Grief is an inevitable part of human life. The development of grief comes as a natural reaction to a loss of any kind. Grief from the death of an individual is referred to as bereavement. The feeling of grief is characterized by anger and deep sadness. Adaptation or coming to terms with a significant loss differs from one person to another. Some of the main variables that come to play include beliefs, background, and the relationship one had with the person lost. Although many people associate grief exclusively with sadness, emotions such as guilt and regret are also present. The case study is about my sister, who has just experienced stillbirth and is learning to cope with the loss. However, the Jewish religion and culture require women to act as superwomen and continue with their life without grieving. The faith does not provide individuals with the chance of letting out their emotions, thereby making the grieving difficult. Regardless of these cultural barriers, women need an opportunity to talk, cry, and grieve about their losses. In providing the much-needed solutions, the essay will focus on four primary areas. First, I will give a brief biopsychosocial assessment followed by the identification of the engagement skills. The third area will focus on the analysis of the client-worker relationship and potential transference and countertransference issues. Lastly, I will identify my thoughts regarding what might help me manage my reactions and feelings as I go through my client's relationship.
Biopsychosocial Assessment
The biopsychosocial model looks at an individual from a holistic perspective. The approach looks at an individual as a whole person with the body and the mind forming interconnected entities. When dealing with grief, the biopsychosocial model must address the biological, social, and psychological components (Bevers, Watts, Kishino, & Gatchel, 2016). In this case study, the client has experienced stillbirth, which is essentially a miscarriage or loss of the baby before the delivery. From a biological perspective, one would anticipate that the client lost blood and other essential body components. Besides bleeding, the mother is likely to have experienced additional biological effects such as breast milk production and sore breasts. The social implications of the client are mainly shaped by her religious roots. The Jewish religion does not allow women to grief. The religious beliefs do not provide any ceremonies or events to mark the death of an unborn baby. Society has generally stigmatized grieving and coping with loss. Thirdly, the stillbirth has resulted in immense psychological impacts on the client. As demonstrated by Human, Green, Groenewald, Goldstein, Kinney, & Odendaal (2014), "The grief reaction following a stillbirth has been demonstrated to be comparable to other types of bereavement with potential to cause serious short-term and long-term psychological problems" (563). The mother regrets not protecting the child from death, thereby ushering in a period of regret. Grief is characterized by pain, stress, depression, and overall sadness. Therefore, the assessment must take a holistic approach and treat the individual as a whole rather than in segments.
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Engagement Skills
Grief support aims to empower the clients to acknowledge their loss and accommodate it to normal and healthy lifestyles. The desired objective is to incorporate the loss as part of their day-to-day functioning and mitigate the potential adverse effects associated with it. Engagement with the clients assists in improving the quality of life (Capretto, 2015). Early engagement and intervention prevent the client from entering into the complicated stages of grief. While working with the patient, the first engagement skill I will demonstrate is empathy. Empathy involves the ability to understand the feelings of an individual. On the contrary, sympathy is when an individual feels bad for another person without understanding their specific situation. Empathy is more needed during a loss than sympathy (Capretto, 2015). Showing empathy is a practical exercise, and the victim of the loss should feel that someone else wants to share in their grief (Kabir, 2017). When engaging with this client, I have the responsibility to leverage my body language and show them that I am actively listening to their points of view. Body language, such as nodding the head and maintaining eye contact, will provide them with the confidence that I am actively listening. Additionally, I might consider providing my client with my personal experiences that might have caused me grief. However, I should remain keen not to take the spotlight from the client. Regardless of the experience I had, the primary focus should be on the client.
As a client, I also have to use the much-needed elaborating skills in this case. Elaborating skills empower the victims to tell their stories. Some of the primary elaborating skills that I can leverage as part of the intervention include containment, listening, questioning, and reaching inside of silences. Besides empathy and elaborating, attending is another fundamental skill that counselors must leverage. In defining attending, the author says, "Attending refers to the ways in which counselors can be 'with' their clients, both physically and psychologically" (Kabir, 2017 p.71). An effective attending process assures the clients that the counselor is with them and can share anything they wish to. I will begin by squarely facing the client and adopting an open posture. Leaning towards the client is crucial as it demonstrates a person's interest and involvement. I should maintain eye-contact and attempt to be relaxed and natural with the client (Kabir, 2017). The process of engagement will also encompass, reflecting on the client's feelings. As a counselor, I am responsible for leveraging a respectful and open-minded reflection on what the client is saying verbally and nonverbally (Kabir, 2017). I should also remain careful with the words I communicate with the client to avoid hurting their feelings. All this should happen within a safe environment that promotes the nurturing of the client. The relationship between the client and the counselor hinge on trust. Therefore, I am responsible for ensuring that the client is well-placed to share their thoughts and confide with me.
Transference and Conference Issues
The First strategy is assessing the nature of the client-worker relationship. The therapeutic relationship between the counselor and the client has received significant attention in the recent past. As described by the author, “The relationship that develops between therapist and client extends beyond the structural aspects of the therapeutic contract of the healer and client” (Rubin, 1998 p.216). Research in this work has shown that grief victims can remain within the territory of loss for an indefinite period. Others are also convinced that they might never come out of the territory. An effective relationship between the client and the counselor could help them come out of this emotional period as quickly as possible. The change process depends on how the client perceives their relationship with the counselor (Rubin, 1998). The relationship can only help the client perceive the therapist as benevolent, helpful, and supportive. However, in some instances, the client might regard the therapist as non-supportive, malicious, and unhelpful, thereby ruining any possible chances of an effective relationship. The way a therapist responds to the client's perception of the relationship matters. It provides them with an opportunity to emphasize the credibility of the therapeutic relationship.
Issues of transference threaten to affect the relationship as the client vents and redirects their anger and disappointment to the therapist (Rubin, 1998). The therapist has the responsibility of evaluating the nature of the client's reaction. Countertransference involved the redirection of the emotions back to the client. Before deciding which emotions to return to the patient, the counselor must first evaluate whether they are negative or positive. I must remain keen to establish an effective therapeutic relationship with my client. Trust, in this case, is not an issue because we are related to the patient. She not only believes me but also has the confidence to confide in me. I should expect instances of transference as the client might want to vent out their frustrations. It is highly unlikely that the emotions will be positive, given that the person lost does not have any direct relationships with me. I am an adult, while the deceased was an unborn baby. Therefore this calls on me to maintain logic and empower the client to deal with her own emotion. I must also maintain openness and remain helpful throughout the session. As illustrated by Rubin (1998), the primary objective is to remove the client from the grieving zone, thanks to the stable and mutual relationship we develop.
Management of My Feelings
Throughout the therapeutic relationship, I must remain keen to manage my feelings and reactions. The goal is to remain helpful and supportive throughout the therapeutic session and guide the client through normality. I believe that patience is an important virtue that will enable me to manage my feelings and thoughts. I have to realize that healing is a slow process, and removing the client from their grieving zone might require time. I must be ready for instances of setback and transference when the client is overwhelmed by her emotions. I could also manage my feelings by developing emotional intelligence (EI). The therapy session might not go the way I want. In some cases, the client will appear overly emotional and disinterested. She has already undergone immense emotional and psychological trauma and only needs a calm head to help her traverse her situation. I must control my emotions and keep them in check for this to become a success. It would be foolhardy to become angry or excessively emotional as this will not help the client. I think asking the client to include other trustworthy individuals in the counseling process would do more good than harm. More importantly, including persons with similar past experiences can enable her to develop coping skills through active learning. Such a move will protect me from the excessive pressure to guide and counsel the client as responsibility is shifted to other entities.
Conclusion
Grieving remains one of the most challenging periods in human life. Individuals have to cope with the loss of their loved ones leading to sadness and regret. The case study involves my sister, who experienced a stillbirth, leading to her unborn baby. She is held between the desire to grief and the need to conform to the Jewish religion's societal demands. Regardless of the cultural demands, stillbirth has a tremendous emotional toll on an individual. The biopsychosocial model empowers us to view grief from a holistic perspective by considering the effects on the social, biological, and psychological welfare of an individual. I must also leverage my engagement skills, such as empathy, attending, and elaborating skills, to make the process more successful. Management of the therapeutic relationship is critical, including the assessment of the transference and conference Issues. Finally, managing my emotions throughout by leveraging patience and seeking support from others will also help the process.
References
Bevers, K., Watts, L., Kishino, N. D., & Gatchel, R. J. (2016). The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. US Neurol , 12 (2), 98-104.
Capretto, P. (2015). Empathy and silence in pastoral care for traumatic grief and loss . Journal of religion and health , 54 (1), 339-357.
Human, M., Green, S., Groenewald, C., Goldstein, R. D., Kinney, H. C., & Odendaal, H. J. (2014). Psychosocial implications of stillbirth for the mother and her family: A crisis-support approach . Social Work , 50 (4), 563-580.
Kabir, S. M. S. (2017). Essentials of Counseling . Abosar Prokashana Sangstha. https://www.researchgate.net/publication/325844441_SKILLS_REQUIRED_IN_COUNSELING
Rubin, S. S. (1998 ). Reconsidering the transference paradigm in treatment with the bereaved. American journal of psychotherapy , 52 (2), 215-228.
