of an object.
A way in which to differentiate loss is to categorise it. Necessary or Development Loss can be seen as a loss that occurs as part of the natural process of development and maturing of a human being for example leaving the womb, being weaned, children leaving parents to go to school, young age adults leaving their family of origin. These leavings make up much of the loss that humans experience as part of the natural process of growing up, maturing, ageing and dying.
Another category of which loss falls into is: Circumstantial, which although is not necessarily an integral part of our developmental process it can relate to our own unique experiences and circumstances. Many of these losses can be traumatic as examples can include the death of a loved one, separation, divorce, disfigurement, serious illness or even the loss of a treasured object. These two categories are considered to be in conjunction with one another.
Loss is considered to be a fundamental aspect of the lives of all people from early childhood until death. It is experienced in different ways and people perceive loss to be in many types and magnitudes as mentioned above. Some losses are perceived as relatively minor (for example the loss of a hat) and others are perceived to be relatively major. Major loss can be conceptualised as: “The loss of something in a person’s life in which the person was emotionally invested. This loss can involve an important person or some other entity.” (Harvey, 2002, p.5) It is from this emotional investment that can lead to how major the loss is perceived. The more emotionally attached to something or someone the more the magnitude of the loss is if experienced.
Other losses can be defined as Primary (initial) and Secondary Losses, of which a secondary loss is seen as a physical or psychosocial loss that coincides or develops as a consequence of the primary loss, highlighting the impact of effects associated with the experience of loss. There are past losses of which a new loss may bring up feelings about past losses therefore grieving over a major loss may bring about grief over our history of loss. Pileup of losses is the experience of a multiple of losses in a short period of time of which emotional distress may be at its highest during these periods of time.
As mentioned earlier I will now go onto critically appraise the model of the grieving process hypothesised by Elisabeth Kubler-Ross, later relating it to the Person-Centred Approach. The Kubler-Ross Model, also known as the five stages of grief was first introduced in 1969 in her book, On Death and Dying, of which outlines five phases humans go through as they deal with the dying process or the loss of a loved one. The first stage or initial reaction is the ‘denial’ of the prognosis.
Littlewood states that: “According to Kubler-Ross almost all people make use of denial when they first have the knowledge that they are dying.” (Littlewood, J, 1992, p.13) The denial is seen as a refusal to accept the reality of the situation initially, and is considered to be a natural and temporary defence mechanism where the individual may state for example that they “feel fine” or be trying to reassure himself that “this can’t be happening to me.” The reality of the situation is being experienced as a dream.
The denial stage of the grieving process is then replaced by a temporary acceptance that then gets replaced by feelings of ‘Anger.’ Instead of the initial feeling of “this can’t be happening to me.” It has become more of a resentful questioning as to “Why me?;” It’s not fair”; “How can this happen to me?” The anger can be manifested in different ways in which people can be angry with themselves and/or with others especially those close to them. Feelings of abandonment and or detachment may also occur.
The next stage brings about ‘Bargaining.’ Kubler-Ross describes the bargaining as: “An attempt to postpone…it also sets a self-imposed deadline offered for good behaviour,… and it includes an implicit promise that the patient will not ask for more if this one postponement is granted” (Kubler-Ross, 2009, p.67) This is where the grieving individual is trying to seek a delay of what is going to happen by looking to higher powers such as their God for help. The promises of behavioural change are offered as an exchange for the reversal of the loss or the loss that’s about to take place.
Once it becomes apparent that Anger and Bargaining are not going to reverse the loss, feelings of ‘Depression’ may begin to set it. It is when the individual confronts the inevitability and reality of the loss and his own helplessness to change it. It is seen as a rehearsal for what is to happen or what has happened depending on the circumstance. During this period, grieving people may cry, experience sleep or eating habit changes, or withdraw from other relationships and activities while they process the loss they have sustained. People may also blame themselves for having caused or in some way contributed to their loss, whether or not this is justified. There is more of an understanding of the reality of the situation and a resulting consequence could be detachment or isolation of the depressed individual.
Finally the individual enters a stage of ‘Acceptance’ where he has processed his initial grief emotions, is able to accept that the loss has occurred knowing it cannot be undone, is once again able to plan for the future and re-engage in daily life. In this last stage, the individual begins to come to terms with his mortality or that of a loved one.
Although it is a widely accepted model I believe that the five stages of grief model is too rigid and linear and for it to be more acceptable perhaps it needs to be viewed upon as a guide rather than a process. It is based on research performed on a set amount of dying patients suffering from cancer albeit the model can be referred to outside death such as the loss of a relationship, finances, mobility, etc. It is a model that I believe that is not fully experienced by every individual experiencing grief. For example through the loss of my father and my friendship there was no wanting to bargain with a ‘higher power’ (mainly for having no religious beliefs) for the postponement or the altering of the losses that I endured. There is no evidence to suggest that a person has gone through these five stages in the order hypothesised. Also with regards to the loss there is no consideration for the fact that the stages can be revisited for example after acceptance feelings of anger may resurface.
The model is also based on a survey of hospital patients dying of cancer in the western society. Further anthropological studies have suggested that grief is experienced differently through different cultures.
However this is not to say that this model is without its merits. The Kubler-Ross model has had a fundamental impact on society in that it has led people to think about coping with death. It has helped people realise the need for understanding and caring for the needs of people that are dying. Through the loss of my father who died of lung cancer five years ago and recently the loss of a friendship there have been feelings of shock and disbelief as to how it could happen to my father who had always seemed such a strong person physically. So from this I can say that I have experienced personally a stage that has been hypothesised by Kubler-Ross. In order to relate the Kubler-Ross model to the Person-Centred Approach, it is important to briefly explain it ‘s theory. The Person-Centred Approach was developed by Carl Rogers during the 1940s and 1950s is based primarily around three core conditions, although originally there were six, whilst using a non-directive approach in order to provide growth and therapeutic change with in the client. The first of these core conditions is: empathy, in which Rogers describes as:
“…Entering into the private perceptual world of the other and becoming thoroughly at home with it…it includes communicating your sensing’s of the person’s world…” (Rogers, 1980, p.142). This means that the counsellor is able to perceive what the world is like from the client’s point of view. The second core condition is known as unconditional positive regard. Merry explains: “It means that the counsellor understands and accepts people, as non-judgementally as possible, as imperfect beings trying to change how they feel and behave.” (Merry, 2002, p.81).
This means that the client is able to freely explore any thoughts and feelings whether they are negative or positive without rejection or disapproval from the counsellor whilst being listened to attentively in a caring like manner. The third core condition of which according to Rogers is the most important of the three is congruence. Mearns and Thorne describes this as: “The realness, or genuineness of the counsellor. The more the counsellor is able to herself in the relationship…the greater will be the chance of the client changing and developing in a positive and constructive manner.” (Mearns and Thorne, 2007, p.17). This means that there is no professional or personal façade. There is no demonstration of hidden knowledge, which thus results in the client not having to guess what the client is really like as a person.
Demonstrating these core conditions: being genuine, non-judgemental and unconditional, and empathic thus allows clients to open up in a non-threatening, trusting relationship, facilitating may help self-exploration and reflection of feelings for the bereaved client. The Kubler-Ross model can be related to the Person-Centred Approach in that a client’s exploration of feelings such as anger, feeling depressed, developing awareness are parts of the grieving process.
Within the counselling process Worden states the importance for the client: “ to come to a more complete awareness that the loss has actually occurred…Surviviors must accept this reality so they can deal with the emotional impact of the loss” (Worden, 1989. P.39). He then goes on to say:
“One of the best ways is to help survivors talk about the loss. This can be encouraged by the counsellor.” (Worden, 1989, p.39). It is through unconditional positive regard, a genuineness and empathic understanding that a client is to develop trust and be more open to expression of feelings. This supports Roger’s hypothesis where he states the need for the right climate for individuals to grow: “Individuals have within themselves vast resources for self-understanding…these resources can be tapped if a definable climate of facilitative psychological attitudes can be provided” (Rogers, 1980, p.115).
I will finally go on to discuss personal issues experienced that could impinge on the counselling process. Though the Kubler-Ross was based on a survey of terminally ill cancer patients I have likened some of the elements of the model to the grieving process I have recently experienced through the loss of a relationship with a partner. Of which I’d undergone feelings of denial, an unwillingness to accept the demise or loss of the relationship and a state of feeling depressed, leading to sleeping pattern changes (sleep deprivation) food habit changes (lack of appetite and resulting weight loss) and n the end resulting to an acceptance that the relationship is finished, or dead.
Through these experiences undergone along with the death of my father I feel it has impinged on the counselling process for bereaved clients that I have seen as through my own awareness of feelings I have been able to more easily demonstrate the core conditions of empathy, entering the client’s frame of reference and being at ease, experiencing his feelings (phenomenological approach). Through more of an understanding of my own grieving process of what has been a major loss to me, I feel I’m able to facilitate the client in a more capable and effective manner allowing the client to be more expressive about the way he feels.
