Sunday, February 13, 2011

Putting Grief Counseling Theory into Practice

   An important aspect of pastoral ministry is reflection on practice. One could argue that there are four basic goals that are associated with grief counseling. These four goals are: 1) To increase the reality of the loss, (2) To help the counselee deal with both expressed and latent affect, 3) To help the counselee overcome various impediments to readjustment after the loss and 4) To help the counselee find a way to remember the deceased while feeling comfortable reinvesting in life. I intend to address all four goals, while showing how the theological concept of incarnation is expressed in my interaction with my counseling “patient”.

Videotaped Counseling Session

   Paul is a 37 year old attorney from New Jersey who has been grieving over the loss of his friend and mentor, Father Thomas Ostrowski, the former pastor of his home parish. Paul was unable to attend Father Thomas’ funeral in August and he has been experiencing grief regarding this since they were friends for over twenty years. Paul appears to be functioning rather well and was not particularly forthcoming in terms of why he had come to see me. He did indicate the Father Thomas had played a major role in his decision to become a lawyer and the fact that he never got the chance to say goodbye to Father Thomas was difficult for him.
   He informed me that I am the first person that he has actually told about his feelings regarding the fact that he was unable to attend the funeral. He is very much aware of the fact that Father Thomas is no longer alive, but is concerned because he will no longer have Father Thomas to turn to in order to help him deal with issues which might come up in other areas of his life. Paul appears to be not only mourning the loss of Father Thomas, but also feels a sense of regret that he never had the chance to tell Father Thomas how much he meant to him. While Paul did not appear to be in denial about the fact that Father Thomas has died, the fact that he is still grieving over the loss after eight months could be an indication that there were some unresolved issues which might need to be addressed.
   Paul expressed the fact that he held Father Thomas in very high regard. He was a family friend and mentor for over twenty years and appears to have had a profound impact on Paul’s life. He was not very open about sharing his feelings and I actually found it somewhat unnerving to sit with Paul for any length of time given his propensity for providing “one word” answers to questions. He did not give me the impression that he was having a difficult time functioning after Father Thomas’ death. I had a difficult time discerning exactly why Paul was still focusing on his friend’s death after almost one year. In his book, Grief Counseling and Grief Therapy, J. William Worden addresses the topic of guilt in Chapter three under the heading of “Principle Two: Help the Survivor to Identify and Experience Feelings”. Worden states that there are a number of things which can cause guilty feelings after a loss. Survivors can feel guilty because they did not provide better medical care or because of a sense that they did not do enough to assist the person while they were alive.1 My sense is that Paul feels guilty because of the fact that he should have gone to the funeral, but was unable to for one reason or another.  
   We spoke about the fact that his family members were there, so it was not as though his family was not represented. It is possible that Paul feels that he did not do enough even though he realized he was unable to attend the funeral due to business commitments. Since Paul was not responsible for Father Thomas’ medical care, there is certainly no reason for him to feel guilty that he had not done enough to help Father Thomas. Paul’s father passed away prior to his becoming a lawyer and there may be some unresolved issues between Paul and his father which came to light when Father Thomas, a genuine father figure, passed away and if Paul has not resolved those issues he may feel guilty over the fact that he did not resolve them when he had the chance. I say “may” because he provided almost no personal information about himself and it was very difficult to get Paul to share anything about himself or his grief experience.
   Another goal of grief counseling is to help the counselee find a way remembering the deceased while feeling comfortable reinvesting in life. Paul’s relationship with Father Thomas goes back over twenty years and he can take some degree of comfort in the fact that Father Thomas played a major role in his decision to become a lawyer. Father Thomas will continue to be a part of Paul’s life through the example which Father Thomas left him. While his earthly relationship with Father Thomas has ended, this does not mean that Father Thomas is no longer a part of Paul’s life. He will continue to live on in the memories that Paul has of him and the counsel which Father Thomas offered to Paul over the years. 
   As a spiritual guide, Father Thomas helped Paul to acquire the knowledge and insight he needed in order to be a faithful and loving disciple of Jesus Christ. The relationship with Paul had with Father Thomas can be understood as a type of mirror of the relationship which we are all called to with God the Father.
   The theological concept, incarnation, is fitting given Paul’s struggle. According to the Dictionary of Pastoral Care and Counseling (DPCC), incarnation pastoral care is understood in two senses; first, as human existence as embodied or incarnated and second as the doctrine of Incarnation, that is the mystery of the Second Person of the Trinity’s becoming human; Jesus Christ as being both fully human and fully divine.2
   The fact that human existence is embodied is primary datum. Humans simply do not exist in a body, but are a body. The idea of bodiliness, as a theological datum, implies that body is a sign of all that a person is.3 It is in and through our bodies that we experience God’s loving self-communication to us. As embodied spirits we primarily experience God’s relationship to the world through symbols, nature, and sacraments, rather than through doctrinal decrees about creation. God’s self-communication is not merely intellectual speculation, but the result of the salvific presence of God in the created world.4
Pastoral care involves personal relationships of incarnate beings who are oriented toward God and capable to transcendence because of the paradigm of Jesus’ incarnation.5 A person’s experience of alienation, pain, grief, joy, loneliness, fear, death, ecstasy, and fulfillment are not alien to Jesus.6 Jesus was truly like us in all things, except sin.
   How does this relate to Paul’s experience? His feeling of guilt is an experience of what could be termed “disincarnation”. He does not need to give mere intellectual assent to the belief that God became man and that in doing so He came to save him. Instead, he needs to experience this reality in his own life. One way that this could be accomplished is by entering into a loving and caring community environment which manifests God’s love for us. Toward the end of the counseling session I made a point of offering whatever assistance I could to Paul and let him know that the entire parish family is here to help him in whatever way we can. These are practical demonstrations of inviting him to become a member of the loving and caring environment that I spoke of earlier A loving relationship involves trust and so it is essential that Paul be willing to trust others enough that he can share such personal feelings about his relationship with Father Thomas and the guilt he feels about not being able to attend the funeral.
   As a Christian pastoral care provider and a priest, my effort is to bring the Good News of Jesus to others. In her book, Grief as a Family Process, Ester Shapiro states that “the blow of death, first and foremost, shatters our view of the world into confusing fragments.”7 My role in this situation is to be present to Paul and help him to not only accept the fact that Father Thomas has died, which he seems to have done, but also to allow him to incorporate this reality into his worldview and so that he can “make sense” of what had transpired and begin to move ahead with his life. Acting in persona Christi, I am attempting to reassure Paul that he is loved by God, not because of anything that he has done but simply because he exists, will enable Paul to move from a sense of guilt and loneliness to one of acceptance and belonging.
   Jesus’ entry into human history did not take place because of our personal worthiness. There is nothing that we can possibly do to earn God’s love, compassion, and fidelity. These are freely bestowed gifts which are made manifest in the lives of believers through the two-fold expression of love of God and love of neighbor. As Christians, we are told to love God with our whole heart, mind, soul, and strength and our neighbor as ourselves. An incarnational experience of such love will help him to realize that he is indeed loveable, not because of his accomplishments, but because of the fact that he is made in the image and likeness of God.
   The pastoral function that appears to fit Paul’s dilemma and the theological concept of incarnation is “sustaining”. According to Clebsh and Jackle, sustaining pastoral care function consists in helping a hurting person to endure and to transcend a circumstance in which restoration to his former condition or recuperation from his malady is either impossible or so remote as to seem improbable.8 Paul’s experiencing of God’s self-communication of love in his own life may help him to accept his feelings of guilt and begin to turn to God and others for assistance and guidance as he realizes that God truly does love him and that one of the ways in which that love is expressed is through the care and support he receives from those around him. I use the word “may” when speaking about Paul’s willingness to accept his illness because such willingness assumes that he will not simply live in a state of denial.
   The idea of establishing a relationship with God may also entail certain challenges for Paul. Since it is in the family setting that one initially comes to an understanding of who God is, his past family experiences may make him leery of trusting God. These are the types of issues that would be addressed over a period of time. Experiencing God’s love will assist him in beginning the process which will enable him to move beyond what has happened in his life and hopefully engage in new relationships with the foundational knowledge that he is loved by God for who he is.
   There are four main tasks involved in the pastoral function of sustaining. These tasks are: Preservation, Consolation, Consolidation, and Redemption. Clebsh and Jackle define these four tasks as follows, “The first task of preservation sought to maintain a troubled person’s situation with as little loss as possible. Second, this function offered the consolation that actual losses could not nullify the person’s opportunity to achieve his destiny under God. Third, consolidation of the remaining resources available to the sufferer built a platform from which to face up to a deprived life. Finally came redemption, by embracing the loss and by setting out to achieve whatever historical fulfillment might be wrested from life in the face of irretrievable deprivation.”9 While the task of redemption may not be appropriate at this time since Paul is still in shock and attempting to assimilate what has transpired in his life, the other three tasks are quite appropriate.
   For pastoral care and counseling, a ministry of sustaining is grounded in the theological belief that all comfort comes ultimately from God.10 The DPCC states the following regarding the theological concept of sustaining, “Christians accept suffering for Christ’s sake and thus become members of a fellowship in which they receive the comfort of God. In turn, they are able to comfort others who are in any affliction with the comfort which they themselves have been comforted by God.”11
   Given the fact that I am not always comfortable with emotional topics, my responses to Paul tended to deal with factual information. At one point I actually inquired as to why he was still struggling with this after eight months. While I did not want to dismiss his feelings of guilt, my response could easily have come across in that light. While these questions and/or statements were not particularly helpful, they did convey the fact that I was listening to everything that Paul told me. If I were able to do the counseling session all over again I would have asked him more empathic questions, such as, “Does it feel as though that this situation is not real?”, “It seems like there isn’t anyone you feel close to, is this true?”, and “Do you feel pretty helpless/overwhelmed with all of this?” These questions provide much more of a listening environment. It is possible that the subject matter may become a source of anxiety for the counselor; however it is essential that he or she acknowledge the anxiety and move beyond it in order to benefit the patient. All of these dimensions must work together in order for someone to be an effective pastoral care counselor.

End Notes

1 Worden, J. William Grief Counseling and Grief Therapy: A Handbook for Mental Health Practitioners (NY: Springer Publishing, 2002), p. 59
2 Hunter, Rodney (ed.), Dictionary of Pastoral Care and Counseling (DPCC) Nashville, TN: Abingdon Press, 1990, p. 573
3 Hunter, p. 573
4 Hunter, p. 574
5 Hunter, p. 574
6 Hunter, p. 574
7 Shapiro, Ester Grief as a Family Process (NY: The Guildford Press, 1994), p. 22
8 Clebsh, William A. and Jeckle, Charles R. Pastoral Care in Historical Perspective, p. 9
9 Clebsh. p. 9
10 Clebsh, p. 10
11 Hunter, p. 574

No comments: