Counselling Case Study: Unresolved Grief
Tina presented to counselling due to her partner recommending it. Tina agreed with him that she had been feeling low in mood and distant from her partner over the last six months, and she agreed that it was time for her to try and do something about it.
For ease of writing the Professional Counsellor is abbreviated to “C”.
First Session Details
In the first session Tina informed the C that her grandmother to whom she was particularly close to passed away a little over six months ago. It has been since this time that Tina has been feeling unmotivated, and she states that she feels ‘sad’ most of the time. Tina states that she is still unable to talk or think too much about her grandmother as it makes her too upset (this was also evident in the interview by Tina’s physical reaction to speaking of her grandmother), and for this reason she avoids doing so.
The first session was spent gaining rapport with Tina, explaining the process and limitations of counselling, and getting a broad view of Tina’s situation. C also pointed out that sometimes at the beginning of counselling client’s can actually feel a bit worse before feeling better, due to bringing up issues that they may have been avoiding. Tina accepted this information and stated that she was ready to deal with the things she had been “pushing aside”.
At the end of the first session, C summarized the main issues presented, i.e. low mood, feeling unmotivated, unresolved grief, some relationship problems, and career issues. From this summary it was deemed by both the C and Tina that the unresolved grief played a key role in all of the other issues and should be the focus of the sessions.
Essential Case Information
Tina is an 18 year old female who completed year 12 last year. She is currently studying Office Administration at TAFE however lately she rarely attends classes and states that she has no interest in the course and would prefer to be studying photography. Tina also works part time at a local bakery. She has held this job for over a year, however she has been calling in sick a lot recently and not attending.
Tina was raised by her paternal uncle with very close involvement from her paternal grandmother, after her mother gave her up at birth as she was so young. Tina had very little contact with her mother until age 14, however she did have regular contact with her father and she remains close to him. Tina has 2 younger half brothers on her father’s side, and one half sister on her mother’s side. Since contact with her mother began, Tina has become very close to her half sister, and she states that her relationship with her mother is improving but that they do not talk about anything personal together.
Tina is currently in a relationship with a 20 year old male named David. Tina met David through a cousin at a party and they have been seeing each other for almost a year. Tina describes David as very supportive and she states he was ‘great’ after her grandmother passed away, although she feels she has been pushing him away lately.
The next session began with easing Tina into speaking of the loss of her grandmother. This involved focusing on how Tina felt she had dealt with the loss so far, i.e. had she cried, yelled, talked with someone about her feelings, spent time alone etc. Tina admitted to ‘blocking out’ any feelings at the time of her grandmother’s death and avoiding thinking about it since. She states that she felt she should be strong for her two younger brothers and her father. Tina stated that she hardly spoke to anyone about her feelings and she had not cried very much at all, at the time or since.
Through negotiation with Tina, C decided to loosely base the counselling sessions on the “Seasons for Growth” manual for working with young people experiencing grief and loss. This manual uses a four stage model, corresponding to the seasons of the year, to help young people work through their unresolved grief issues.
Before beginning these sessions, C assisted Tina to come up with some definite goals of counselling. This was an important process as it enabled the two to come together as a team to brainstorm ideas of goals for Tina. Tina came up with a number of goals which included:
- Stop ‘blocking’ thoughts of her grandmother
- Allow self to grieve and especially cry if needed
- Become able to remember grandmother and speak about her without becoming too upset to do so
- Move forward positively in her life
The C then moved on to stage one of the Seasons for Growth manual. The first season “Autumn” focuses on accepting the reality of the loss. The goal of this stage is to assist the client to acknowledge the reality of change and the loss that has taken place in her life.
This stage with Tina involved exploring the concept of change (positive and negative) and discussing other losses or changes that have occurred in her life. For Tina these included getting to know her mother, finishing high school, beginning a new relationship, and the loss of a pet dog that she had had for a number of years. Tina was able to discuss these events in detail and was able to accept through feedback and input from C that change is a natural part of life, and whilst change often means the end of something it can also bring about new experiences.
The second stage “Winter” relates to working through the pain and grief associated with change and loss. In these sessions the C assists the client to learn about possible reactions to change and loss and to explore how they have experienced these.
In regards to Tina, this involved a discussion on the various ways different people grieve. Tina was asked for suggestions and a list was created. This list included words like; denial, anger, guilt, sorrow, confusion etc. Tina was able to see the wide variety of grieving methods and this helped to normalize her own reactions. This stage involved a great deal of reflection of feelings from the C to help Tina recognize and name her own feelings of loss.
This stage also included gently encouraging Tina to relate the details of her grandmother’s death to C, and to explore the changes that the death has caused in Tina’s life and also in Tina’s own personality, and the way she has been relating to others. As a visual exercise, Tina was also asked to bring in some photos of her grandmother to assist this process and enable her to reflect on some memories of her grandmother.
At the end of this session Tina stated that for the first time she had actually felt good talking about her grandmother. As homework during this stage, Tina was requested to either choose a song that reminded her of her grandmother and bring it in to the next session, or to write a brief story relating one of her favourite memories of her grandmother. Tina enjoyed this task and actually wrote a song and a poem to her grandmother. These were both very descriptive and allowed Tina to express her emotions. Tina is a very creative young woman and it was good to utilize on these strengths in sessions and in homework tasks.
The third stage “Spring” relates to the client adjusting to an environment in which the significant person is no longer present. The C also assists the client to develop skills to assist in processing their grief.
For Tina this stage was the hardest, as she expressed feelings of not wanting to admit that her grandmother was really gone. Tina also felt guilty and ungrateful imagining the world going on without her grandmother in it. She felt that if she was happy and enjoying life that she was not being respectful to her grandmother.
At this stage the C aimed to get Tina to think about what her grandmother would want for her and how it would be making her feel watching Tina being unhappy. The C also attempted to get Tina to explore her own goals in life and the positive aspects of her life, separate to her grandmother. In this way the counsellor was attempting to encourage Tina to explore her future and see that it could be a good thing.
In regards to developing skills to process her grief, the counsellor firstly reiterated that grieving is a natural process and that some emotions should be expressed. The C then assisted Tina to come up with a list of coping strategies that would assist her if she felt like her emotions were getting too much for her to handle. These included: Tina allowing herself to cry sometimes, expressing her feelings in her artwork or poetry, going for a walk, having a relaxing bath, or talking to a supportive friend.
The last stage “Summer” focuses on emotionally relocating the client to enable them to move on with their life. This involves exploring with the client ways of letting go and moving forward.
For Tina this was also a difficult stage. It was important for the C to continue to remind Tina that “letting go” did not mean “forgetting”. It was vital to stress the importance of keeping memories of her grandmother alive and not letting these go, but to be able to deal with the grief and move forward so that recollecting these memories would not be so painful.
The C also offered some self disclosure in regard to ways she had dealt with the loss of a close friend in the past. This involved creating a list of all her favourite memories of the friend and putting it away somewhere safe so that these memories would never be able to fade or be forgotten. Tina appreciated this gesture and believed it was a good idea, as forgetting little details was something she was very afraid of.
Guided imagery was also used in this stage. This involved getting Tina to relax and visualize a kite flying in the sky on a beautiful sunny day. Tina was asked to imagine that she was holding the end of the kite string and watching the kite flying about in the breeze. Tina was required to imagine that she was happy watching the kite and the kite was dipping and diving in the sky. After a while the kite begins to pull hard on the string and it becomes difficult for Tina to hold it anymore. It is almost as if the kite wants to fly off into the bright blue sky.
Tina was then asked to visually let go of the kite string and watch the kite fly away into the distance. The kite is pictured as happily floating away into the distance. Tina was then asked to imagine that the kite was her grandmother and although it was now gone she still held the beautiful memory of flying the kite, and by letting go of the string she had not only freed her grandmother, but allowed herself to move on and leave the park to go and explore other things on the beautiful sunny day. Due to Tina being a very visual person, she found this guided imagery a very useful tool. She stated that afterwards she felt calm and more accepting of letting her grandmother go.
At the end of sessions Tina stated that she felt better about moving on with her life. She stated she felt more in charge of her future and ready to make some important changes. She had also spent some time discussing her feelings with both David and her father, and she had even visited her grandmother’s grave on one occasion. Tina stated that although it does still make her sad that her grandmother is gone, she now feels better able to cope with these feelings and she feels more than ready to move on.
Author: Sarah Shanley