Counselling Case Study: Working with Grief
Maggie is a 35 year old woman who came for counselling six months after the break up of her nine year marriage to Michael, the father of her two children, Josh aged 6 and Joseph aged 12 months. Currently both children are in Maggie’s sole care. Maggie has been referred to counselling by her General Practitioner whom she has been seeing for a number of minor physical ailments and early signs of depression.
For ease of writing the Professional Counsellor is abbreviated to “C”.
Maggie and Michael met at university when they were studying business computing. After graduating they were employed in separate companies and dated for a number of years before finally getting married. They both continued working until the birth of their first child Josh, when Maggie took a year off before returning to work part time. Michael continued in full time work and received a number of promotions over his years of continuous employment.
Maggie continued working part time until the birth of their second child Joseph, when she again took a year off to care for both children at home. She was about to return to work when Michael came home one night and said he was leaving her for a woman he had met at work. Two weeks later Michael moved out of the family home. He has not contacted Maggie or the children since. Maggie has not felt well enough to return to work and is now in danger of losing her position with the company.
Application of Person-Centered Counselling
The counsellor applying this approach is primarily concerned with communicating empathy and unconditional positive regard to the client. This includes the application of micro skills such as active listening, reflection of feeling and meaning and summaries in the context of a genuine interaction between the counsellor and the client. The counsellor’s role is specifically ‘non expert’ supporting the client to recognise personal strengths and to find answers that are congruent with her/his own values and beliefs.
C’s preparation of the counselling room included placing chairs in face-to-face mode, checking the position of curtains to minimise glare, and placing a box of tissues within easy reach of the client’s chair. C also spent a couple of quiet moments clearing her mind of prevailing thoughts from the previous client in order to give Maggie her full attention.
Upon Maggie’s arrival, C introduced herself and spent some time developing rapport in an attempt to make her feel welcome and at ease. This was done by asking Maggie to be seated and making general conversation about the weather, and about how Maggie’s day had been so far.
C formally began the session by asking Maggie whether she had received the counselling agency’s letter sent to confirm her appointment details and a brochure containing information about the counselling service including fees, hours of opening, qualifications of staff and map location. Maggie confirmed she had received the leaflet and said that it had been very useful and informative.
C then asked if Maggie had any questions not covered in the information brochure. Maggie replied in the negative and C proceeded to ask Maggie what had brought her to counselling.
Maintaining good eye contact and an open posture, C waited for Maggie to start speaking. After about 20 seconds of silence during which Maggie looked down at the floor, she finally spoke through tears. “My husband left me for another woman six months ago and I just don’t seem to be able to get on with my life.”
C observed Maggie’s emotional reaction and decided that Maggie would be best supported by a person centered approach which would allow her to voice her feelings surrounding the loss of her marital relationship.
C responded with a paraphrase and reflection of feeling “You sound devastated by the loss of your marriage Maggie.”
Maggie replied “Yes I am, but it was six months ago, I should be getting on with my life by now. That’s what my family and friends are saying anyway. But I still miss Michael so terribly and the boys cry for him every night at bedtime.”
C: “So, am I right in saying that you and the boys are still heartbroken yet friends and family think you should be over it by now?”
Maggie: “Yes, that’s about it. Maybe I should be over him by now. What do you think?”
C: “Let me ask you Maggie. Do you think six months is long enough to mourn the loss of a long-term intimate relationship?”
Maggie: “No I don’t.”
C: “And you’re the only one who knows how it feels to have lost your relationship with Michael, Maggie.”
Maggie nodded and continued telling the story of her life in the past six months, pausing occasionally to wipe her reddened eyes with a tissue from the box nearby. Maggie described the physical and emotional upheaval as she struggled to cope with looking after the children on limited income. She also voiced her fears and uncertainty about her own and her children’s future.
C continued to stay focused on Maggie emotionally and to use encouragers and reflections of feelings to confirm and validate her feelings.
After one of many silences, during which C had remained silent but attentive, Maggie looked up without speaking. C decided that this was an opportune time to summarize some of the issues Maggie had raised so far and said “Maggie, you’ve described a huge upheaval in your life in the past six months that has meant reorganising your life in many ways. You’ve taken on the sole responsibility for two children, managing the house and finances and at the same time dealing with the emotional loss of your marriage. That sounds like an awful lot to deal with at once.”
Maggie: “Yes, I suppose it is when you put it all together. It didn’t seem so daunting when Michael was there to help.”
Thereafter, through continued bouts of tears Maggie described her childhood dream of being married with children and the emptiness she now felt having lost that dream so suddenly. She also voiced feelings of anger and self-recrimination for not being able to cope with her new circumstances as a sole parent.
Through the use of open questions, paraphrases and reflections, C was able to explore with Maggie her feelings of anger and also clarified the meaning of what being a ‘good mother’ meant to her. Maggie talked about memories of her own mother who did not work outside the home and was always waiting for her when she returned home from school.
Further exploration through paraphrases and reflections highlighted the significant differences in parenting lifestyles of the past and today, with many parents now assuming the onerous task of undertaking responsibilities of homemaking, parenting and external work.
Maggie then said ” Yes, I suppose being a mother has changed a lot since my Mum’s time.”
C: “That’s for sure Maggie.”
Maggie then went on to describe how much she missed working outside the home and having a career. C reflected Maggie’s feelings (expressed explicitly verbally and implicitly though non verbal signals such as frowns, smiles and wistful glances at the ceiling) and used open questions to explore what Maggie liked about her work including her strengths and capabilities.
Maggie: “You know, maybe I could negotiate to return to work part time for a while until I can get my life organised a bit better? I have a few friends who might be able to help me out with picking the boys up from childcare if I need to work late occasionally.”
C (smiling): “So you think working part time with some childcare support from friends might be the way to go Maggie?”
Maggie: “Yes, I think I’ll put the idea to my boss on Monday.”
From then on, Maggie’s talk slowed and she assumed a more relaxed posture sitting back in her chair. C asked if there was anything else she’d like to talk about today. Looking at her watch Maggie replied that she would need to get going to pick up the boys up from the childcare centre. She also said she would like to come back again the following week.
C replied that she was most welcome to come back anytime and wished her luck as she left looking tired, but definitely more relaxed.
In this session, Maggie, given the freedom to voice her emotional pain in an atmosphere of empathy, genuineness and unconditional positive regard was able to acknowledge that the expectations she was placing on herself were unrealistic and was able to begin to consider other ways of managing her new life.
The use of the Person Centered Approach to counselling in this initial session was well suited to a client such as Maggie who was able to articulate and explore her feelings associated with the loss of her marriage and future uncertainty.
The key concepts of Person Centred Therapy applied in this session were:
- The creation of a non-directive and growth-promoting climate wherein the client feels nurtured and respected.
- A congruent and empathic approach by the counsellor that emphasises and promotes self worth and empowerment encouraging clients to find answers that are congruent with her own values and beliefs.
Author: Liz Jeffrey