Bereavement, Counselling and Hypnotherapy
Ruby Smith R.G.N. and Ronald Shone
Bereavement, the loss through death of someone to whom there has been a strong attachment, is part of the cycle of life and death. But because all of us at some stage lose someone we are attached to - whether it be a parent, a partner, a brother or sister, a sibling, or just a close friend - it is generally assumed that we can all cope with the experience. Yet it is recognised that such an experience is one of the most traumatic that a person can go through. It leads to a loss which requires coming to terms with. For many individuals, this process is achieved satisfactorily. For others, however, they simply find it too difficult to cope with. They get “stuck” somewhere along the process to full adjustment. The process of bereavement is halted at some point and does not complete its natural progression. This can at times be very extreme. The grieving individual can simply “stop living”. They function, they may even go to work, but they simply exist in a constant grieving state. For others, the grieving is so great that they even stop functioning normally. It is for such individuals that counselling is often sort.
Counselling the bereaved can take many forms, but in order for the counselling to be effective it is important for the therapist to be acquainted with the bereavement process. Only then can the most appropriate therapy be undertaken. In this article, therefore, we set out what is now a fairly well recognised bereavement process. Individuals do not get stuck at the same point in the process, and it is not obvious that the same therapy should apply for all the stages of the bereavement process. This is important for successful therapy. Bereavement is not a single entity; rather it is a process which takes place over time. Individuals dealing with their bereavement can take different lengths of time to come to terms with the death, can become stuck at different points in the process, and can develop different coping strategies for handling the experience. Only by recognising this can the therapist develop a suitable therapy for the individual seeking counselling.
But it is not just recognising the bereavement process. Some individuals who suffer excessive grief find themselves in a vicious circles of loss where their grief is unresolved. But in order to break this circle of loss it is necessary for the counsellor or therapist to note that there are different types of unresolved grief, where each type is likely to lead to a different possible solution. Counselling and hypnotherapy have different approaches. The only right approach is the one that allows the bereaved individual to adjust. When one approach, however, leads to little progress then it is important to change direction. This is illustrated in the final section where we consider a case study in which a young man had great difficulty coming to terms with the sudden death of his mother. After two years of counselling with little progress, the young man sort hypnotherapy.
The bereavement process
The first reaction to death, no matter how much one is prepared for it, is usually one of shock or numbness. This is followed by a period of realisation, when movement takes place from the primary denial or avoidance of the loss to one of acceptance of the fact. During this period there may be a variety of feelings taking place including anxieties, restlessness, isolation and the feeling that no one cares or understands what the bereaved individual is going through. Very often the individual has an urge to search for and find the dead person in some form or other. For instance this can take the form of being convinced of a sense of the continued presence of the dead person. In some instances there is an element of anger, where blame is laid on others; or guilt, where it is directed at themselves. What can also be felt is one of internal loss, a feeling in which part of the person has gone and can never be replaced. This in turn can lead to a feeling of apathy and despair. In some instances the bereaved may attempt to identify with the lost one by adopting mannerisms, traits or even symptoms similar to those of the deceased. Gradually through time there is an adjustment to a greater or lesser extent. For many people there is a kind of turning point. Whether sudden or gradual, the bereaved individual once again takes up their life.
What this process indicates is that the therapist is not concerned with the loss per se but rather with the feelings associated with the loss, namely:
• numbness • loss • anxiety • restlessness
• isolation • deserted • vulnerable • empty
• incomplete • despair • anger • guilt
This is most especially true when the feelings become extreme and lead to a dis-functional individual.
The most characteristic element of bereavement is grief. It is when grief becomes excessive that counselling is sought or becomes necessary. There are basically ten aspects (principles) to grief counselling of the bereaved individual:
The purpose of such counselling is to help the bereaved recover and to enable them to ‘let go’ of the loved deceased person. It is useful, therefore, to see these principles in relation to the needs of the bereaved. These are set out in Table 1.
Help in assessing how the individual is minimising their pain and the defences they may be establishing in this respect. To understand their possible social withdrawal and other coping strategies, such as drinking and drugs.
One aspect that the counsellor needs to address is the often experienced vicious circle in which the bereaved person can find themselves, shown in Figure 1. The loss leads to loneliness and social withdrawal and hence to further social loss. Both counsellor and hypnotherapist need to enter the circle at some appropriate point and break it. In particular, providing not only reassurance but alternative scenarios for the bereaved to consider.
When an individual is trapped in such a vicious circle of loss they are very often experiencing unresolved grief. However, for the counsellor or hypnotherapist to break this vicious circle of loss and resolve excessive grief it is important to realise that unresolved grief itself can take at least six forms, which are summarised in Table 2. The extent to which unresolved grief becomes pathological depends upon the severity of its features and the extent to which normal functioning is impaired. Only by listening and considering the needs of the bereaved can these be ascertained.
Figure 1 Vicious circle of loss
Table 2 Unresolved Grief
In trying to assess whether the grief is abnormal some writers consider it necessary to think of the grieving process in terms of an approximate time scale. But such chronological time scales of the grieving process should be taken as only a very crude guide.
Hypnotherapy and grieving
The hypnotherapist involved in resolving grief will approach the problem in quite a different way. The first two needs of the individual - an understanding and coming to terms with the loss along with identifying and expressing personal feelings about the loss - are likely to be dealt with together. The typical approach is regression and dissociation. Within the trance state the individual can be regressed to the time of the death, or before, to establish their feelings and thoughts. The individual can be put through imaginary scenarios in which they interchange with the deceased before their death. This is especially important in dealing with unresolved issues between the two individuals or with things they would have liked to have said but could not bring themselves to say. In the relaxed trance state these can be done. It is also possible to aid them in expressing feelings of sadness, remorse, anger, etc. while in such a trance state. Dissociation, in particular, will allow the individual to express the things they may never have had an opportunity to do (see the case study later).
Their own sense of loss, how this is affecting them personally and to come to an understanding of what is ‘normal’ behaviour can be dealt with by suggestions, both direct and indirect, while in a trance state. Emphasis here is what they were like before the bereavement, since this sets the basis for ‘normality’. Confidence boosting and a general positive attitude to life can also be undertaken. Pseudo-orientation is also a useful approach in establishing future scenarios. Throughout the hypnotherapist should be taking note of what the individual needs are and re-introduce these into the suggestions and metaphors.
Different individuals need different time periods for adjustment, they also need different emphasis. In counselling this must be established by question and answer. In hypnotherapy, however, it is possible to be a little more direct. It is quite easy to use ideomotor responses (IMR’s). This is particularly important in establishing whether the individual has had enough time to implement some change, or whether there has been enough lapse of time for the individual to have come to terms with some aspect of the relationship which now cannot take place. Or even whether the time is right to move on!
Finally, hypnotherapy can be used to provide the individual with a solution to their difficulty and allow them to move on. Techniques can be used (as in the case study) to allow the individual to find either a solution, or a better solution, to their difficulty. Neuro-linguistic programming (NLP) techniques within the context of hypnosis can be particularly useful in this regard. Scrutton points out that counselling is a ‘problem-solving’ approach. What NLP along with hypnotherapy does is allow the individual to come up with their own solution to the problem - admittedly at the unconscious level.
A case study
Robert (not his real name) was a young man, a member of a closely knit family, who was of Irish origin and studying in Scotland . Very active in the sports club and having a good social life along with his studies. His mother was a nurse who became ill and died rather suddenly. Robert himself was called home on her illness, and the day she died Robert could not be found. Robert’s exact whereabouts never did come to light since he repressed the whole of the week surrounding his mother’s death. The bereaving process began, but then got stuck. Robert had many of the characteristics of the unanticipated grief syndrome outlined in Table 2. That the grief became pathological was the fact that it went on for two years! Robert went into the vicious circle of loss shown above. He became depressed, withdrawn had difficulty sleeping and was generally not a nice person to be with. He continued his studies but he more and more found little purpose in his studies, his social life nor even in his football, which he loved dearly. Even his football mates were beginning to shun his company.
Robert clearly was aware of his difficulty in coming to terms with his mother’s death and sort a student counsellor. Counselling proceeded for the most part of two years with little progress. The counselling seemed to prevent further decline, but could not get Robert to break out of the vicious circle of loss so that he could once more continue with his own personal growth. He became desperate and sort the help from a hypnotherapist.
Robert was a responsive subjective. The early sessions involved getting Robert to express his grief, guilt and remorse in a trance state. An important element in the therapy was getting Robert to visit his mother in hospital “in the mind’s eye” and have him say all the things he wanted to say and did not say. Equally important, he was to hear his mother tell him how he was to handle her coming death and how he was to go on with his life. In order to allow Robert full time to engage in this an IMR was first elicited. When the whole interchange was complete he was to raise his “yes” finger. Pseudo-orientation and visual imagery were also used along with metaphors for overcoming personal difficulties. Although these early sessions had some success, they failed to break through Robert’s circle of loss. He continued with the same behaviour pattern. Age regression, although it took place, could not unlock what happened the week surrounding his mother’s death. Some deep repression was taking place which had brought about the prolonged grieving, and even under trance was not allowing change and development to take place.
A totally different approach was called for. Although not an obvious choice, the therapist chose to use reframing combined with hypnosis. The basic six step approach to reframing is discussed in Frogs into Princes and is readily adapted within the trance state. The six steps in reframing are the following.
In carrying out these six steps in a trance state an IMR is first established and this is used to take control of the creative part, to indicate that it knows the intent of the behaviour and to indicate when alternatives have been found and to indicate that the ‘best’ three have been found and that the most satisfying of these three has been selected. Finally, the individual is to try out “in the mind’s eye” the choice and to indicate whether it is working satisfactorily. In line with the approach, Robert was asked, by means of an IMR, whether he was prepared to try out the new choice for a period of three weeks.
One of the important features of this approach is that no one need know what the alternatives are and what the unconscious has decided to try out. In fact, Robert had no idea what it was himself. He was aware his “yes” finger was rising indicating he had found ten alternatives, and that he had selected three, and that finally he had homed in on one. But what this was he had no idea. In such therapy it is useful not even to inquire about the solution. In Robert’s case it seemed to satisfy some aspect of his deep repression. Since he did not need to reveal it, this too was unconsciously satisfying.
From that one session on recovery began, and moved quickly. Further sessions simply continued to inquire with the unconscious whether it was happy with the new behaviour and whether it would continue in helping Robert overcome his grief and to pursue a more normal life-style. A continual “yes” response was obtained with never a hint at what the solution was. It is probable that an important reason why the therapy was so successful is that Robert came up with the solution himself and not the therapist!
Reinforcement soon followed. Friends commented on how much better he looked and how more positive he was. He had at last broken out of the circle of loss and entered the virtuous circle of recovery.
 Colin Murray Parkes (1986) Bereavement: Studies of Grief in Adult Life, 2nd edn. Harmondsworth: Penguin. This is not the only way to view bereavement. For example, J. William Worden (1991) Grief Counselling and Grief Therapy: A Handbook for the Mental Health Practitioner, 2nd edn. London: Tavistock, views it as a series of tasks to be completed.
 A typical case is C. S. Lewis (1961) A Grief Observed. London: Faber & Faber.
 J. William Worden (1991) Grief Counselling and Grief Therapy: A Handbook for the Mental health Practitioner, 2nd edn. London: Tavistock.
 Adapted from Steve Scrutton (1995) Bereavement and Grief. London: Edward Arnold, Chapter 4.
 Compiled from C.M. Parkes (1986) Bereavement: Studies of Grief in Adult Life, 2nd edn. Harmondsworth: Penguin; C.M. Parkes and R. Weiss (1983) Recovery from Bereavement. New York: Basic Books; B Raphael (1984) The Anatomy of Bereavement: A Handbook for the Caring Profession. London: Hutchinson and others by Silvia Bourne, Trinity Hospice.
 Jenny Penson (1991) ‘Bereavement’ in Jenny Penson and Ronald Fisher (Eds.) Palliative Care for People with Cancer. London: Edward Arnold. Chapter 13.
 This is why the time scale of the grieving process should be taken only as a very rough guide.
 Richard Bandler and John Grinder (1979) Frogs into Princes. Neuro Linguistic Programming. Utah: Real People Press, p.160.