Grief and Loss

Solution-Focused Brief Therapy and Worden's Grief Tasks

Research paper:
Solution-Focused Brief Therapy and Worden’s Grief Tasks

Much has been written on Worden’s four-task approach to grief; much less has been written about how a strengths-based approach, such as Solution-Focused Brief Therapy (SFBT), might be useful to counsellors working within Worden’s formulation.

The average number of client sessions entered into for grief and loss counselling at AnglicareSA’s Loss & Grief centre in Hindmarsh, Adelaide is five; Simon (2010), citing Simon & Nelson (2005), reports that the average number of sessions run when using SFBT is 4.5, although Simon does not state the average number of sessions required for Loss and Grief counselling. He does, however, go on to present three case studies in the area that are between one and two sessions in length, with the suggestion being that two to three sessions are his typical duration.

However, it should be noted that Simon limits his loss and grief scope of practice to those who have had some time lapse (a minimum of one month in his case studies) from the death event – he does not suggest SFBT interventions for events nearer in time. Generally, one would expect some resilience and coping strategies would have been utilised by the client after one month: “This has been a difficult time for you. What is it that keeps you going day after day? How did you just get up out of bed and come here to see me?” (Simon, 2010, p. 91)

A solution-focused approach, argues Simon, allows the client and counsellor, in partnership, to co-create possibilities rather than limitations. But what effect does the type of partnership between counsellor and client have on the therapeutic outcome?

Recognising the well-cited What works in therapy (Duncan, Miller, Wampold, & Hubble, 2014) claim that 70-75% of the success of therapy can be put down to the strength of the therapeutic relationship, Miller, Duncan and Hubble (1997) claim that the clinical bond and therapy duration are not connected. So it seems that the strength of the relationship is key, but the relationship need not be a long one. But it is not just the counsellor and client that can be agents of change; solution-focused practitioners view the individual as part of diverse social systems, where social systems are both the context and agent for positive change (de Shazer, 1991; cited in Simon, 2010). But there is an ‘either/or’ dichotomy at work in much of the general population’s knowledge of grief—one is either grieving or one is healing. In reality the two co-exist: healing is taking place at the same time as grieving is being undertaken (Simon, 2010).

Worden (2008) proposes four tasks that the bereaved and grieving need to attend to in order to healthily process their grief and move forward with their life. These can best be remembered by the acronym ‘tear’:

· To accept the reality of the loss;

· Experience the pain of the loss;

· Adjust to the new environment without the lost person; and

· Reinvest in the new reality whilst staying connected to the lost person (Psychology Tools, 2008-2016).

Worden quotes Shucter and Zisook who write:

A survivor’s readiness to enter new relationships depends not on “giving up” the dead spouse but on finding a suitable place for the spouse in the psychological life of the bereaved—a place that is important but that leaves room for others. (Worden, 2008, p. 51)

Worden argues that these four tasks must be accomplished for the process of mourning to be completed and equilibrium to be re-established. He acknowledges that people may need to revisit certain tasks over time, that grief is not linear, and that it is difficult to determine a timeline for completing the grief tasks.

It is in regard to the first and third tasks, accepting the reality of the loss and adjusting to the new environment, that SFBT and other strength-based approaches may have something to say. The author’s wife lost her first husband to cancer and she strongly believes that a strengths perspective is invaluable in meeting the requirements of tasks one and three.

She suggests that, in order to help the bereaved accept the death of a loved one, they be encouraged to write down all the things that they can no longer do—for example, go dancing, go walking together, visit the cinema together, and so on. But, and here is where a strength approach is helpful, the bereaved is also encouraged to write down all of the things that they can now do—perhaps finish a project that required lots of time, take a holiday to a place the other person didn’t want to visit, and so on. Alongside this, the bereaved is asked to ask of themselves, “What routine can I no longer do, what can I replace it with?”

Traditional counselling often stays clear of solution-talk, but to ask the client about their various resources is not a counselling crime. Traditional counselling’s approach is a neglectful and disrespectful one; as if asking a client about their strengths and resources would make the counsellor blind to their problems. This would be like an accountant not noting a company’s assets in case it caused blindness to its debts (Ratner, George, & Iveson, 2012).

Additionally, problem-focused counselling (traditional counselling) assumes that the grieving process is long and troubled. However, in some cases, that may not be so. I am reminded of a client of mine who has been grieving the sudden death of his wife of 48 years. Because their marriage had been ‘difficult’ for the last two decades he is both sad at his loss and relieved at the same time. In a sense he had already grieved for the loss of his marriage and is now looking at moving on to a new relationship. Indeed, during his first session with me he asked me how long he should grieve for before he could see someone new. SFBT is a strengths-based therapeutic model that rests on the belief that all individuals have strengths and resources, even when the situation is the bleakest (De Jong & Berg, 2013). SFBT does not pathologise clients. Instead, it perceives clients as only being “stuck” in dealing with their problems (Ng, Parikh, & Guo, 2012).

Because of its focus on cognitions and behaviour and its time-limited orientation, SFBT often does not allow therapists time to explore the affective experience of clients. Also, discussing emotions during counselling is not encouraged in purist-led SFBT because it is perceived as ‘problem talk’ (Ng et al., 2012). However, there is an example of the counsellor displaying client-centred approach, which Ng et al. (2012) showed with clarity in the second session of their case study. And it should be remembered that attending to emotions is a requisite to developing a therapeutic working alliance – without which counselling cannot progress. “It is unclear if SFBT is best suited to individuals who are more resilient; but it is the job of counselors to help clients locate and use their resources to build solutions to their problems” (Ng et al., 2012, p. 229). As Sharry and colleagues point out, a good therapist should be flexible enough to adapt to the client’s wishes, “even if it means abandoning the solution-focused model if required” (Sharry, Madden, & Darmody, 2003, p. 90).

Conclusion

With every therapeutic approach that works, it works, in the end, because the client has been helped to draw in some different way on their resources: therapy doesn’t change people, it enables them to discover their own resources so they can make the changes themselves (G. Miller, 2014). A strengths-based approach, such as SFBT, enables the counsellor to assist the grieving client find the resources they need to get through the difficult days, weeks and months ahead after a loss.

References

De Jong, P., & Berg, I. K. (2013). Interviewing for solutions (2nd ed.). Pacific Grove, Calif: Brooks/Cole.

Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (Eds.). (2014). The heart & soul of change: Delivering what works in therapy (Second ed.). Washington, DC: American Psychological Association.

Miller, G. (2014). Burkean Dialectics and Solution-Focused Consultation*. InterAction, 6(1), 8-22.

Miller, S., Duncan, B., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: Norton.

Ng, K.-M., Parikh, S., & Guo, L. (2012). Integrative solution-focused brief therapy with a Chinese female college student dealing with relationship loss. International Journal for the Advancement of Counselling, 34(3), 211-230. doi:10.1007/s10447-012-9152-x

Psychology Tools. (2008-2016). TEAR model of grief. Retrieved from http://psychology.tools/tear-model-of-grief.html

Ratner, H., George, E., & Iveson, C. (2012). Solution-focused brief therapy: 100 key points & techniques. Hove, UK: Routledge.

Sharry, J., Madden, B., & Darmody, M. (2003). Becoming a solution detective: Identifying your clients’ strengths in practical brief therapy. Binghampton, NY: The Haworth Press.

Simon, J. K. (2010). Solution focused practice in end-of-life and grief counseling. New York: Springer.

 

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