The RRL model and a pluralistic approach to counselling

The RRL model and a pluralistic approach to counselling (See chapter 7. Machin 2014)

The variability in direction and intensity of grief represented in the RRL model challenges practitioners to identify the individual characteristics of a client’s grief and adopt a pluralistic therapeutic repertoire, tailored to the uniqueness of the individual and capable of facilitating the best possible outcome for each person seeking help (Cooper and Mcleod 2011).

A pluralistic approach uses notions of goals, tasks and methods as the structure on which multiple therapeutic approaches might be applied to the individual need of a client (Machin 2014).  These approaches might make use of the following: Rogers (1961, 1980) defines clearly the values and qualities of engagement with a client, which will best facilitate the deeper exploration of grief. Accounts of attachment history (Bowlby 1980) and the nature of current relationships (Berne 1961) provide the psychosocial background against which reactions to loss can be understood. A cognitive-behavioural focus (Beck 1976; Ellis 1989) addresses the challenge to revise thoughts and actions, in the face of new life circumstances. The process of reviewing life assumptions (Parkes 1993; Marris 1974) will lead to the central task of therapy which is that of ‘retrieval of meaning’ (McLeod 1997, p.112). Overall this is a process in which the client and the counsellor will work collaboratively to reconstruct a new narrative, made up of stories that can be ‘lived by and live with’ (Mcleod 1997: 86).’ (Machin 2009:71)

Combining these approaches gives a rationale for a pluralistic approach to working with grief:

A person- centred approach provides the foundational way of being with a client throughout the counselling process.

A narrative approach identifies the structures within the accounts people give of their experience andmakes use of that ‘story’ to gain insights and new perspectives – a process of telling, exploring, revising, and adopting.

Person-centred and narrative approaches provide a secure base within which grief can both be accepted and re-appraised.

Core grief reactions, vary on a spectrum from a state of being overwhelmed feelings, where emotions dominate, to one of controlled functioning, where thinking and acting override emotions. Securing a balance across this spectrum is an important goal of counselling. To achieve this will mean that, a bias towards an overwhelmed reaction requires a focus on cognitive processes as a way of countering distress and restoring a sense of effective control over day to day life. While a bias towards control requires an exploration of factors which will provide new opportunities for feelings to be addressed, without heightening a fear of powerlessness. This will involve an exploration of those relationships and experiences which have contributed to the exclusion, distrust or minimisation of feelings e.g. attachment approach.     

The coping spectrum - vulnerable to resilient responses – will require variable approaches to the changing needs of the client. Early in bereavement or loss most people will feel and manifest a degree of vulnerability. Receiving the expressions of vulnerability in a person-centred way will powerfully affirm the normality of grief and its all-pervading impact. For most people this reassurance together with general support, including that from family and friends will be sufficient. Only in more complex personal or practical circumstances will intensive therapeutic intervention be necessary, where evidence of vulnerability persists.  In this case a number of aspects need to be explored. How far the nature of the death has contributed to this? How far there are underlying vulnerabilities in physical or mental health? How far there are difficult circumstantial factors e.g. housing, finance etc? How far there is a lack of social support? How far is making sense of the experience of loss problematic? Having assessed (by listening to and appraising the nature of the ‘story’) the dimensions of vulnerability, practical information/guidance/ support may be necessary.

Vulnerability may also result from an inability to accept the loss or make sense of it. Nurturing resilience in the following ways will help to address this. A focus on building from existing strengths and exploring new and effective ways of coping with the consequence of loss will help change the attention from problem to possibility. The approaches will include developing new perspective on the story of loss which will facilitate the acceptance of feelings, and the integration of thinking and acting; making good use of support – a systems approach to identifying and create effective social support; and exploring the meaning which clients attribute to the world and their experience of loss –  a meaning making approach (Neimeyer and Sands 2011). 

 

References

  • Beck, A. (1976) Cognitive Therapy and the Emotional Disorders. Harmondsworth: Penguin.
  • Berne, E. (1961) Transactional Analysis in Psychotherapy. New York: Grove Press.
  • Bowlby, J. (1980) Attachment and Loss: Vol. 3 Loss: Sadness and Depression. Harmondsworth: Penguin.
  • Ellis, A. (1989) ‘The History of Cognition in Psychotherapy’, in A. Freeman, K.M. Simon, L.E. Beutler and H. Arkowitz (eds.), Comprehensive Handbook of Cognitive Therapy. New York: Plenum press. pp.5 – 20.
  • Machin, L. (20014) Working with Loss and Grief.  London: Sage.
  • Marris, P. (1974) Loss and Change. London: Routledge and Kegan Paul.
  • McLeod, J. (1997) Narrative Psychotherapy. London: Sage.
  • Neimeyer, R.A. and Sands, D.C. (2011) ‘ Meaning Reconstruction in Bereavement’, in R.A, Neimeyer, D.L. Harris, H.R.Winokuer and G.F. Thornton (eds), Grief and Bereavement in Contemporary Society. New York: Routledge. pp. 9-22.   Parkes, C.M. (1993) ‘Bereavement as a Psychosocial Transition: Processes of Adaptation to Change’, in M.S. Stroebe, W. Stroebe, and R.O. Hansson (eds.), Handbook of Bereavement. Cambridge: Cambridge University Press. pp. 102 – 11.  
  • Rogers, C. (1961) On Becoming a Person. London: Constable.
  • Rogers, C. (1980) A Way of Being. Boston: Houghton Mifflin.