'GET A LIFE !'
THERAPEUTIC COACHING
CASE STUDY
Shelly came for coaching, sent by her mother to ‘sort herself out and get her life organised.’
She had tried to study for A-levels but had dropped out unable to keep abreast of the written work. Exams were a particular problem. When I met Shelly, she looked tired and a bit dishevelled as though she had just fallen out of bed. She said that she was currently working part time in a pub and felt her lifestyle was unhealthy with the late nights, alcohol and smoking having an impact on how she felt.
A questionnaire showed she often felt tense, nervous and anxious and had very poor sleep. Working with the coaching wheel of life highlighted dissatisfaction around work, health and learning but also showed she had no real money worries and was very happy with the situation around home, family and friends.
She spoke of her frustration, confusion and lack of motivation about the future. Shelly was drawn towards several possibilities for a career between pub management, accountancy and nursing.
It was clear she wanted to take back control of her life so that she was proactive rather than reactive. The setting smart goals exercise proved particularly useful for her and I suggested that we consider one of her career options and progressed through the questions, painting a picture of what life might be like if she chose to go down that particular path.
As it was something she was familiar with, we highlighted pub management is a point for discussion and began to work our way down the smart goals questionnaire, looking specifically at the talents and resources she brought to that role and looking very closely at what her future life might look like. I avoided embedding this image in guided imagery as I was aware that there were other possibilities for a future career and did not want to influence Shelly’s final decision which should come from her.
A breakthrough occurred when Shelly talked of her negative feelings about the future. ‘I’m used to failure’ she said. ‘It's like I'm trying to walk but somebody's hanging onto my legs, holding me back.’
This kind of metaphorical insight is therapeutic gold and I did not miss the opportunity to develop the image. I asked Shelly to close her eyes and see who it was but was holding on to her legs.She replied ‘It's me……. A part of me is trying to move forward and another part of me is lying on the ground, clinging onto my ankles and pulling me back.’
I asked Shelly to imagine a TV screen and to view herself on the screen being held back in this way and I asked her to notice how she could free herself in some way from this other part so that she could move forward more easily and perhaps notice how she might feel lighter or freer as a result. She reported that she had chosen to step out of her shoes and run barefoot..
At the next session, Shelly arrived looking quite different. The shadows under her eyes had gone. She looked tidy and healthier. I reflected this back to her and asked what had changed. She said everything had changed. She had enrolled on an accountancy course at college and had already started. There was an offer from a family friend of a job on completion of the course which would last 12 months.
She had already reduced her smoking from 25 to five cigarettes a day, noticing the link with less opportunity for negative thinking as a result. She still intended to stop smoking completely by the end of October. Her sleep was better. She felt she had taken charge of her life and there was now a feeling of forward movement.
I asked her how the smart goals exercise might have influenced her decision and she said it painted such a clear picture of the future she did not want that it helped her decide the direction to move in.
I asked what had been most useful in our work together.
‘It’s all about positive mental attitude’ she said with a smile.
*******************
'HIS SLOW SMILE'
COUNSELLING FOR CRUSE
CASE STUDY
Jane is 30 years old, married with a small daughter of 3 years. Her husband, John, is her long term partner of twelve years.
She seems to me a jolly woman with a ready smile. She lives in a home which appears to be in the process of some redecoration. All around is evidence of her young daughter who is with her maternal grandmother for the hour that I will be with Jane.
Jane’s mother is supportive although Jane’s relationship with her stepfather is described as ‘distant’.
Jane’s birth father left when she was thirteen years old and now lives in Spain with his second wife. She says she does not miss him, has no contact with him and gives him very little thought. She tells me she was glad when he left. She does not know why.
My client’s husband is not close to his own parents, who have also separated. And so I have the impression of a small but close nuclear family.
My client reports that her younger brother, Michael, died very suddenly two years ago of a heart attack. She spoke to him on the ‘phone in the morning and he was dead by the afternoon, having collapsed at his flat. He was pronounced dead on arrival at hospital.
Jane tells me that she feels she has ‘boxed up’ her emotions. She makes every effort to forget that her brother has died but rather pretends he is on holiday somewhere and will one day telephone her or perhaps just appear at the door as he once did.
Her coping mechanism is mirrored by her mother, who never speaks of Michael. She has removed all his photographs from her home and makes very little reference to her own distress.
Jane reports symptoms of depression, especially on important anniversaries, lethargy, low self esteem, with a dark vision of her own future and a sense of impending doom.
Her most troublesome symptom is the panic attacks. She tells me that, although she successfully blocks out the death of her brother most of the time, the realisation of the true situation hits her ‘like a train’ on regular occasions and the sudden depth of her emotions will bring her quite literally to her knees.
At these times, she is unable to catch her breath, has a pounding feeling in her chest, and feels certain that she will die.
I explain to Jane the boundaries of Cruse counselling. There are monthly reviews, but counselling for bereavement is open-ended.
My paradigm in this instance is centred in the Rogerian model, acknowledging the tasks of grief as outlined by Kubler-Ross and Murray-Parkes. There is no limitation to the number of sessions and this is consistent with my client centred approach.
In terms of empowerment of client, this is perfect. Endings are obviously very significant in the bereavement process and it is important that Jane knows I will not leave suddenly. This ending will be within her control. No conditions of worth will be imposed by me and I hope this gives Jane the confidence to know that she can take her time. Grief cannot be rushed.
I will make no judgements about Jane, no hypothesis and no treatments plan. The person centred approach will allow for my Client to show me the way. Jane knows what hurts, what needs attention and what to bring and she will also know when to end.
My task is to apply the core conditions of congruence, empathy and unconditional positive regard whilst being aware of the stages, the twists and turns, her personal experience of grief may take.
The first meeting is often a time for the counsellor to assess the needs of the client and for the client to have an indication of whether she can work with the counsellor.
An assessment form is completed with details of client’s family background, doctor’s address and details of how and when the death occurred.
When I ask Jane what she would like from the counselling process, she thinks for a while and then tells me she cannot go on not acknowledging her brother’s death any longer. She cannot cope with the panic attacks and would like the sense of impending doom to leave her.
She also tells me that she would very much like to be able to talk about Michael and especially with her mother who she realises is the one other person in the world who shares the depth of her grief.
Human beings instinctively form deep relationships.
This satisfies the basic need for love, intimacy and security. When a close relationship is broken, the person who is left alone feels unsafe, empty, insecure. These feelings will persist until external circumstances or internal dynamics adjust and allow the bereaved to adapt and move on.
Every bereavement is unique and every person’s reaction to grief is also unique. Usually painful and of unknown duration, it can seem like a ‘bottomless pit’ or ‘endless and exhausting journey.’ Although counsellors can help, and try to understand what the world looks like from the perspective of the client, ultimately they cannot take the pain away as it is a necessary part of the process.
Grief is not always expressed or shared. It may not even happen and, sometimes, the bereaved stay locked in the past, the grief being the only connection with the lost loved one, and a connection they are unwilling to sever. Others make a new life without apparent difficulty, but this is unusual. The depth of reaction is often an indication of the depth of the original attachment together with the client’s own innate resilience.
The dimensions of grief are immense and diverse. Grief has many faces.
Death may be viewed as the amputation of a limb, and the grieving is a healing process.Death may be seen as a breakdown of order and the recovery becomes a slow and necessary process of rebuilding.
Or death can be seen as a cruel interruption of the narrative of our life and the grieving becomes the new chapter in our book.
The models of grief incorporate stages, tasks or processes and these models are helpful,
‘But the most important thing for counsellors is not to force the client to fit the model’
(Colin Murray Parkes.)
The earliest model for grief was Lindeman (1944) and later, Kubler-Ross (1970), then Parkes (1972) and Sanders (1999).
Elizabeth Kubler-Ross spoke of the five stages of loss as denial, anger, bargaining, depression and acceptance.
These have been rather misinterpreted over the years as a linear process through which the bereaved moves in a predictable way.
Recent theory suggest a dual process, an oscillation between loss and restoration much like the swinging of a pendulum.But, perhaps it is safer to think of the stages as a map offering just a guide to recovery. The terrain may be similar, but there may be varying obstacles or landmarks that are individually encountered. Just as there is no typical loss, there is no typical response, but an understanding by the counsellor of where the client may be in her recovery process will be helpful in providing appropriate support.
Many feel an overwhelming sense of loss after bereavement. They function at the most basic level and can do little more than talk, cry and mourn. They continually search, either physically or psychologically for the lost one, hoping for their return.
Their consciousness is locked into the past and they are unable to see a way forward.
But grief is a natural and necessary process. The pain of loss is the realisation of the break of attachment. It may take a long time for recovery and, sometimes, the bereaved may become ‘stuck’, unable to move forward from the extreme emotion, to engage once more with life.
Others may distract themselves, avoiding painful feelings, determined not to allow their loss to overwhelm them.
These are situations where grief can become complicated or pathological.
And these are occasions where bereavement counselling can be helpful, offering understanding, support and the encouragement to rebuild their lives.
TRANSCRIPT OF MY SECOND SESSION :
After settling into two comfortable armchairs in the home of my client, two cups of coffee are in place on the coffee table and we begin…
Cllr. 1: Jane, I wonder what came up for you this week?
Jane 1: A lot has come up after last week. I’ve done such a lot of thinking.
Cllr. 2: There’s been lots to think about?
Jane. 2: Yes I keep thinking about when we went to the hospital after the phone call.
Cllr. 3: After the phone call about Ian.
Jane. 3: Yes. The call from the hospital to say Ian had collapsed.
Cllr. 4: So, after the phonecall you made your way to the hospital. What happened when you got there?
Jane. 4: We were taken into a small side room, me, John and Mum and I just knew it was bad.
Cllr. 5: You had a feeling it was bad news.
Jane. 5: Yes, this overwhelming feeling that he was gone.
Cllr. 6: An instinctive feeling that Michael had died.
Jane.6: Yes. And then a doctor came into the room and said ‘I am sorry to tell you that Ian died at 2pm today. He was pronounced dead on arrival at hospital.’
Silence.
I nod assuring that Jane knows I have heard her. I do not want intrude into this moment which is very powerful and at the heart of Jane’s acceptance of her brother’s death. After a while, Jane continues…
Jane. 7: I could hear what the doctor said but it seemed to be coming from another room.
Cllr. 7: Another room.
Jane. 8: Yes. Like a distant voice, but I was hit by the realisation. It hit me like a train.
Cllr. 8: You realised at that moment that Ian had died.
Jane. 9: Yes……
Silence.
My client is overwhelmed by her emotion. She takes a cushion and holds it to her, something I have seen her do before. I wait. She is ‘reliving’ the moment.
Jane. 10: He was dead and I had only been talking to him that morning on the phone.
Cllr. 10: How did you feel at that moment?
Jane. 11: I felt as if my world had ended. I just wanted to die too.
Cllr. 11: the shock was so great you felt as if you wanted to die.
Jane. 12: Yes. I just fell to the floor and I must have started screaming. I can’t remember how long I screamed for. I can’t remember anyone else or what they did.
Cllr. 12: The emotion was so intense that you fell to the floor and screamed.
Jane. 13: Yes. It must have been bad because a nurse came and asked us to keep the noise down as it was disturbing the other patients.
Cllr. 13: You were told to keep quiet. Were you able to keep quiet at that moment?
Jane. 14: Yes. I was embarrassed.
Cllr. 14: Embarrassed that you had reacted so emotionally to the news of Michael's death?
Jane. 15: Yes….no, embarrassed that the nurse came in and saw me like that. I shut up after that.
Cllr. 15: You controlled the emotion.
Jane. 16: Yes.
Cllr.16: And when you say that it sounds as though you were told not to react…. almost as though you had been reprimanded for grieving the loss of your brother.
Jane. 17: Yes. I was told to shut up and that’s what I’ve done ever since.
Cllr. 17: You’ve shut up and controlled the emotion.
Jane. 18: Yes……
Cllr. 18: What would you have liked to happen instead of the nurse coming in?
Silence.
Jane thinks for a very long time before affirming…
.
Jane. 19: I wish we could all have been left alone to cry together and hug each other, for as long as it took……..
ANALYSIS OF INTERVENTIONS:
Cllr.1: in the person centred paradigm, I remain non directive, allowing Jane to lead the way. And so I would not say, for instance ‘what has been worrying you’ as that would suggest that there have been worries and would ‘lead’ the process.
Bereavement counselling is very gentle, much of it involves really listening, empathising, holding, real core counselling skills. To be too challenging would be inappropriate for Jane. She needs to be heard.
Cllr. 2/3: Reframing, mirroring, reflecting Jane’s statement. Active listening that shows I am attending, being present, real in the moment.
Cllr. 4: Uncovering the story, I am encouraging my client to tell what happened on the day her brother died, something I believe she has never done before.
Cllr. 5: I connect Jane with her feelings, noting the difference between ‘knowing’ and ‘feeling’. Feeling is a difficult area for Jane. Somewhere she has been afraid to go.
Cllr. 6: Connecting at a deeper level and drawing Jane’s attention to her instinctive or ‘gut’ feelings. We have moved from thoughts to feelings to instincts very quickly and my client now falls silent.
Silence.
Jane is reliving the experience in her mind and her heart, she looks emotionally distressed and holds a soft cushion to her like a child with a teddy. I wonder if the cushion is comfort, protection or even represents her younger brother, perhaps all three.
I stay with the silence. I do not offer tissues. That may be seen by Jane as a reflection of my own discomfort, that it is not OK to cry.
Cllr. 8: ‘You realised at that moment that Michael had died.’ Although it sometimes feels almost cruel to repeat that fact that he has died, it is helpful for the client, especially as denial is a presenting problem. Sometimes just hearing the words helps the move forward to acceptance.
Silence.
I stay in the moment. I hope at this time that Jane feels emotionally held and safe. The reality contains powerful emotions. I connect empathically with her pain, show concern but allow her to feel supported. I wait. Grief cannot be hurried.
Cllr. 10: Staying with the feelings is important.
Cllr.11: I relate the feelings to a state of shock, a normal grief reaction and one not to be ashamed of.
Cllr. 12: It is OK to feel intense emotion. I want Jane to feel completely ‘normal’, give her permission to explore the intensity of her grief whilst being emotionally held.
Cllr. 13/14: This is at the heart of the matter. Jane was denied, in that moment, the access to her own grief, so intense that it threw her to the ground.
Cllr. 15/16: Reprimanded and embarrassed by her reaction. It feels as though Jane has remained ‘stuck’ in the moment, unable to allow herself to fully address the grief, fully acknowledge the depth of her feelings.
Cllr. 17: By drawing Jane’s attention to the control of the emotion and the possible reasons for it, I hope she will see a pattern. When her panic attacks happen, she falls, once more, to the floor and then begins to pull back from the moment, never staying with it long enough for the loss to be fully acknowledged. Like a broken record that repeats and repeats, a flashback that resembles post traumatic stress.
Later on in the session, I ask Jane what she would have liked to happen instead of the nurse coming in. She thinks for a while before affirming her wish that she could have been left with her mother and husband to cry, hug and support one another.
I wonder aloud what that would have been like instead of being told to keep quiet…again Jane is very reflective.
‘That’s how it should have been.’ She said with a sad smile.
Having suggested a second ending to the scenario, a better ending, it is likely that whenever Jane remembers that day, she will also have an image of how it could have been, the way she wanted it to be.
The image of loving support from her family and allowing the tears to come is very powerful and very healing.
I sense this is a key moment for Jane or what Zimrung (1990) called a ‘hot emotion’, a huge move forward.
MIDDLE SESSIONS:
I continued to see Jane for nearly twelve months. She only cancelled her session once, when she had a bad cold. She seemed very committed to counselling and I was hopeful of a good outcome, although, in person centred terms, it is not necessary to hypothesise about the way forward.
Still, I had noticed changes in Jane. She was wearing brighter clothes. She reported that the panic attacks had lessened and that she had now been free of them for several weeks.
Still, she had real problems talking about Michael with her mother.
I had realised in an earlier session that her brother’s possessions had been removed from his flat after death, bagged up and taken to my client’s house. Jane’s mother had felt unable to receive them. My client had not been able to open the bags and they had been put in her loft, where they had remained, undisturbed, for the last two years.
The creation of ‘a memory box’ is something which has been found to very therapeutic for bereaved clients when the timing is right. It serves many purposes and can help move the process forward. Until now, my client was very fearful of going into the loft and I had not wanted to press her on this subject, but had an image that the emotions associated with those belongings were literally ‘hanging over her.’
Finally, my client announced that she was pregnant and they intended to move to a larger house to accommodate her expanding family. This time they would buy rather than rent, something they had hoped to do for a long time.
I felt really pleased for Jane. We had some lovely existential conversations about ‘the circle of life. My client’s mood was elevated and thoughts were about the future, new beginnings.
I wondered if the time was right to consider the memory box. My client agreed it had to be done. Logistics had forced her hand!
A LATER SESSION: TRANSCRIPT:
Jane.1: I can’t believe I did it. Finally, after all this time, getting the stuff out of the loft and starting to sort it out.
Cllr.1: You look so pleased. I think I can sense a lot of relief. Is that so?
Jane.2: I am pretty pleased with myself. Not just because we got the stuff out of the loft, but Mum came over and helped too.
Cllr.2: Wow Jane, that really is a huge step forward for you and your Mum. How did it go?
Jane.3: I told her what I needed to do and I said we were going to make a start on Sunday afternoon …..and she just turned up. My husband got the bags down and we made a start.
Cllr.3: how did it feel?
Jane.4: I felt a bit tearful at first. I had to go and stand in the garden for a while. I needed to be on my own. Mum came out after a while and we just hugged each other….
Silence.
Jane.5: We hugged each other and I felt a bit better after a while….stronger, and then we got on with it.
Cllr.5: Almost as though the hug, the support had given you extra strength.
Jane.6:Yes.I was so glad Mum was there. She needs to do this too.
Cllr.6: What does she need to do?
Jane7: Face up to it. Come to terms with it. We have to accept Michael has gone and start talking to each other.
Cllr.7: Talking.
Jane.8: Talking. That’s what we haven’t done. That’s all changed now…..
ANALYSIS OF INTERVENTIONS: EXPLICIT AND IMPLICIT MEANING:
Cllr.1: I am reflecting my client’s emotion back to her, noticing her pleasure and sensing her relief at beginning a task that had hung over her, quite literally, for nearly two years.
Cllr.2: I empathically connect to Jane’s excitement and sense of achievement, noticing it and mirroring her body language. Much of the counselling process is connected to non verbal communication. The power is often contained in what is not said.
I encourage her to tell the story, actively listening and affirming the ‘huge step forward’. This is important. Moving forward was one of Jane’s presenting needs from counselling.
Cllr.3: Connecting to feelings. Jane is still afraid of some of the intense emotion that is part of the bereavement process. Like a journey through a deep, dark wood, there is no alternative route. Going through it is truly the only way. Feeling, experiencing the pain, and emerging the other side, changed but safe.
Cllr.5: Drawing strength from physical and psychological support in grief is natural and essential. Acknowledging the need is sometimes difficult especially for previously self sufficient people.
Cllr.7: Talking. I am drawing my client’s attention to something she has said which is crucially important for her. Talking is indeed the way forward for both Jane and her Mother. If they continue to talk, the likelihood is that Jane will not need to continue with professional counselling. The healing is in communication. Grief can be an isolating experience.
Jane and her Mum share the intensity of the loss. Until now, they have been unwilling to share the intensity of the grief. I am hopeful that this is a new beginning for them both.
The act of opening the bags that contained Michael's belongings, sharing the experience, supporting each other, was hugely symbolic.
Items were saved to go into a memory box for Michael… books, CDs, some personal jewellery, a favourite scarf. The process took several weeks, slowed down by the fact that my client was now pregnant with her second child and planning a house move.
A very touching discovery was that of a video made when Michael was a media student. It showed him and some friends enacting a comedy sketch. It was a silent movie.
Jane had a special evening when she showed the video to the old friends that were also in the film. It felt a very brave and cathartic thing to do.
Jane told me ‘I had forgotten the way he moved, his slow smile…..’
ENDINGS:
I realised that Jane was coming to the natural end of counselling when she said ‘I am feeling so much better now, I feel guilty I am taking up your time when others are so in need.’
I reassured her that there was no time limit to Cruse counselling but realised that she was, indeed, sending me a clear message. The birth of her baby was approaching, they had moved home. I had been seeing Jane for almost a year and her thoughts were now moving to the future.
Working as a bereavement counsellor, I have an interest in moving and beautiful poetry written about the experience of grief. As the end of our counselling relationship approached, I discovered a piece which stunned me by its simplicity of perception.
A celebration of the life lived, an affirmation of choice between dwelling on the past or embracing life and moving on. It seemed so appropriate for Jane. I knew she enjoyed poetry and had written some herself.
It is a piece by David Harkin, a British poet and artist, written in 1958:
You can shed tears that he is gone, or you can smile that he has lived.
You can close you eyes and pray he will come back, or open them and see all that he has left.
Your heart can be empty because you cannot see him, or you can be full of the love you shared.
You can remember only that he is gone, or you can cherish his memory and let it live on.
You can cry and close your mind, be empty and turn your back,
Or you could do what he would want:
Smile, open your eyes, love and go on.
CONCLUSION AND PERSONAL REFLECTION:
My time with Jane was very special. Jane was warm, open and friendly. She was desperate to talk and I allowed her the space to do just that. For two years she had ‘boxed up’ her emotions and was aware that she could not continue in that way.
In a sense she had finally given herself permission to grieve, to finally experience the pain. Dissociation from feelings is, in fact, a useful coping mechanism and an explanation of the initial numbness often experienced after loss. It defers the pain until it is experienced as ‘safe’ for the body to do so.
The shock of the news of her brother’s death sent Jane to the floor, paralysing her, an intense but normal reaction to sudden loss. However, the natural expression of her emotional pain was interrupted and intruded on by the nurse. Thereafter, her grief pattern became complicated to the point where counselling was sought.
Bereavement counselling is a gentle process. Strategies and goals are inappropriate in this context, especially in the very early stages. Later, there may be subtle, well timed interventions to try to help the bereaved engage once more with life.
The reality is that grief goes on forever. You do not ‘get over’ the loss of your loved one; you learn to live with it. Recovery involves healing, rebuilding around the loss, incorporating it into your life. You may become whole again, but you will never be the same.
The time after a significant loss is spent largely experiencing the kind of intense emotions we normally try to avoid. Feelings of sadness, anger, despair and tragedy become our constant companions, their intensity beyond our normal range of experience.
Encountered for the first time, they are terrifying, draining and everything in between and it is almost impossible to perceive that they are part of the healing process. However, until they are truly experienced, there is a sense that the grieving process is merely deferred.
Colin Murray Parkes said (1986);
‘Viewed as a process rather than a condition, grief should be seen as just as much a part of life as the joy of love. It is, perhaps the price we pay for love, the cost of commitment.
Travelling alongside a person who is in deep grief is a challenging but ultimately rewarding experience for a counsellor. The journey can be long, tiring, with many unexpected twists and turns. The counsellor’s task, as Shakespeare wrote, is ‘to give sorrow words.’'
During the twelve months I counselled Jane, we developed a close, professional relationship. She came to trust me, revealing the depth of her grief, her darkest fears.
I feel privileged that she allowed me into her world for a short time. My association with her started with a death and ended with a birth and, at that moment, it seemed to me, the cycle was complete.
Death is nothing at all.
I have only slipped away into the next room
I am I and you are you
Whatever we were to each other we are still….
Life means all that it ever meant….
I am waiting for you at an interval
Somewhere very near
Just around the corner.
All is well.
Canon Henry Scott-Holland 1910
Copyright (c) 2010 Frances Masters
